Who Can Get Medicare

Before age 65, you are eligible for free Medicare hospital insurance if:

• You have been entitled to Social Security disability benefits for 24 months; or
• You receive a disability pension from the railroad retirement board and meet certain conditions; or
• You have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis); or
• You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program; or
• You are the child or widow(er) age 50 or older, including a divorced widow(er) of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program.
• You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and: you are eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
• You have worked long enough in a Medicare-covered government job; or
• You are the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.

Medical insurance (Part B)

Anyone who is eligible for free Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium.

If you are not eligible for free hospital insurance, you can buy medical insurance, without having to buy hospital insurance, if you are age 65 or older and you are:

• A U.S. citizen; or
• A lawfully admitted non-citizen who has lived in the U.S. for at least five years.

Medicare Advantage plans (Part C)

If you have Medicare Parts A and B, you can join a Medicare Advantage (formerly Medicare + Choice) plan. With one of these plans, you do not need a Medigap policy, because Medicare Advantage plans generally cover many of the same benefits that a Medigap policy would cover, such as extra days in the hospital after you have used the number of days that Medicare covers.

Medicare Advantage plans include:

• Medicare managed care plans;
• Medicare preferred provider organization (PPO) plans;
• Medicare private fee-for-service plans; and
• Medicare specialty plans.

If you decide to join a Medicare Advantage plan, you use the health card that you get from your Medicare Advantage plan provider for your health care. Also, you might have to pay a monthly premium for your Medicare Advantage plan because of the extra benefits it offers.

People who become newly entitled to Medicare can enroll during their initial enrollment period or during the annual coordinated election period from October 15 – December 7 each year. There are additional enrollment periods for special situations.

Medicare prescription drug plans (Part D)

Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. You can wait to enroll in a Medicare Part D plan if you have other prescription drug coverage but, if you don’t have prescription coverage that is, on average, at least as good as Medicare prescription drug coverage, you will pay a penalty if you wait to join later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.

People who become newly entitled to Medicare should enroll during their initial enrollment period. After the initial enrollment periods, the annual coordinated election period to enroll or make provider changes will be October 15 – December 7 each year. There are additional enrollment periods for special situations.

Help for some low-income people

If you cannot afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer programs for people who are entitled to Medicare and have low income. The programs may pay some or all of Medicare’s premiums and also may pay Medicare deductibles and coinsurance. To qualify, you must have Part A (hospital insurance), a limited income, and, in most states, your resources, such as bank accounts, stocks and bonds, must not be more than $4,000 for a single person or $6,000 for a couple.

If you are not sure if you have Part A, look on your red, white and blue Medicare card. It will show “Hospital (Part A)” on the lower left corner of the card. If you are still not sure, you can call Social Security toll-free.

You can get more information about these programs from the Centers for Medicare & Medicaid Services (CMS). Ask for a copy of You could save in Medicare expenses (Publication No. CMS-10126) by calling the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048.

Only your state can decide if you qualify for help under these programs. To find out, contact your state or local medical assistance (Medicaid) agency, social services or welfare office.

You also may be able to get extra help paying for the annual deductibles, monthly premiums and prescription co-payments related to the Medicare prescription drug program (Part D). You may qualify for extra help if you have limited income (tied to the federal poverty level) and limited resources. These income and resource limits change each year, and you can contact us for the current numbers.

If you have both Medicaid with prescription drug coverage and Medicare, Medicare and Supplemental Security Income, or if your state pays for your Medicare premiums, you automatically will get this extra help and you don’t need to apply.

For more information about getting help with your prescription drug costs, call Social Security’s toll-free number or visit our website. You also can apply online at Social Security’s website.

UP NEXT: SIGNING UP FOR MEDICARE »