Who Can Get Medicare?

 In the U.S., Medicare is the go-to healthcare program for older individuals 65 and up, but it’s also there for people under 65 with certain disabilities, and those with ESRD (end-stage renal disease) or ALS (amyotrophic lateral sclerosis).

To receive Medicare benefits, you need to be a U.S. citizen or have been living here legally for at least five years.

What It Costs: 

For most, Medicare Part A won’t cost a dime, but there are some deductibles and copays to keep in mind.

Medicare Part B, on the other hand, comes with a monthly cost (or premium) for everyone. If you’re making more money, expect to pay a bit more. In 2024, the Part B premium is $174.70.

Signing Up: 

You can sign up during your Initial Enrollment Period (IEP), which is the three months before, the month of, and the three months after you turn 65.

There’s also the Medicare Annual Enrollment Period from October 15 to December 7. And if you’re leaving a job with group coverage, you can get into Part A and/or Part B without a penalty during a Special Enrollment Period (SEP).

If You’re Over 65: 

Waiting to join Medicare after you’re 65 could lead to a 10% Part B premium penalty for every year you delay. But, if you’re working past 65 and have insurance through your job, you can get a SEP to sign up without penalties.

If You’re Under 65:

You might qualify for Medicare before 65 if you have ESRD, are getting SSDI (Social Security Disability Insurance) benefits, or have ALS. The timing for when you can start varies—ALS patients get covered immediately, but SSDI recipients usually wait 24 months.

Next Steps

To make the most of Medicare, assess your eligibility and enrollment periods. If you’re approaching 65, plan to sign up during your Initial Enrollment Period to avoid penalties. If you’re already 65 and delaying enrollment due to job-based insurance, ensure you understand your Special Enrollment Period options. For those under 65 with qualifying conditions, confirm your specific eligibility and start dates. Take these steps now to secure the health coverage you need.

Medicare Resources

Understanding Medicare

Medicare does not cover all healthcare expenses, leaving you responsible for certain out-of-pocket costs and services like long-term care.

To manage these gaps, you have several options:

– Original Medicare: Includes Part A (Hospital Insurance) and Part B (Medical Insurance)

– Medicare Supplement: Also known as Medigap, this insurance helps cover the costs not included in Original Medicare

– Medicare Advantage (Part C): An all-in-one plan that may include additional benefits

– Part D: Prescription drug coverage provided by independent insurers.

Medicare Plan Options

– Original Medicare Part A: Covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.

– Original Medicare Part B: Covers doctor services, outpatient care, durable medical equipment, and preventive services.

– Medicare Advantage (Part C): Offers an alternative to Original Medicare with potential additional benefits and access to HMO or PPO networks.

– Part D: Helps with the cost of prescription drugs and some recommended vaccines.

– Medicare Supplement (Medigap): Plans A-N fill gaps in Original Medicare coverage, such as deductibles, copayments, and coinsurance.

How to Enroll in Medicare

How/when do I enroll in Medicare?  

Most people should apply for Medicare during their Initial Enrollment Period (IEP), which spans seven months around your 65th birthday. The fall Open Enrollment Period runs from October 15 through December 7 each year for making changes to your Medicare coverage. If you miss your initial enrollment period and don’t qualify for an exception, you can enroll during the General Enrollment Period (GEP) from January 1 to March 31 each year. Keep in mind, that this may incur higher premiums.

How do I switch Medicare plans?  

You can switch Medicare plans during the Open Enrollment Period or Special Enrollment Periods if you qualify. This is also when you can switch between Original Medicare and Medicare Advantage or add Part D coverage.

When is the deadline to enroll into Medicare?  

The Initial Enrollment Period is your main opportunity to enroll in Medicare without penalties. For changes or new enrollments outside this period, be aware of the Open Enrollment Period from October 15 to December 7, and the General Enrollment Period from January 1 to March 31.