Medicare is the federal health-insurance program that provides coverage for millions of retired and disabled Americans. While the government has made efforts to make it easy for participants to sign up for Medicare benefits, there are a handful of eligibility hurdles that potential enrollees need to be aware of.
Who is eligible for Medicare?
Medicare coverage starts at age 65 for everyone who is either a U.S. citizen, or has been a permanent legal resident for at least five years. Beyond that, you need to satisfy at least one of the following two conditions before you will be eligible to receive benefits:
- You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement Benefits (RRB), which equates to 40 credits or 10 years of work.
- You or your spouse is a government employee or retiree who has not paid into Social Security, but did pay Medicare payroll taxes while working.
There are also a few conditions that will qualify you for Medicare coverage prior to age 65, including:
- You are permanently disabled and have received disability benefits for at least two years.
- You have End-Stage Renal Disease requiring dialysis, or have had a kidney transplant.
- You have ALS -- which is more commonly known as Lou Gehrig's disease.
If you meet any of these criteria and are interested in figuring out if you qualify for Medicare coverage, the government created an easy to use website that will help you confirm your eligibility, and will help you estimate your costs.
What if I'm 65 or older, but I do not meet the work record requirement?
You can still receive Medicare benefits, but unlike those that meet the work requirement, you'll likely have to pay premiums for Medicare Part A -- which covers hospital bills and other inpatient services. Premiums for Part A coverage will vary depending on how many work credits you have accumulated. You'll also have to pay the same premiums as other participants for Part B, which covers medical insurance for expenses like doctor bills and outpatient services, and Part D prescription drug coverage.
When am I eligible to enroll?
If you are a U.S. citizen or permanent legal resident and you meet the necessary criteria, you can first sign up at the start of your initial enrollment period, which runs for a total of seven months. It starts three months prior to your 65th birthday, includes the month of your birthday, and ends three months later.
Will I be enrolled automatically?
Medicare enrollment isn't automatic for everyone, but there are several cases in which participants are automatically enrolled, including:
- If you are already receiving benefits from Social Security or the RRB, you will most likely automatically be enrolled in Part A and Part B. Your benefits will be begin on the first day of the month that you turn 65.
- If you are under 65 and have a disability, you are also automatically enrolled in Part A and Part B if you receive Social Security benefits, or certain disability benefits from the RRB for 24 months.
- If you have ALS.
- If you live in Puerto Rico, and are already receiving benefits from Social Security or the RRB, you will automatically be enrolled in Part A, but not Part B. Anyone in this situation needs to complete an application to enroll in Part B.
If any of these situations apply to you, then you should expect to receive your Medicare card in the mail three months prior to your 65th birthday, or on your 25th month of disability.
What if I'm not automatically enrolled?
If you're not included in the list of applications that enroll automatically, then you'll need to apply for Part A and Part B coverage manually. This applies to you if:
- You are not currently receiving Social Security or RRB benefits.
- You have End-Stage Renal Disease and qualify for Medicare.
- You live in Puerto Rico and are automatically enrolled in Part A, but want to add Part B coverage, too.
Thankfully, its easy to apply online for Medicare, so your benefits will start on time. You can also visit a local Social Security office if you need help, or can call 1-800-772-1213 if you prefer to use the phone (railroad workers should call the RRB at 877-772-5772).
If you meet the eligibility criteria and have not yet enrolled, it's generally smart not to wait. In certain cases, you'll pay penalties if you wait too long to enroll.