For the vast majority of Americans who look forward to receiving Original Medicare health benefits, eligibility is as uncomplicated as celebrating your 65th birthday. But your eligibility to receive Medicare coverage without having to pay a premium – and your eligibility for other Medicare plans – depends on such factors as your work history and your health status.Here's what you need to know:
Generally, you're eligible for Medicare Part A if you're 65 years old and have been a legal resident of the U.S. for at least five years. In fact, the government will automatically enroll you in Medicare Part A at no cost when you reach 65.
All you need to do is check your mail for your Medicare card, which should automatically arrive in the mail three months prior to your 65th birthday (or the 25th month of a disability). Find out why some people have to sign up for Part A.
Sound good? It's even better if you don't have to pay a premium for Part A coverage. You're eligible to receive Part A coverage premium-free if:
If you (or your spouse) have not been paying Medicare taxes for at least 10 years, you'll still be eligible for Part A coverage, but you'll need to pay a premium – and your premium will depend on your work history. If you worked and paid into Medicare less than 10 years, you'll pay $254 a month. Your premium will be $461 a month if you've paid into Medicare less than 7 ½ years.
When you receive notification that you're eligible for Medicare Part A, you'll also be notified that you're eligible for Part B coverage, which is optional. If you enroll during an initial invitation period, Part B will kick in on your 65th birthday.
If you don't enroll during that period, you won't lose eligibility for Part B, but you will be penalized with an increased premium, which climbs 10 percent for each year that you're eligible but don't enroll in Part B.
Your eligibility for Medicare Advantage is determined by some of the same criteria that apply to Original Medicare. To be eligible, you must:
To be eligible for Medicare Part D prescription drug coverage, you must be entitled to Medicare Part A benefits and/or enrolled in Medicare Part B. You must also live within your Part D plan's service area and you must not be enrolled in more than one Part D plan.
Like Part B, you are still eligible for Part D prescription drug coverage if you don't enroll when you're first eligible, but you may pay higher premiums if you enroll later on.
If you're enrolled in both Medicare Part A and Part B, you're eligible to purchase a Medigap policy. The primary factor that will affect your ability to purchase the policy – regardless of your health – will be whether you enroll during your Medigap Open Enrollment Period.
For most folks, eligibility for Original Medicare is as simple as reaching age 65. But your eligibility for premium-free Medicare coverage – and for other Medicare plans – depends on such factors as your work history and health status.
If "you snooze," you could stand to lose a lot by missing the initial enrollment periods for certain Medicare plans. (Premiums for some plans climb 10 percent for each year you could have signed up, but didn't.)
With Original Medicare, enrollment can be as easy as opening your mail and putting your Medicare card in your wallet. For some other plans, you'll probably have to work a bit harder.