Medicare Eligibility - The Basics

Medicare Eligibility - The Basics

The Medicare system, the number of options available, and senior eligibility benefits that help manage your health can be terribly confusing for anyone.

Understanding the basics regarding general eligibility and enrollment may help you manage your health and make better decisions when it comes to choosing options that best suit your needs.

Medicare Eligibility

You are considered eligible for Medicaid Part A and Part B if you:

  • Already collect Social Security benefits or Railroad Retirement Benefits (RRB)
  • You have a disability such as amyotrophic lateral sclerosis (ALS) also commonly known as Lou Gehrig's disease
  • You currently receive disability benefits from the Social Security Administration or the Railroad Retirement Board

Such individuals automatically receive Medicare Part A, which takes care of hospital insurance. You must choose to receive Medicare Part B, which offers medical insurance and coverage for items such as provider services. Medicare Part B requires a premium, but premiums are lower when you sign up for this part of Medicare services at the same time that you sign up for Medicare Part A.

Medicare Eligibility

Medicare Enrollment Basics

Medicare is available to individuals who are 65 years of age or older. Some individuals who are under 65 and experience some sort of disability may also be eligible for Medicare benefits. For example, anyone diagnosed with end-stage renal disease is also a candidate for inclusion into the Medicare program.Medicare Part A coverage begins the first day of the month you turn 65 when you already receive Social Security benefits or Railroad Retirement benefits. Disability benefits start the first day of the 25th month following your first Social Security benefit or benefits from the Railroad Retirement Board. Coverage under Medicare Part A and Part B starts the first day of the month, the same as your Social security or Railroad Retirement benefit disability benefits.

Individuals can sign up for Medicare services three months before or following their 65th birthday. The general enrollment period for Medicare Part B services (doctor and provider services) ranges from January 1 through March 31 of each year. Individuals can sign up for Medicare Part B at their local Social Security Office. Individuals who receive benefits from the Railroad Retirement Board can contact their local representative's office regarding eligibility and how to sign up.

If you sign up for benefits during the first three months before you turn 65, you'll avoid delays in coverage and services under Medicare Part B. If you wait until the month of your birthday or the three following consecutive months, the start date for your coverage will likely be delayed. For example, if you enrolled during the last three months of the initial enrollment period and you turn 65 in July, your monthly coverage begins on August 1 following that date. However, look at the difference between enrollment and covered start dates as offered by

  • August enrollment - October 1 coverage start date
  • September enrollment - December 1 coverage start date
  • October enrollment - January 1 coverage start date

However, even if you didn't sign up for Medicare Part B benefits, you can do so during the general enrollment period, which mentioned before, occurs between January 1 and March 31 of every year.

Medicare Eligibility

Medicare Eligibility - Delayed Enrollment

It's best to take advantage of the Medicare enrollment as soon as possible when approaching your 65th birthday. If you don't sign up for Medicare Part A when you're eligible, penalties for later enrollment may amount to 10% of the typical Part A premium. The 10% premium penalty will occur even if you're two days late. Individuals who wait for longer periods will have to pay the premium penalties for two times the number of years that Part A was available but you didn't sign up. For example, if you wait two years to enroll in Medicare following your 65th birthday, you may end up paying penalties for 10% of the premiums for four years.

Individuals delaying enrollment in Medicare Part B will also pay an extra 10% of Part B premiums for each 12-month period that enrollment is/was delayed. Individuals may have to pay that penalty for the length of time they have Medicare Part B services.

Medicare Eligibility - Conclusion

Special circumstances and special enrollment periods may delay or eliminate penalties or fees for late enrollment, but wherever possible, take advantage of the benefits provided by both Medicare Part A and Part B before your 65th birthday. For more information on this please see the Medicare Website

Medicare and Medicaid Page

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