Author: Carmelo DeFranco
Date: 06/16/2022
Reading Time: 3 minutes

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It is essential to have health insurance, especially when growing old because medical care needs increase. Over the decades, Medicare Insurance has been reliable insurance for seniors. However, it is not easy to understand the insurance coverage because it has different eligibility requirements and 'parts.' Most people even find it hard to determine when they qualify for Medicare! It is not about memorizing the set age because there are other factors to consider. If you are wondering when you are eligible for Medicare, this guide will help you understand everything you need to know. 

Eligibility Based on Age

With age being the primary eligibility factor, 65 years is the age Medicare is available to American citizens and permanent residents. After reaching 65 years of age, their Medicare Part A & B enrollment is automatically initiated by the Social Security Administration for those receiving social security benefits. However, those who have not yet started receiving social security benefits four months to attaining 65 years are required to enroll in Medicare Part A & B themselves. Remember, if you are not automatically enrolled, you have seven months (on the year you turn 65) to complete the enrollment. The enrollment period window is three months before your birth month and three months after.

The cost of Medicare coverage varies depending on your status as a taxpayer. While most people who have reached 65 years receive Medicare Part A coverage without paying a premium, if you failed to pay Medicare taxes, you will have to pay a premium and cannot qualify for Medicare Part A. However, whether you pay premiums or not, you have to pay coinsurance costs and deductibles. Here are some options you can choose from when signing up to change your coverage depending on your needs:
• Medicare Advantage rather than the original Medicare

• Original Medicare with some supplemental coverage such as Part D drug prescription coverage or Medigap Supplement

Other Factors to Consider

Although 65 is the age one qualifies for Medicare coverage; other factors are considered to determine whether one is eligible for Medicare. Some circumstances can make one eligible for Medicare regardless of age. People with disabilities or certain diseases like amyotrophic lateral sclerosis (ALS) and permanent kidney failure are eligible for Medicare.

Those who receive government disability payments via Rail Road Retirement Board or Social Security Administration can become eligible for Medicare coverage at any age. However, certain criteria must be met. For example, getting two years of disability payments before they start getting Medicare coverage. 

Medicare Part A Eligibility

If you qualify for this Medicare insurance plan, you will not pay any premiums. Medicare Part A covers hospitalization, and it is available to all those eligible for Medicare. However, to qualify, either you or (your spouse) must have paid Medicare taxes for at least 40 quarters throughout your employment period. 

Medicare Part B Eligibility

This insurance plan covers medical tests, mental health services, preventive services, doctor's visits, etc. If you are eligible for Medicare Part B, you are required to pay a premium. Usually, the premium is deducted from the social security payments. Remember, enrolling in Medicare Part B is voluntary.

Before rejecting Medicare Part B (If you have other insurance covers), it is vital to consider all the factors. You will have to pay a late enrollment penalty if you decide to enroll at later stages. Suppose you do not qualify for Medicare Part A and you are interested in Hospitalization covers. In that case, you will have to enroll in Medicare Part B first to become eligible for Medicare Part A. 

Medicare Part D Eligibility

This insurance plan covers prescription drugs that aren't included in Medicare Part A and B. Although Medicare Part D is crucial to most seniors, it has strict enrollment deadlines and hefty late enrollment penalties. With Medicare insurance coverage, you are eligible for Medicare Part D. 

Medicare Advantage Eligibility

This insurance plan offers an 'all in one' insurance. If you join the Medicare Advantage plan, you still have your Medicare insurance plan. However, the bundled plan includes Medicare Part A, Medicare Part B, and Medicare Part D. Remember, you qualify for Medicare Advantage if you initially qualified for Medicare. Finally, it is essential to verify the details provided to determine the plan that suits your needs.

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