Currently, US citizens and non-citizens who qualify for US Social Security retirement benefits are eligible for Medicare if they meet one or more of the following criteria:
- Age 65 or older
- Disabled
- Have end-stage renal disease
Age 65 or Older
Anyone who is eligible for Social Security retirement benefits becomes eligible for Medicare during the month of turning age 65. Medicare uses the first of the month, not your actual birthday, to start your coverage; thus, if you turn age 65 on the 28th day of the month, your coverage starts on the first day of that month.
Disabled
Anyone receiving Social Security benefits due to disability for 24 months automatically becomes eligible for Medicare. Government (state, federal, and city) employees who are disabled but do not qualify for Social Security benefits may become eligible for Medicare after 29 months.
Individuals disabled due to amyotrophic lateral sclerosis become eligible for Medicare as soon as they begin to receive Social Security disability benefits.
End-stage Renal Disease
Individuals with end-stage renal disease who have received a kidney transplant or need to undergo regular dialysis may be eligible for Medicare if they meet any one of the following criteria:
- Are receiving Social Security retirement or disability benefits
- Have worked long enough to qualify for Social Security retirement benefits
- Are the spouse of a person who has worked long enough to qualify for Social Security retirement benefits
Individuals who meet the above requirements become eligible for Medicare as soon as they start regular at-home dialysis treatments, three months after starting regular dialysis at a center, the month during which they receive a kidney transplant, or up to two months prior to the kidney transplant if they are hospitalized to prepare for the kidney transplant.
Part A and Part B
Original Medicare includes two major parts, Part A and Part B. Part A pays for in-hospital care and Part B pays for outpatient care. Note that neither Part A nor Part B covers prescription medications, hearing aids, or vision corrective care such as eyeglasses. Individuals who are enrolled in Part A and Part B can sign up for prescription medication coverage separately through Part D. Medicare Part A and Medicare Part B does not cover dental or oral surgery.
More commonly referred to as Medicare Advantage, Medicare Part C is an alternative to Original Medicare. Medicare Advantage plans are purchased through private insurance companies. These plans provide coverage equivalent to or better than Orginal Medicare. However, they may be more costly. Individuals interested in Medicare Advantage need to read the details of each individual plan and consider their options carefully before enrolling.
Premium-free Part A
Most people will receive Part A without having to pay anything out of pocket (premium-free). If you qualify for premium-free Part A, you are automatically eligible for Part B. If you have to pay a premium for Part A, you are only eligible for Part B if you meet all of the following criteria:
- Age 65 or older
- A US resident
- A US citizen OR have permanent US residence status and have been continuously residing in the US for at least 5 years
In order to qualify for premium-free Part A, you or your spouse must have paid money into Social Security via FICA for a certain number of months (called Coverage Quarters, or QCs) throughout your life. The exact number of required QCs varies somewhat, but most individuals employed for most of their adult life easily qualify for premium-free Part A. Your local Social Security office can tell you whether you qualify or not.
Enrollment
If you have been receiving any type of Social Security benefits for at least four months before you become eligible for Medicare under one of the three criteria listed above, you will be automatically enrolled in Original Medicare Part A and Part B. However, you can refuse to enroll in Part B. Everyone else needs to take action to enroll in Original Medicare.
Individuals who qualify for premium-free Part A can enroll in Part A at any time after they qualify and then they should enroll in Part B during their Initial Enrollment Period. Individuals who must pay a premium for Part A should enroll in Medicare Part A and Part B during their Initial Enrollment Period.
The Initial Enrollment Period extends for seven months, including three months before the month during which an individual becomes eligible for Medicare, the month during which they become elibible, and three months after the month during which they become eligible. Coverage begins on the first of the month during which they become eligible.
Individuals who are eligible but fail to enroll in Medicare during their Initial Enrollment Period can enroll in Part A and Part B during the General Enrollment period from January 1 through March 31. Coverage then begins on July 1.
All individuals enrolled in Part A can enroll in Part B during their Initial Enrollment Period or during the General Enrollment period from January 1 through March 31. Everyone has to pay a premium to enroll in Part B, even if they qualify for premium-free Part A. Unfortunately, if you do not enroll in Part B during your Initial Enrollment Period and decide to enroll in it later, you will have to pay a late fee every single year thereafter that you keep your Part B plan.
