Medicare Eligibility

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). It is comprised of four parts:

Part A – hospital costs

Part B – doctor and outpatient care

Part C – Medicare Advantage (combines hospital costs, doctor and outpatient care plus added services, such as eye exams and hearing aids)

Part D – prescription drugs

 

What is Medicare Part A and Part B?

Medicare Part A and Part B is also referred to as Original Medicare. Most people age 65 and older are entitled to premium-free Medicare Part A if they or their spouse have made payroll tax contributions for 10 or more years. (Note: you qualify for Medicare at age 65, even if your Social Security full retirement age is older than 65.) If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.) If you’re close to 65, but not getting Social Security or Railroad Retirement Board (RRB) benefits, you’ll need to sign up.

People under 65 and disabled will automatically get Medicare Part A and Part B after they receive Social Security Disability Insurance (SSDI) or certain disability benefits from the Railroad Retirement Board (RRB) for 24 months. People who have ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) will automatically get Part A and Part B the month their disability benefits begin. People who have End-Stage Renal Disease (ESRD) will need to sign up for Part A and Part B.

 

What is Medicare Advantage (Part C)?

A Medicare Advantage plan (Part C) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all of your Part A and Part B benefits. If you’re enrolled in a Medicare Advantage plan, Medicare services are covered through the plan and aren’t paid for under original Medicare. Most Medicare Advantage plans include Prescription Drug Coverage (Part D).

 

When can I enroll in a Medicare Advantage Plan?

There are certain times during the year to enroll or make changes in a Medicare Advantage Plan (Part C).

Initial Enrollment Period (IEP): During the seven-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the three months before you turn 65, your coverage will begin the first day of the month you turn 65.

Annual Enrollment Period (AEP): Between October 15 and December 7, anyone Medicare eligible can choose a Medicare Advantage Plan. Your coverage will begin on January 1 of the following year.

Special Enrollment Periods (SEPs): In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Some examples include:

  • You change where you live
  • You lose your current coverage
  • You have a chance to get other coverage
  • Your plan changes its contract with Medicare
  • When can I change my Medicare Advantage plan?
  • You may only change plans during Medicare’s Annual Enrollment Period, which runs from October 15 through December 7 for coverage beginning on January 1 of the following year, or during a Special Enrollment Period.

For additional information on Medicare in general, please call 1.800.MEDICARE (TTY users call 1.877.486.2048) 24 hours a day, 7 days a week, or visit medicare.gov