Medicare Eligibility Requirements

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By law, you’re allowed to sign up for any Medigap policy in your state as long as you enroll during the initial window, even if you have medical issues that would otherwise prevent you from getting covered. An insurer has to charge you the same premium rate as a healthy person, too, so enrolling during this initial period is essential if you need the extra coverage. Your guarantees under the initial enrollment window expire once that 6-month eligibility period ends. Outside of the initial eligibility window, you may not find Medigap coverage at all. And if you do, it will probably cost a lot more.

Original Medicare (Part A and B) Eligibility and Enrollment

To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.

Medicare Eligibility and Enrollment

good as Medicare’s or better, you shouldn’t be charged a late penalty as long as you sign up within the deadlines. After insurance from an employer ends, you must sign up for Part B within 8 months and for Part D within 63 days. Keep in mind that an insurance policy from an employer with fewer than 20 employees works differently with Medicare. If you work for a company of that size, you should sign up for Medicare when you are first eligible. You will not incur penalties if you don’t, but without Medicare Part B coverage, you could be without coverage for outpatient services.

Disability Planner: Medicare Coverage If You’re Disabled

Everyone with Medicare also has access to prescription drug coverage (Part D) that helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s "How to get drug coverage" page.

Does Medicare or Medicaid Come With Social Security or SSI Disability Benefits?

Note that SSI recipients in 209(b) states are allowed to spend down even if the state doesn’t have a “medically needy” program, a separate type of Medicaid  eligibility  program that allows some individuals to spend down their medical expenses. In the 209(b) states that  do  have a medically needy program, SSI recipients have to spend down only to the 209(b) income standard, not the medically needy income limit (MNIL). (In most 209(b) states, the 209(b) income limits for Medicaid are higher than the income limits for Medicaid’s medically needy program.)  

Federal Poverty Level Eligibility for Medicare and Medicaid Benefits

If your income is under 135% FPL, there are other Medicare Savings Programs you can qualify for. One of these programs is the Qualifying Individual (QI) program, which pays your monthly Part B premium. The income limit for another Medicare Savings Program, Specified Low-Income Medicare Beneficiary (SLMB), is 120%, but the program provides the same benefit—payment of the monthly Part B premium.

Related posts:

  1. Does Medicare or Medicaid Come With Social Security or SSI Disability Benefits?
  2. Medicare Eligibility Requirements
  3. Medicare Eligibility and Enrollment
  4. Medicare Eligibility Requirements
  5. Medicare Eligibility Requirements

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