Who Qualifies for Medicare?

Medicare was originally designed for individuals who had retired from the workforce. As a result, the standard was set that you qualify for Medicare when you’re 65 years old. However, there are now additional ways to qualify for Medicare. Younger people with qualifying disabilities can also be eligible, along with individuals with end-stage renal disease. If you meet certain qualifications, you can get Medicare Part A for free, but Medicare Part B comes with a monthly premium.

It’s important to understand who is eligible for Medicare Part A and Part B and who is not eligible for Medicare so you get the benefits you understand your medical benefits and costs.

Medicare Eligibility Requirements

There are a variety of requirements to be eligible for Medicare, especially if you want Part A with no monthly premium. Below are some of the more specific details on Medicare eligibility requirements.

To qualify for Medicare you need to:

Be a U.S. citizen or permanent legal resident who has been in the U.S. for at least five years
Be 65 or older
You can qualify for Medicare if you’re under 65 but have a qualifying disability or end-stage renal disease

Who Qualifies for Premium-Free Medicare Part A?

You can get Medicare Part A without a premium if:

You are 65 or older and you or a spouse worked and paid Medicare taxes for at least 10 years
You receive benefits from Social Security or the Railroad Retirement Board
You or your spouse had government employment that was Medicare-covered

Who Can Apply For Medicare Part A and Part B?

Anyone who meets the eligibility requirements can apply for Medicare coverage. Your initial enrollment period begins three months before your 65th birthday and lasts seven months. If you sign up during the first three months of your enrollment period, your Medicare coverage will go into effect the first day of the month you turn 65.

If you qualify for premium-free Medicare Part A and you are receiving Social Security benefits when you become eligible for Medicare, your Part A coverage will begin automatically when you turn 65. . If you’re not receiving benefits, you can still get Medicare Part A on time by enrolling online or contacting Medicare directly. While Part A may be automatic for some, all individuals must apply to enroll in Part B. You can sign up for Part B during your initial enrollment period that occurs around your entitlement to Part A, and then generally only between January 1 and March 31 of each year (unless you have delayed because you continue to work). .

If you don’t apply for Medicare Part B when you’re eligible, you’ll most likely have to pay a late enrollment penalty.

If you have to pay for Medicare Part A, it follows the same rules as Medicare Part B. You can only enroll at specific times, and you have to sign up.

Who can Apply for Medicare Online?

Any qualifying individual can apply for Medicare online, however, you can only sign up during the initial enrollment period and then between January 1 and March 31 of each year.

Medicare Eligibility FAQs

Here are a few common questions we hear about Medicare eligibility:

Can I Get Medicare at 62?

Some people begin to claim retirement benefits from social security at age 62 and might wonder if they can also get Medicare benefits at that time. Generally, the answer is no. You can only get Medicare before age 65 if you have been on Social Security disability for at least two years, have ALS (Lou Gherig’s disease), or suffer from end-stage renal disease.

Can You Get Medicare If You’ve Never Worked?

If you haven’t worked, you can still qualify for Medicare, but you may have to pay a monthly premium for both Medicare Part A and Part B. You may still be able to get Medicare Part A premium-free if your spouse worked, or if you have specific disabilities or medical conditions.

Who Can Get Premium-Free Medicare Part A?

You can qualify for premium-free Medicare Part A if you qualify for Original Medicare and have the appropriate work history as described above (i.e. paid Medicare taxes for 10 years). Generally, you have to pay a premium for Medicare Part B, but there are options for those with limited income and limited assets.

The Medicare Savings Program (MSP) can help pay your Medicare Part A and B premiums if you qualify.

Learn More About Medicare Eligibility Requirements

If you’re curious about your Medicare eligibility and want to talk to a licensed insurance agent, we’re here to help. Simply give us a call at 1-866-955-0898 (TTY 711) or visit our website to review your options today!

Medicare In 2023: Changes & Updates

When planning ahead for your healthcare expenses and how they align with your Medicare coverage, it’s very important to stay informed on the changes to Medicare each year. Several aspects of Medicare - particularly related to out-of-pocket costs - can change on an annual basis. Beyond costs or plan changes, Congress also occasionally proposes and passes legislation that often impacts Medicare benefits. In this article, we’ll review the recent changes, including the 2023 Medicare costs and an overall look at the state of Medicare in 2023. 2023 Medicare Costs: An Overview The Medicare costs that change each year are: Part A deductiblePart A daily coinsurancePart B deductible Medicare Part A CostsThe changes to Part A costs include:Part A deductible - $1,600, an increase of $44 from 2022Part A daily coinsurance for hospital stays over 60 days - $400 per day, an increase of $19 per dayPart A daily coinsurance for hospital stays over 90 days - $800 per day, an increase of $22 per dayPart A daily coinsurance for skilled nursing facility stays longer than 20 days - up to 100 days $200, an increase of $5.50 per month Keep in mind that it is possible to pay the Part A deductible more than once in a year. This would only happen when you have multiple hospital stays in one year, and your stays are separated by more than 60 days. In this situation, you’d pay the Part A deductible each time.When you pay the Part A deductible, that gets you 60 days in the hospital and 20 days in a skilled nursing facility. If your stay goes beyond those times, you’ll have to pay the updated daily co-insurance amounts indicated above. Medicare Part B CostsThe Part B deductible for 2023 decreased to $226. It was $233 for 2022. You have to pay the Part B deductible each year before Medicare starts paying its portion of your outpatient care. Unlike the Part A deductible, you’ll only be required to pay the Part B deductible once per year.After you’ve met the Part B deductible, Medicare will pay the first 80% of the cost for your care; you’ll be responsible for the remaining 20%. Besides standard Part B coinsurance, you might encounter Part B excess charges, which can be as much as 15% of the Medicare-approved cost for your care.There were no changes to these coinsurance costs for 2023. How Much Will Medicare Premiums Increase in 2023? The standard Part B premium for 2023 is $164.90, which is a decrease of $5.20 per month. This decrease takes some of the sting out of last year’s increase, which was one of the largest in history. You may pay a higher premium for Medicare if you have incomes exceeding $97,000 (single filers) or $194,000 (married filing jointly).In addition to the costs for using your coverage, you’ll also have to consider the cost for getting your coverage. Most people don't have to pay a premium for Part A coverage (because it’s been pre-funded through payroll tax deductions), but you do have to pay a premium for Part B coverage. Medicare Part D Changes Another major component of your Medicare coverage is Medicare Part D, also known as Prescription Drug Plans (PDPs). Part D is offered by private insurance carriers with a Medicare contract - not offered by the federal Medicare program. There have been major changes to Part D in the past year as a result of the Inflation Reduction Act. Some of these changes won’t take effect until 2024 or later, but a few of them will be effective in 2023. The changes that will be applicable for 2023 include:Caps on the cost of certain insulinTaxes on excessive increases in the cost for prescription drugsLowering the cost of many vaccinations covered under Part DEach of these changes will have an impact on both standalone Part D Prescription Drug Plans (PDP) and Medicare Advantage Prescription Drug Plans (MAPD). New Caps On Insulin PricesThe Inflation Reduction Act has brought us the Insulin Savings Program, which was a temporary “test program” that began in 2020. The program is now permanent and mandatory. But previously, it was optional: Part D plans could choose to participate on a voluntary basis.The Inflation Reduction Act limits monthly cost sharing for covered insulin products to no more than $35 for Medicare beneficiaries, as long as the insulin is on the plans formulary. No deductible will apply to these insulin prescriptions. For 2023 and beyond, insulin prescriptions are capped at $35 for a one month supply. This price level stays the same throughout the year, even if you enter the coverage gap or “donut hole.” Excise Tax On Excessive Cost Increases Cost increases on prescription drugs, which are set by the manufacturers, will be subject to a new tax beginning in 2023. Medicare will use 2022 drug prices as a baseline and will investigate the prices for 2023 prescription drugs. If the increases from 2022 to 2023 are larger than the official rate of inflation, the manufacturer will pay a tax equal to 100% of the amount that the increase exceeded inflation for the year. Drug prices will be tracked each year in this way. The hope is that manufacturers will be less likely to increase prices aggressively since they won’t be able to keep any of the extra revenue that large cost increases used to bring them.While this new policy doesn’t directly reduce or limit the prices you pay through your drug plan, over time, it may allow for smaller copayments and coinsurance for your prescriptions. Reduced Vaccine Costs Under Part D The Inflation Reduction Act is also impacting how much you’ll pay for vaccinations under Part D. Prior to 2023, most non-essential vaccines were subject to cost-sharing, which meant that you had to pay a copayment or coinsurance for them. For example, the shingles vaccine was famously expensive. For 2023 and beyond, many Part D covered vaccines will be available at no cost. This brings the Part D vaccinations into alignment with the rules and cost structure for Part B vaccines (like the COVID-19 and flu shots). This includes the shingles shot, so protecting against this painful illness will be cheaper starting in 2023. There are still vaccines that you’ll have to pay for under Medicare, even after these recent changes. Vaccines that are needed to treat injuries or exposure to certain diseases may still require cost-sharing. General Enrollment Period (GEP) ChangesThe last major change to Medicare in 2023 relates to entering Medicare when you’ve missed your original enrollment window. Most people get to enter Medicare when they turn 65-years-old. In that case, you have a seven-month enrollment period known as your Initial Election Period (IEP) during which you can enroll. If you miss this chance, you have to enroll during the General Enrollment Period (GEP). GEP runs from January 1st to March 31st each year. Previously, if you enrolled during the GEP, your Medicare coverage wasn’t effective until July 1, which left you with a significant gap in your medical coverage.For 2023 and beyond, your coverage will be effective on the first day of the month after you sign up during the General Enrollment Period, eliminating the lengthy waiting period. Learn MoreIf you still have questions about 2023 Medicare costs and how they impact you, call 800-620-4519 to speak to one of our licensed insurance agents. You can also view our Medicare resources online:Compare Medicare plans: Visit our Medicare plan comparison tool.Learn about Medicare: View our Medicare Learning Center.Note: These 2023 Medicare costs and updates are courtesy of the Centers for Medicare & Medicaid Services (CMS). For more information, visit the CMS newsroom.

10 Costly Medicare Mistakes to Avoid

Researching your Medicare plan and understanding how to use your benefits wisely is key to maximizing your Medicare plan. But if you don't take the time to learn all that your current plan has to offer, or if you avoid comparing Medicare plans when it may be time to make a change, you could end up paying more money for your healthcare. To help you make an informed choice, we’ve put together this guide about 10 costly mistakes to avoid when picking a Medicare plan. Mistake #1: Using Doctors And Medications That Are Not Covered By Your Plan Medicare Advantage plans have formal networks of providers and lists of medications that are covered (called a formulary). If you see doctors who aren’t in-network, you’ll be paying more for your care than if you use in-network providers. While some PPO plans will allow you to see non-network providers, you’ll save the most money when you use in-network providers. In the same way, plans only provide coverage for medications that are on the formulary. If you use non-covered medications, you’ll end up paying full price for them. So if your current plan doesn’t work with your doctors and medications, you may want to consider making a change to your coverage a qualifying enrollment period. Our online guided Medicare enrollment tool also allows you to check and see if your doctor and drugs are covered in a Medicare Advantage plan. Mistake #2: Not Taking Advantage of Additional BenefitsOne of the reasons Medicare Advantage plans are increasingly popular is because they usually provide benefits that are not covered by Original Medicare. These kinds of benefits can include dental, vision, hearing, or prescription drug coverage.These benefits also may be included in your plan at no additional cost. If you don’t use them, you might be paying more than you need to for these services. In addition to the potential cost savings, these additional benefits are designed to help you live a healthier life. Mistake #3: Paying Cash For Your MedicationsIt can be tempting to pay cash for some of your less expensive medications. This is especially true when you look into any of the various prescription discount card programs that are currently available. However, it's wise to avoid paying for your medications if you're expected to reach the third coverage stage of the Medicare Part D drug program (often called the donut hole). Your drug plan tracks your spending, so if you pay cash for a prescription, it doesn’t count towards your official spending. This means that you might not be able to move out of the donut hole if you pay cash for some of your medications. Instead, consider using your plan even if you’ll pay more, if it means that you’ll move out of the donut hole faster. Mistake #4: Not Understanding Your Plan’s CostsWhile Medicare Advantage plans generally help to limit your healthcare costs, it’s important to remember that there are costs you’ll be expected to pay for your care. These costs are usually referred to as cost-sharing. Cost-sharing can include deductibles, copayments, and coinsurance. Besides these amounts, you’ll want to double check your plan’s Out-of-Pocket Maximum (OOPM), which is the most you could possibly spend in one year. Mistake #5: Choosing A Plan Based On Premiums AloneIt can be tempting to focus on the monthly premium you pay for your coverage, and not dig deeper into the costs you’ll pay to use your benefits. Pay particular attention to any deductible that you have to meet, as well as co-payments for services you’re likely to use. Besides these, consider your total costs in light of any costs for prescription drugs you take, too. Mistake #6: Not Checking To See If You Qualify For Financial AssistanceThere are a number of federal and state programs that are designed to help you pay for the cost of your health care. These can include Medicaid, Extra Help, Low Income Subsidy, and state pharmaceutical assistance programs. While there are income and asset limits for participation in some of these, you should apply for them if you think there is any chance that you could be eligible. Many times the limits are dependent on household size so you may qualify even if your income appears to exceed the limits. The upside is huge and there’s no downside to applying, so don’t miss out any potential for savings with these programs. Mistake #7: Not Considering Late Enrollment PenaltiesIt’s very important to consider the impact of late enrollment penalties, especially when you’re first entering Medicare. You can potentially be subject to enrollment penalties for both Part B and Part D. These penalties are assessed in the form of an additional monthly premium. Importantly, these penalties are generally permanent; once you’re subject to them, you’ll pay them for the rest of your life.If you’re already in Medicare, and you have avoided late enrollment penalties so far, just make sure that you continue to have Part D drug coverage, either from a Medicare Advantage Plan or a standalone Prescription Drug Plan.Mistake #8: Not Reviewing Changes In Your CircumstancesIt's important to review any changes in your circumstances on an annual basis. If you’ve been referred to a new specialist, prescribed a new medication, or diagnosed with a new medical condition, you might be better served by a different plan for the new year. So be sure to consider the impact these kinds of circumstances may have on your Medicare coverage. Mistake #9: Automatically Renewing Your Plan Each YearEach year, your plan will mail your Annual Notice of Change (ANOC) before the fall Annual Enrollment Period (AEP). The ANOC outlines changes in your plan benefits or costs for the upcoming year. Use this document, along with your plan’s overall Evidence of Coverage (EOC) to know how to use your benefits for this year.If you don’t make a change during AEP, you’ll automatically stay in your current plan. But plan benefits change from year to year, as do Medicare Advantage plan networks. So it's essential to review your coverage each year. Mistake #10: Not Working With A Licensed Insurance AgentAs you research the plans available in your area, consider working with a licensed insurance agent like one of our TogetherHealth agents. We work with a network of the nation’s major insurance carriers and can provide you with a variety of plan options to fit your healthcare needs, remain in-network with your doctors, and give you strategies to save money on prescription drugs. Get Help With MedicareIf you need more guidance, call 1-800-620-4519 (TTY 711) to speak to one of our licensed agents and get advice on how to avoid these 10 costly Medicare mistakes.

2023 Medicare Annual Enrollment Period Guide

The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Open Enrollment or the Medicare Annual Election Period, runs from October 15 to December 7 each year. This is the time period in which Medicare-eligible consumers can make certain changes to their Medicare plans. These plan changes would then become effective on January 1. View Our Medicare Annual Enrollment Period Guide Medicare plan costs and benefits can change annually, so it's wise to review your Medicare coverage each year. Use our Guide to the Medicare Annual Enrollment Period as a resource to review your current Medicare plan on an annual basis, then call our licensed insurance agents to compare Medicare plans during AEP. Medicare Guide to Annual Enrollment Medicare Guide Understand your Medicare plan options and learn what actions to take and when. Download your guide Call to compare Medicare plans: 1-888-605-1433 (TTY 711). Our licensed insurance agents are available to help 7 days a week. Weekdays: 8am – 11pm ET Saturday: 10am – 7pm ET Sunday: 11am – 6pm ET Overview of Medicare Enrollment PeriodsIt's important to know that the Medicare Annual Enrollment Period is different from other Medicare enrollment periods. Here’s a quick overview of the differences:Initial Enrollment Period (IEP): The 7-month initial enrollment period when you can first sign up for Medicare Parts A, B, C or D. This period spans:3 months before your 65th birthdayThe month of your 65th birthday3 months after your 65th birthdayAnnual Enrollment Period (AEP): An election period that allows you to make changes to your Medicare coverage each year. Open Enrollment Period (OEP): Applies only to those with Medicare Advantage, who can change Medicare Advantage plans or drop them and return to Original MedicareGeneral Enrollment Period (GEP): Open enrollment period to join Medicare Part A and B.Special Enrollment Period (SEP): Occurs if you have eligible life changes that mean you need to change your plan before the next annual enrollment period.Be sure to visit our guide to different enrollment periods to learn more.What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period?The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods.The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A) or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.If you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare AEP:Change Medicare Advantage plans.Change Prescription Drug (Part D) plans. Enroll in a Prescription Drug Plan.Cancel your Prescription Drug Plan.Switch from Original Medicare to a Medicare Advantage plan.Switch from a Medicare Advantage plan back to Original Medicare (and add a Part D plan or Medicare Supplement plan if needed). 5 Tips to Prepare for the Medicare Annual Enrollment PeriodThere are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs.1. Mark Your CalendarThis may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan.You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1.Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities.2. Review Your Medicare Annual Notice of ChangeYou’ll receive lots of information over the next month or so prior to and during AEP, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read.Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1 each year.Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year.While evaluating your current Medicare plan, you may want to ask yourself questions like:Did the plan cover the services I needed?Did I use out-of-network providers?Did I spend more out of pocket than I originally anticipated?Has something changed with my health (new diagnosis, new prescriptions, etc.)?The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any).Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company.3. Make a List of What’s Important to Your HealthKeeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period.Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any.We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget.For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs.Another thing to consider is whether or not you have an elective surgery planned for 2023. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan.4. Check Your Plan’s Drug FormularyYour Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance carrier to see if your prescription drugs will be covered for the 2023 plan year.If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them.5. Talk To Your DoctorAnother “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. If they aren’t, you may want to take advantage of the Medicare Annual Enrollment Period.So be sure to ask your doctor if he or she plans on changing health plan affiliations over the next year.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.But if you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare Annual Election Period:Change from Original Medicare to a Medicare Advantage plan.Change from one Medicare Advantage plan to another.Disenroll from your Medicare Advantage plan and go back to Original Medicare.Change from one prescription drug plan (Medicare Part D) to another.Enroll in a prescription drug plan.Cancel your prescription drug coverage.What Are The Benefits of a Medicare Advantage Plan?Understanding your Medicare plan options - starting with a Medicare Advantage plan - is a smart first step to take because you can switch, enroll into or disenroll from Medicare Advantage plans during AEP.Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. These plans are offered by private insurance companies. And while Original Medicare offers you a number of benefits, it may not cover health and medical services you might need.Medicare Advantage plans are appealing to many people because they’re considered “all-in-one” plans that give you an annual cap on your spending as well as access to extra benefits, which may include: Dental and vision coveragePrescription drug coverageAccess to fitness programsHealth incentive programsRides to medical appointmentsTelemedicine servicesNote: If you have limited income, you might also qualify for extra savings on Medicare costs through these programs.Medicare Savings Programs. These programs help pay for some of your Medicare Part A and Part B out-of-pocket costs, such as copays, deductibles and premiums. Most programs are for Medicare beneficiaries who also qualify for Medicaid. And as mentioned, Medicaid covers the majority of your costs when you join a Medicare Advantage Special Needs Plan. You can check if you qualify through your local Medicaid office.Medicare Extra Help. Extra Help reduces your Medicare prescription drug plan costs. You should contact Social Security to check your eligibility for Extra Help if you have an existing Medicare drug plan or you join one during AEP. Find A Medicare Advantage Plan During AEPTo enroll in an eligible plan during the Medicare Annual Enrollment Period, you can use our comparison tool as a guide to assess your needs and help you choose a Medicare plan. Or, you can give us a call.Our licensed insurance agents are available to help 7 days a week. Call us toll-free at 1-888-605-1433 (TTY 711). Weekdays: 8am – 11pm ET Saturday: 10am – 7pm ET Sunday: 11am – 6pm ET Tip: Be sure to have these 3 items handy before you call us or enroll in a Medicare plan online during AEP:Your Medicare number, which is found on your red, white and blue ID card.Your list of prescription drugs and preferred pharmacy.Your list of preferred doctors and hospitals.We’re here to help you compare your options and find you a Medicare plan that meets your individual needs.

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