Medicare Eligibility

Are you eligible for Medicare? Generally, you’re eligible for Medicare at age 65 if you’re a U.S citizen or a legal permanent resident (green card holder), and you’ve lived in the United States for at least five years in a row prior to applying for Medicare.

You can also qualify for Medicare if you:

are younger than age 65 and receiving Social Security or certain Railroad Retirement Board Disability benefits for at least two years.

have been diagnosed at any age with Lou Gehrig’s Disease, also called Amyotrophic Lateral Sclerosis (ALS), and received Social Security Disability.

have been diagnosed at any age with End Stage Renal Disease, also known as ESRD, have been on dialysis for at least three months, or have had a transplant.

Part A Eligibility

Part A is known as Original Medicare, and it covers hospital expenses, skilled nursing, limited home care and hospice. 

Eligibility for Medicare Part A requires you or your spouse to have legally worked and paid income taxes for at least 40 quarters (10 years) in the United States.

Because you paid taxes (FICA) during your employment, you won’t be required to pay Part A premiums when you’re eligible.

If you haven’t worked the mandatory 10 years to qualify, purchasing Part A is still an option, but you’ll be required to pay for this coverage.

To find out the exact premium that you will have to pay, you will need to contact Social Security. 

Part B Eligibility

Part B is also part of Original Medicare. It helps pay for services that are medically necessary like doctor office visits, lab services, outpatient surgery, x-rays and preventative care.

Just like Part A, you’re also eligible for Part B at age 65. This coverage, however, is not free. You’ll pay a monthly premium based on your annual household income.

You may have to pay a penalty if you don’t enroll in Part B within your enrollment period.

WORKING PAST 65

Are you planning to keep working after turning 65 and have employer group health insurance?

If you want to keep your group health insurance, you have the option to delay enrollment into Part B without paying a late penalty.

It’s important to make sure your Part B substitute coverage is what the CMS defines as creditable.

If you’re considering delaying enrollment into Part B in favor of keeping your group coverage, we recommend that you consult with your employer to determine how Medicare coordinates with your group coverage plan.

We also suggest that you consult with a qualified insurance broker who can compare your Medicare options with your employer coverage to see which one best suits your needs.  They can explain to you as well the Special Enrollment Period (SEP) which you will need to use once you retire to avoid the risk of a late penalty. Contact us at 703-214-2600 for help today. 

Medicare Advantage Eligibility

Medicare Advantage, also referred to as Medicare Part C, is another option for Medicare coverage.

 Medicare Advantage plans are private health plans that are approved by and have contracts with Medicare. You can choose to enroll in a Medicare Advantage plan if you prefer to get your benefits through a private insurance company instead of Original Medicare.

With Medicare Part C plans, you generally are required to use providers that are approved by Medicare, and some of these plans include built-in Part D coverage.

AN IMPORTANT FACT ABOUT MEDICARE ADVANTAGE 

To be eligible for Medicare Advantage, you must be enrolled first in both Medicare Parts A and B. You must also live in the plan’s service area.

If you enroll in a Medicare Advantage plan, you can’t drop Part B to avoid paying its monthly premium. You must still continue to be enrolled in Parts A and B.

To keep your coverage under a Medicare Advantage plan, you must also continue to be enrolled in Parts A and B and regularly pay your Part B premium—including late penalties.

Part D Eligibility

Medicare Prescription Drug plans are offered by private health insurance companies that are approved by Medicare.

You can obtain drug coverage by a stand-alone Part D (PDP) plan or a Medicare Advantage Plan that includes prescription drug coverage (MAPD).

AN IMPORTANT FACT ABOUT PART D 

You must be actively enrolled in either Part A and/or B to be eligible to enroll in a Part D plan offering prescription benefits. You also must live in the service area of the plan that you choose.

Medicare Part D is optional but recommended if you have no other drug coverage. Be aware that you can face a penalty if you do not enroll when you are first eligible.

If you’re enrolled in a Medicare Advantage plan with prescription drug coverage, you must be enrolled in Parts A and B, and pay your associated premiums for Part B—including late penalties.

Do You Qualify For Medicare?

Determining if you’re eligible for Medicare can be confusing. Though it may seem overwhelming to you, our agents are here to guide you through the process. Get in touch with us to learn more. 

Contact Us

  • 10809 Second Street Fairfax, Virginia 22030
  • 1-703-214-4600
  • info@medicareportal.org