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MEDICARE ANSWERS

When am I eligible for Medicare?

Here is the common eligibility criteria for different parts of Medicare:

1. Medicare Part A (Hospital Insurance):

  • You are eligible for Medicare Part A at age 65 if you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters). This is often referred to as "premium-free Part A."
  • If you do not meet the work history requirements, you may still be eligible for Part A, but you may have to pay a premium for it.

2. Medicare Part B (Medical Insurance):

  • You are eligible for Medicare Part B at age 65, regardless of your work history, as long as you are a U.S. citizen or a legal resident and you meet the enrollment requirements.
  • You can also become eligible for Part B if you are under 65 and have a disability, or if you have end-stage renal disease (ESRD) or Lou Gehrig's disease (Amyotrophic Lateral Sclerosis, ALS).

3. Medicare Part C (Medicare Advantage):

  • Eligibility for Medicare Advantage Part C follows the same criteria as Parts A and B. You must be eligible for both Medicare Part A and Part B to enroll in a Medicare Advantage plan.

4. Medicare Part D (Prescription Drug Coverage):

  • Eligibility for coverage for prescription drug coverage for prescription drugs is the same as for Part A and Part B in that you must be eligible for Medicare to enroll in a Part D plan.

It's important to note that some people may automatically be enrolled in Medicare Parts A and B if they are receiving Social Security benefits or Railroad Retirement Board benefits when they turn 65.

If you're not automatically enrolled, you can typically sign up for Medicare during specific enrollment periods:

Initial Enrollment Period (IEP): This is the seven-month period that begins three months before your 65th birthday month, includes your birthday month, and extends for three months after your birthday month. During this period, you can enroll in Medicare Parts A and B.

Special Enrollment Period (SEP): If you have employer-sponsored health coverage through your job or your spouse's job when you turn 65, you may be eligible for a Special Enrollment Period that allows you to enroll in Medicare without penalties when the employer coverage ends.

General Enrollment Period (GEP): If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you can enroll in Medicare Parts A and B during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage typically begins on July 1 of the same year.

Keep in mind that there are specific rules and deadlines for enrollment, and failing to enroll when you're eligible may result in Medicare Late Enrollment Penalties and delays in coverage. It's advisable to familiarize yourself with the Medicare enrollment process and timelines to ensure you get the coverage you need when you're eligible.

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