Medicare Eligibility

Medicare Eligibility

Medicare eligibility is generally based on:

  • Age
  • Health
  • Disability
  • Or enrollment Status

 

Before you can enroll in any additional Medicare coverage such as Medicare Advantage, Part D, or supplements, you must be enrolled in Original Medicare (Part A and Part B).

Original
Medicare
Eligibility

The foundation for eligibility in all other Medicare plans is enrollment in both Part A and Part B.

Many people enroll in Original Medicare (Parts A and B) at age 65. At that time, you will have what is called your Initial Enrollment Period (IEP).

Roughly 3 months before your 65th birthday, you will receive a notice in the mail—either that you have been automatically enrolled in Part A and/or Part B, or instructions on how to enroll.

You may, however, be eligible before you turn 65 based on a few factors, one of which is your current health. If you have End-Stage Renal Disease (ESRD), Lou Gehrig’s Disease, or ALS, you have the opportunity to enroll in Medicare.

You can also be eligible before age 65 if you have a disability. After 24 months of receiving Social Security benefits, you will be automatically enrolled.

Medicare
Advantage
Eligibility

In order to be eligible for Medicare Advantage, you simply have to be enrolled in both Part A and Part B. Once you have done so, providers of Advantage plan cannot turn you away for health issues.

Medicare
Part D Eligibility

The same goes for Part D as Part C—as long as you’re enrolled in Original Medicare, you are eligible for Part D. However, if you have an Advantage plan, you may already have prescription drug coverage, and therefore don’t need Part D.

Keep in mind that you will no longer be eligible for Part D if you have a supplement plan—you may only have one or the other.

Medicare
Supplement
Eligibility

Like both Part C and D, you must first be enrolled in Original Medicare before you are eligible for a supplement plan. You can enroll in a supplement plan during your Medigap General Enrollment Period (GEP), which takes place the 6 months following your 65th birthday. During this time, you cannot be turned away for any health issues.

However, after these 6 months have passed, your eligibility requirements change. At that point, providers can turn you down for coverage based on your health. So, if you have any substantial conditions, you may not be accepted into the plan.

The easiest way to enroll in a supplement plan, then, is to do so during the GEP. You will still be eligible after this period, but meeting requirements will be significantly more difficult.

Five Common

Medicare

Mistakes

and how you can avoid them

Five Common Medicare Mistakes Book Cover

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