Eligibility for Medicare
Turning 65? Delaying retirement? Changing plans? Here's what you need to know to determine your eligibility for Medicare.
Qualifications for Medicare:
- Be age 65 or older
- Be a legal resident living in the U.S. for at least five consecutive years
- If under 65 you can qualify if:
- You've been collecting Social Security disability for 24 consecutive months (your eligibility begins the first day of the 25th month)
- You have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or
- You have ALS (amyotrophic lateral sclerosis) also known as Lou Gehrig's disease
Select the scenario that fits you best to learn when you are eligible to sign up for Medicare.
Turning 65 and retiring
Happy birthday and congrats on retirement!
If you’re ready to retire once you turn 65, your eligibility for Medicare occurs over a seven month period known as, the Initial Enrollment Period. This period begins three months before you turn 65 and lasts three months after you turn 65. During this time you can sign up for Medicare Part A and/or Part B (Original Medicare).
If you are retired and are signed up for Social Security benefits or Railroad Retirement Benefit, you will be automatically enrolled in Medicare Parts A and B beginning the first day of the month in which you turn 65. If you have not yet received Social Security benefits, you should sign up for Medicare.
It's important to know that you may incur a late enrollment penalty if you don’t sign up for Medicare Part B when you first become eligible.
Working past 65
You may still need to sign up for Medicare Parts A and B even if you continue working age 65, because this is when Medicare eligibility begins. Once you do retire, you will have eight months (known as a Special Enrollment Period) from when you leave your job or the last day that your Employer Group Coverage ends (whichever comes first) to sign up and avoid a late enrollment penalty fee.
Signing up for Medicare Part A:
If you continue to work past Medicare eligibility age 65, you can still sign up for Part A as soon as your Initial Enrollment Period begins. (See "Turning 65 and retiring" above for when your Initial Enrollment Period is.)
If you paid Medicare taxes for a certain amount of time, you may qualify for Part A with no premium.
Signing up for Medicare Part B:
The size of your employer and health coverage your employer provides may impact when you are eligible to sign up for Medicare Part B.
If you or your spouse continue working for an employer with 20 or more employees and have group health coverage, you may be able to delay signing up for Medicare Part B without incurring a late penalty. Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). If so, you do not need to enroll in Part B, since your employer's plan will remain your primary coverage. When you do eventually retire or leave work, you'll be able to sign up for Part B, without incurring a late penalty, during an eight-month Special Enrollment Period. (See exceptions to eligibility and enrollment below.)
If you continue working for an employer with less than 20 employees or your company provides insurance that does not qualify as a group health plan, you should sign up for Medicare Part A and Part B when you first become eligible for Medicare. This will become your primary insurer. If you do not sign up for Medicare Part A and Part B at this time, you may have to pay a late enrollment penalty for as long as you keep Part B coverage once you do enroll.
It's important to understand how the coverage you get on the job works with Medicare. Talk to your employer when you become eligible for Medicare to help plan for your future.
Changing Medicare plans after enrollment
Medicare Annual Enrollment Period (AEP)
There are certain times when you can switch your Medicare plan, depending on your current coverage. If you currently have a Medicare Advantage (Part C) or prescription drug (Part D) plan, you can add, drop or change your plan during the Medicare Annual Enrollment Period (AEP) from October 15 through December 7. You may qualify for a Special Enrollment Period outside of AEP if you experience a "qualifying event".
(See exceptions to eligibility and enrollment below for examples of "qualifying events".)
You can switch Medicare supplement plans at any time.
Medicare Advantage Open Enrollment Period
If you are enrolled in a Medicare Advantage plan, you have between January 1 through March 31, to leave your plan and go back to Original Medicare (Parts A and B), or you have a one-time opportunity to:
- Change your Medicare Advantage plan
- Enroll in a stand-alone Part D prescription drug plan if you are unenrolling from a Medicare Advantage plan that included Part D prescription drug coverage to return to Original Medicare.
Qualifying events for insurance - Special Enrollment Period (SEP)
If you’re covered under an employer group health plan when you’re first eligible for Medicare, you have an eight-month Special Enrollment Period that starts the month after your employment ends or your employer group health plan ends, whichever happens first, to sign up for Medicare.
Medicare Special Enrollment Period (SEP)
There are exceptions to the rules that allow you to switch Medicare Advantage (Part C) or prescription drug (Part D) coverage without waiting until AEP. These exceptions are called “qualifying events.” If you qualify for any of them, you can join, leave or change your coverage during a Medicare Special Enrollment Period (SEP).
“Qualifying events” for Special Enrollment Period include:
• Moving out of your plan’s service area
• Moving within your current plan’s service area, with new plan options
• Moving into or out of a qualified institution (nursing home, psychiatric hospital, etc.)
• Leaving your employer, or the end of retiree, union or COBRA coverage
• Losing creditable drug coverage through no fault of your own
• Your current Medicare plan stops servicing your area
• Qualifying to enroll in a Medicare/Medicaid dual-eligibility Special Needs Plan
• Other life events may qualify for SEP, too. Call your local State Health Insurance Assistance Program (SHIP) office for details.
Y0032_18270_1_M File and Use 10/1/18
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