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Medicare eligibility can be a confusing matter to sort through and figure out on your own. There are factors, conditions, eligibility requirements and deadlines that can affect your coverage and benefits. In addition, there are special enrollment periods which allow an extension of time for filing for coverage. Wondering if you qualify?
If you were not in need of Medicare when you first became eligible and now need coverage under the program, you may be unsure of your Medicare eligibility.
If you did not sign up for Medicare Part A and/or Part B because you had health insurance coverage via an employer or a spouse's employer, you may be entitled to apply for coverage via a special enrollment period that is offered by the program.
In most cases your Medicare eligibility allows you to register for Part A and/or Part B as indicated below:
Anytime that you or your spouse are working and are provided health insurance coverage through a group health care plan through the employer, you qualify for the special enrollment period.
In addition, you are qualified for this special enrollment period during the 8 month period that begins the month after the employment ends or the group health insurance coverage ends, whichever occurs first.
You are also eligible if you're a volunteer serving in a foreign country.
Note: If you have COBRA coverage or a retiree health plan, this means that you don't have coverage based on current employment and therefore, you are not eligible for a special enrollment period when that coverage ends.
Medicare health coverage is divided into four parts. Medicare eligibility for Parts A, B, C and D is determined by United States citizenship for people who are 65 or older. Medical eligibility is also defined for people with kidney failure requiring dialysis or transplant as well as those under 65 with certain disabilities
Medicare Part A is usually free of charge as long as the person or their spouse has paid Medicare taxes through their employer. People that are not eligible for free Medicare Part A may purchase Part A coverage if they are enrolled or enrolling in Medicare Part B and meet United States citizenship requirements. People under 65 who are disabled and have received free Part A, but have returned to work are also eligible for Part A coverage for a fee. People who choose to pay for Part A often must also pay for Part B coverage. State assistance may be available in certain cases.
Medicare part B coverage requires payment of a standard monthly premium. People may be required to pay more for a monthly premium when the person's IRS tax returns for the prior two years is above a certain threshold. Those who must pay a higher premium are notified by the Social Security Administration, and when in disagreement may contact the Social Security Administration at their toll free number or by email. A late enrollment penalty may be charged for people who don't participate when they are initially eligible.
Medicare Part C is covered by third party insurers. Fees may vary based on insurer and region, but are regulated by Medicare. Part D Medicare prescription coverage also requires Medicare Part A or Part B coverage and is usually offered by third party insurers that are chosen and regulated by Medicare. Cost and drugs that are covered may vary from plan to plan.