If an individual qualifies for one of these programs, they will also qualify for Extra Help, which is a program that offers financial assistance for prescriptions.
Individuals who are 65 and older are eligible to receive Medicare benefits. They must be a U.S. citizen or a permanent resident who has lived in the U.S. for five consecutive years. The individual must have paid Medicare taxes for ten years to receive premium-free Part A. Enrollment is automatic if the individual has been receiving Social Security benefits.
Individuals who have been receiving disability benefits from Social Security for 24 months are also eligible for Medicare. Enrollment is automatic and will be effective on the 25th month of disability.
Finally, those with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease are also eligible. ALS individuals will be enrolled in Medicare automatically, but those with ESRD must enroll themselves. Individuals with either of these conditions will receive premium-free Part A regardless of tax status.
Other Medicare Eligibility Requirements
To receive premium-free Part A, an individual must have paid Medicare taxes for ten years. A spouse who has not met that requirement but who is married to someone who has will also be eligible for premium-free Part A. Those who have not met the requirement must pay a premium for Part A.
Beneficiaries with low income may be eligible for financial assistance and may also be eligible for Medicare and Medicaid.
Beneficiaries with high income may pay a higher premium for both Part B and Part D. This added premium is calculated by using the tax return from two years ago. The added premium is called the Income-Related Monthly Adjustment Amount (IRMAA).
Individuals who have been receiving disability benefits for 24 months will be automatically enrolled in Medicare on the 25th month. In some instances, the individual does not have to wait the full 24 months.
People with ALS will be eligible for Medicare on the month that the disability benefits begin.
Disability is determined by the Social Security Administration, not the Medicare Program.
Am I automatically
enrolled in Medicare when I turn 65?
If an individual has already been collecting Social Security benefits prior to age 65, they will be automatically enrolled in Original Medicare, unless they do not qualify for premium-free Part A.
Otherwise, 65-year-olds should enroll in Original Medicare during their unique Initial Enrollment Period. This begins three months before their 65th birthday.
Medicare enrollment can be delayed if the individual has other creditable health insurance. However, it is important to find out if your current coverage is “creditable.” All employers who have at least 20 employees have creditable coverage.