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Requirements for Medicare Age 65 Eligibility

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Bob Phillips As a Medicare expert, Bob's writing serves as invaluable guidance for his readers. He is an avid sports fan and loves spending time with his wife, three children, and two grandchildren. He's enjoying life in Texas as a writer.
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As with any medical coverage, there are often changes in Medicare rules which can have a major impact on your coverage .

Read answers to some of your most pressing questions then consult with a professional to select the best coverage for you. 

Medicare Coverage & Eligibility: An Overview 

Having a firm understanding of the different parts of Medicare is necessary in order to understand what to choose and when you can apply for the different options available. The Medicare “parts” and what they cover are as follows:

  • Medicare Part A: covers the costs for in-patient hospitalization.
  • Medicare Part B: covers doctor’s office visits and out-patient services.
  • Medicare Part D: covers prescription drug coverage.

The Essential Medicare Age 65 Eligibility Questions You’ll Want Answered

  • Basic Qualifications—What are the basic qualifications for Medicare eligibility?
  • Open Enrollment—If you’re turning 65 this year, when do you need to enroll for Medicare Part A benefits
  • Early Eligibility—Does an individual with a disability have to wait until they are 65 to qualify for Medicare Part A? 
  • Supplemental Insurance—what other options are available to me for additional expenses?

Basic Qualifications

  • Individuals need to be an American citizen to be eligible for Medicare benefits, or a legal permanent resident for at least five consecutive years to be eligible for Medicare benefits.. 
  • Someone receiving disability pension benefits from Railroad Retirement Board is automatically enrolled at age 65. 
  • Eligibility at age 65 also requires that an individual has worked and paid Medicare taxes for 10 years prior to applying. 
  • An individual may also be eligible at age 65 or older if they have a spouse who’s  has worked and paid Medicare taxes through their employment for at least 10 years.

Open Enrollment

  • There’s an open enrollment period of seven months surrounding the month of the individual’s 65th birthday for Part A enrollment.  This includes three months before the birthday month, the birthday month itself, and the three months after the birthday month. For example, if someone’s birthday is in October, they would have from July until December to enroll.
  • Applications must be made during this time  to be guaranteed coverage. During this time, you don’t need to provide proof of insurability. 
  • For Part A coverage, all pre-existing conditions will be covered in full at no extra charge. 
  • For Part B and Part D coverage though, there is a monthly cost. Contact a professional to learn more and get a free quote.

It’s advisable to enroll in Part B and Part D coverage at the same time as Part A, because coverage will be guaranteed at this time regardless of the enrollee’s previous medical history. 

Early Medicare Eligibility 

As previously mentioned, an individual is eligible for benefits when they turn upon turning age 65. However, there are additional circumstances which may allow someone to be enrolled when they turn at age 62. These are as follows:  

  • An individual may be eligible for Medicare benefits if they’ve received Social Security disability benefits for a period of 24 months. 
  • A patient has end-stage renal failure requiring regular dialysis or a kidney transplant. They are eligible for benefits after their first dialysis treatment and stop being eligible it they receive a transplant that no longer requires dialysis.
  • An individual has Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease. Having ALS will allow for benefits to begin immediately following a diagnosis.
  • If someone retires at age 62, they may be eligible for Social Security retirement benefits, but they will need to acquire an individual or family health insurance policy to cover have coverage for medical expenses.

Medicare Supplement (Medigap)

Medicare Supplement policies are available to cover expenses not included in Part A or Part B. These are most often offered through insurance companies that specialize in insurance policies for seniors. 

It’s advisable that you contact a  licensed insurance agent to review the different policies offeredThis way you can get the best coverage for your  individual situation 

Here are a couple of things to remember:

  • There are a lot of details that go into Medicare eligibility and benefit rules. Talking with someone who does this every day can be a life saver. 
  • You don’t want to wait too long to apply for benefits that you’re legally entitled to. This is an unnecessary cost you can avoid.

Also, eligibility rules, as well as other enrollment conditions, are subject to change.

 

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