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Medicare Eligibility in 2021

Understanding Medicare eligibility is very important for soon-to-be Medicare beneficiaries. Though most people qualify for Medicare because of their age, there are also certain health conditions that can impact Medicare eligibility.

Am I eligible for Medicare?

The majority of people become eligible for Medicare when they turn 65. You can apply for Medicare during the seven-month period that includes the three months leading up to your 65th birthday, your birthday month, and the three months that follow it. You also must be a U.S. citizen or legal permanent resident who has lived in the United States for at least five continuous years to be eligible for Medicare. 

However, there are other reasons that may impact your Medicare eligibility that have nothing to do with your age.

Disability

You may qualify for Medicare if you are permanently disabled, but only once you have been receiving Social Security disability benefits for 24 months. Once the 25th month starts, you will be automatically enrolled in Medicare. 

However, in certain circumstances, you won’t have to wait 24 months to become eligible, such as if you have had a kidney transplant or receive regular dialysis or if you suffer from Lou Gehrig’s Disease (ALS).

End-Stage Renal Disease (ESRD)

People who suffer from End-Stage Renal Disease (ESRD) are also granted Medicare eligibility. This encompasses people whose kidneys don’t work and need regular dialysis OR who have undergone a kidney transplant.

If you suffer from End Stage Renal Disease and would like Medicare coverage, you or your spouse must also have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee (or are already receiving benefits). However, you won’t be automatically enrolled, so you will have to sign up with Social Security. 

Amyotrophic Lateral Sclerosis (ALS)

If you suffer from Lou Gehrig’s disease (ALS), you don’t have to wait 24 months after receiving Social Security disability benefits to get Medicare. Rather, you qualify for Medicare the same month that your disability benefits begin. 

Unlike people with End-Stage Renal Disease, who have to manually enroll in Medicare, individuals who suffer from Amyotrophic Lateral Sclerosis (ALS) can be automatically enrolled in Medicare the first month they start receiving Social Security or railroad disability benefits.

Medicare Part A Eligibility

You (or your spouse) must have worked and paid Medicare taxes for at least 10 years in order to be eligible for premium-free Part A. If you are already enrolled in Social Security or are receiving Railroad Retirement Board benefits, you will automatically be enrolled in Part A. 

However, if that is not the case for you and you don’t qualify for premium-free Part A, you have the option of paying a premium for your Part A coverage.

Medicare Part B Eligibility

The same requirements that apply for Medicare Part A eligibility also apply to Part B. However, unlike with Part A, the majority of people have to pay a monthly premium for Part B. In 2021, the standard Part B premium is $148.50.

But how much you have to pay for your Part B premium will depend on how much you earned. This is calculated based on your income from two years ago and is called the Income-Related Monthly Adjustment Amount (IRMAA). Certain high-income earners  have to pay this supplemental amount on top of their Part B monthly premiums.

Medicare Part C Eligibility

If you qualify for Medicare Part A and Part B, then you are also eligible for Medicare Advantage, or Part C. If you want to purchase a Medicare Advantage plan, it is mandatory for you to be enrolled in both Part A and Part B. And if you are enrolled in Medicare Part C, you cannot also sign up for a Medigap plan.

In the past, individuals who had Medicare eligibility because they suffered from ESRD were not able to enroll in Part C. However, as of 2021, Medicare Advantage plans are available to these individuals.

Medicare Part D Eligibility

You become eligible for Medicare Part D drug coverage at the same time that you become eligible for Original Medicare. However, in order to sign up for Part D, you must also be enrolled in Part A and/or Part B. People who are enrolled in certain Medicare Advantage policies, such as HMO and PPO plans, are not eligible to enroll in a Part D stand-alone drug plan, though many Medicare Advantage plans include drug coverage.

Do you still have questions about whether or not you are eligible for Medicare? Get in touch with our team at Medicare Plans Direct for a free Medicare consultation with one of our experienced insurance agents.

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