What Age Are You Eligible For Medicare Benefits

Are There Plans To Reduce The Medicare Enrollment Age

Some legislators have proposed measures to lower the Medicare eligibility age. Senator Bernie Sanders wrote a bill that would make all Americans eligible for Medicare in 2019. Representative Pramila Jayapal wrote a similar bill in 2021. Neither bill passed.

When this article was published, no changes had been made to the Medicare eligibility age.

Options For Coverage Of A Younger Spouse

Can I File For Medicare If I Work Beyond 65

If you continue to work beyond age 65, things get a bit more complicated. 7 You will have to file for Medicare, but you may be able to keep your companys health insurance policy as your primary insurer. Or, your company-sponsored insurance plan might force you to make Medicare primary, or other conditions may apply to you.

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What Are The Basic Qualifications For Medicare Eligibility

Be a United States citizen or resident who has lived in the US for at least 5 years and at least one of the following:

The basic qualifications that make you eligible for health insurance through Medicare are:

• You are a United States citizen or a legal resident who has lived in the U.S. for at least five years, and:
• You are 65 years of age, or
• Have a disability based on the Social Securitys definition of total disability, or
• You worked and paid Medicare taxes for at least 10 years

Why Would You Want Your Own Medicare Card

There are a bunch of advantages to getting your own Medicare card: You’ll be able to get support for your own wellbeing like going to a psychologist or getting a sexual health check up with less worry about who can see that you’ve had the appointment. You’ll get a sense of independence having a card of your own.

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Review Your Medicare Choices Each Year

Whether you enroll in original Medicare or a Medicare Advantage plan, you generally do not need to renew coverage every year. That being said, plans are sometimes discontinued or their benefits and costs may change to the point that the plan no longer meets your needs. Its not unusual for pharmacy and provider networks to change, for costs to increase, or the list of covered prescription drugs to vary. Thats why its a good idea to review your plan each year and compare it against your current health care needs.

Your health insurer is required to send you an Annual Notice of Change by September 30 each year. The notice outlines any changes in coverage and costs expected to begin the following January. If you decide to change your health care plan after reviewing those updates, you can do so during Medicares open enrollment period. The period runs from October 15 to December 7. During this time, you can switch from original Medicare to Medicare Advantage or vice versa. You can switch from one Medicare Advantage plan to another or from one Medicare Part D plan to another. You can also enroll in Medicare Part D if you have not done so already, although late enrollment penalties may apply.

If you find that the new health care plan is not meeting your needs, you can reverse some plan decisions January 1 to March 31 of the following year. Guidance for the renewal process is offered through the U.S. governments phone line at 1-800-MEDICARE or through your local SHIP.

Preparing As The Eligibility Age Nears

If a person already receives benefits from the Social Security Administration, the Administration will automatically enroll them in Medicare parts A and B.

The person will receive a âWelcome to Medicareâ packet 3 months before their 65th birthday, with instructions on how to sign up.

A person does not have to be retired to receive Medicare. If a person is not currently receiving Social Security benefits, they can apply for Medicare benefits as early as 3 months before their 65th birthday.

For example, if a person turns 65 years of age in April, they can apply for Medicare benefits in January of the same year.

Applying for Medicare benefits as early as possible may help the Social Security office process the paperwork in time for the personâs 65th birthday.

People who apply too late may face a premium 10% higher than that of those who apply on time. This premium would apply for double the time a person has been eligible but did not apply.

A person can apply for Medicare during their birth month or up to 3 months after their birth month without having to pay penalties for Medicare coverage.

However, their benefits will not begin until the Centers for Medicare and Medicaid Services process their request.

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Your Social Security Benefits Could Be Reducedtemporarily

Your age matters here, as well see below, but any reductions that do occur are temporary. The IRS will eventually recalculate your benefit and give you credit for months when you didnt receive a benefit, thereby boosting your future benefit. So, dont let a temporary reduction in payments keep you from returning to work. Heres how the age rules work:

If you havent yet reached your full retirement age between 66 and 67 for people born in 1943 or laterworking could mean temporarily giving up $1 in benefits for every $2 you earn above the annual limit .

Heres an example of how that might look:

What If Im Not Automatically Enrolled At 65

If your Medicare enrollment at 65 is not automatic, but you want to enroll, here are some more magic numbers.

3 and 7.

To start taking advantage of Medicare at 65, you need to sign up during the three months before the birthday month you turn 65. Those are the first three months of your seven-month Initial Enrollment Period.

Unless your birthday is on the first day of the month, your Initial Enrollment Period includes the three full months before turning 65, the month you turn 65, and the three months after you turn 65. If you were born on the first day of the month, IEP is the four months before your birth month, along with your birthday month and the two months after.

If you sign up during one of the months before your 65th birthday, your coverage will begin on the first day of the month you turn 65 .

Are you eligible for cost-saving Medicare subsidies?

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Does The Eligibility Age Change For Types Of Medicare Coverage

No. You need to have Medicare Part A and Part B if you want to sign up for a Medicare Advantage plan or a Medicare Supplement insurance plan. If you sign up for a stand-alone Medicare prescription drug plan, you need Part A and/or Part B.

So, itâs not like you can get a Medicare Advantage plan, for example, when youâre younger than 65 unless you qualify by disability.

How To Apply For Medicare Part A And Part B Before Age 65

Some people are automatically enrolled in Original Medicare. If youve been receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months in a row, you will be automatically enrolled in Original Medicare, Part A and Part B, when you reach the 25th month.

If you have ALS or Lou Gehrigs disease, youre automatically enrolled in Medicare the month you begin receiving your Social Security disability benefits.

Some people will need to sign up for Medicare themselves. If you have end-stage renal disease , and you would like to enroll in Medicare Part A and Part B, you will need to sign up by visiting your local Social Security Office or calling Social Security at 1-800-772-1213 . If you worked for a railroad, please contact the RRB to enroll by calling 1-877-772-5772 , Monday through Friday, 9 AM to 3:30 PM, to speak to an RRB representative.

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Medicare Advantage Plan Eligibility For 2022

Heres what you need to know about eligibility for Parts C and D:

You can also switch to Medicare Advantage or join a Part D drug plan during the Medicare annual open enrollment period, which runs from October 15 through December 7 each year. And if you already have an Advantage plan, you can use the Medicare Advantage Open Enrollment Period to make a one-time change to your coverage.

• A Part D drug plan
• A Medicare Advantage plan with drug coverage
• Another Medicare health plan that covers prescription drugs
• A plan from an employer or union

What Is The Minimum Age To Qualify For Medicaid

This Medicaid coverage group is for individuals who are disabled and are between ages 16 and 65. Individuals who meet the Social Security disability requirement and who are employed may qualify when total gross income is at or below 250% FPL and when unearned income is at or below the current SSI Payment Level.

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Medicare For Divorced Spouse

The Social Security Administration requires you to meet specific criteria to qualify for Medicare benefits from a divorce. Qualifying for Medicare is different than Social Security benefits. You can be eligible for your spouse/ex-spouse Social Security benefits at age 62, and you wont qualify for Medicare until age 65. Of course, you may be eligible for Medicare sooner if you have End-Stage Renal Disease or disability for at least two years.

If youre 62 and your spouse or ex-spouse is 65, you CANNOT use their Medicare benefits for eligibility. You must wait until the age of 65 to qualify unless youre eligible through disability.

If the following situations apply, you may qualify for Medicare after divorce:

• Your ex-spouse is at least 62 years old and eligible for Social Security.
• You must be currently unmarried.
• Youre at least 65 years old.
• You were married for 10+ years.

Medicare Part A benefits are free when you, a current or former spouse, have at least 40 calendar quarters of work or ten years of work history paying into Social Security.

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How Could Lowering The Medicare Age Affect Out

What is current policy? The Medicare Savings Program is a Medicaid pathway that helps to cover Medicares premiums and/or cost-sharing requirements for current Medicare enrollees with low income and limited assets. This is an important consideration because Medicares premiums and cost-sharing are higher than those under Medicaid, which limits the populations who can be subject to premiums and has nominal cost-sharing. Box 1 summarizes current Medicare out-of-pocket costs and the assistance available through MSP.

Box 1: Medicare Out-of-Pocket Costs and the Medicare Savings Program

Medicare Part A, which covers inpatient hospital services, has an annual deductible of $1,484 in 2021. Medicare Part A also requires co-insurance for hospital stays over 60 days. Most Medicare beneficiaries qualify for Part A without a premium, based on their work history. Medicare Part B, which covers outpatient services, requires a monthly premium of $148.50 for most beneficiaries in 2021. Part B also requires an annual deductible of $203 in 2021 and co-insurance of 20% of the Medicare-approved cost of services after the deductible is met.

To help low-income enrollees afford Medicares out-of-pocket costs, state Medicaid programs must offer three MSP pathways:

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Signing Up For Premium

You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security . Coverage cant start earlier than the month you turned 65.

After your Initial Enrollment Period ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods.

If Your Income Has Gone Down

If your income has gone down and the change makes a difference in the income level we consider, contact us to explain that you have new information. We may make a new decision about your income-related monthly adjustment amount for the following reasons:

• You married, divorced, or became widowed.
• You or your spouse stopped working or reduced your work hours.
• You or your spouse lost income-producing property because of a disaster or other event beyond your control.
• You or your spouse experienced a scheduled cessation, termination, or reorganization of an employers pension plan.
• You or your spouse received a settlement from an employer or former employer because of the employers closure, bankruptcy, or reorganization.

If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a federal income tax return for the year in question, you need to show us your signed copy of the return. Use Form Medicare Income-Related Monthly Adjustment Amount Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.

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Joint Coverage For Medicare And Spouse

Every now and then we speak to beneficiaries looking for a joint Medicare plan with their spouse. No matter who you are or what plan you choose, your Medicare will always be an individual plan. This means you will have your own Medicare claim numbers and your Part B premium will be paid separately.

With that said, there are some Medigap plans that will offer you significant savings on your monthly premium through a Spousal Discount even when you have separate Medicare claim numbers.

Our software at Boomer Benefits helps us to find the best discounts for you and your spouse when we are quoting Medigap policies.

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How Medicare Works With Other Insurance

If you have

and other health insurance , each type of coverage is called a payer. When theres more than one payer, coordination of benefits rules decide who pays first. The primary payer pays what it owes on your bills first, and then sends the rest to the secondary payer to pay. In some rare cases, there may also be a third payer.

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How Much Does Medicare Cost At Age 65

The standard premium for Part B modestly increases year over year. Part A costs also can increase, including the annual deductible and other coinsurance. Known as hospital insurance, Part A doesnt require a monthly premium as long as you have paid Medicare taxes through employment for at least 10 years.

Part B, known as medical insurance, typically pays 80% of the covered cost while you pay the deductible and then 20%.

Effects On Federal Deficits And Debt

CBO and JCT estimate that lowering the Medicare eligibility to 60, if fully implemented in calendar year 2026, would increase deficits by $155 billion over the five-year period between 2026 and 2031. Increased Medicare spending as a result of the additional enrollees would be partially offset by increased Part B premiums, lower disproportionate share payments to hospitals, reduced Medicaid spending, and decreased spending on subsidies for employment-based coverage.

The report focuses on a specific policy that would lower the age of eligibility for Medicare to 60, but CBO and JCT also find that, in general, policies that lower the age of eligibility would increase budget deficits and policies that raise the age of eligibility would decrease budget deficits. Exploring the adjustment of Medicares age requirement is just one possible option to put federal healthcare spending on a more sustainable path, but there are other routes that lawmakers can consider for healthcare reform. Lawmakers should come together to find a balanced reform that both secures Medicares future for the long run and creates a sustainable budget outlook. As it stands currently, parts of this essential program, relied upon by millions of Americans, is set to become unable to pay out full benefits by 2028.

Image credit: Photo by Brandon Bell / Getty Images

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