NC Health Coverage, Al Crouse - NC Health Insurance  

Medicare Eligability - Parts A and B

Medicare Eligibility: Who may enroll in Medicare


Medicare Eligibility - Parts A and B


To be eligible for Medicare Parts A and B, you must be a U.S. citizen or a permanent legal resident for at least five years. Also you must meet at least one of the following:

  • Be age 65 or older and eligible for Social Security
  • Be permanently disabled (even if under age 65) and receive Social Security disability insurance benefits for at least two years
  • Have End Stage Renal Disease (ESRD) (permanent kidney failure that requires dialysis treatment or a kidney transplant)
  • Have Lou Gehrig's Disease (Amyotrophic Lateral Sclerosis (ALS))


Once you meet eligibility requirements for Medicare Part A (Hospital Insurance) you may be automatically enrolled. However, you must sign up for Medicare Part B (Medical Insurance) after you become eligible. Your qualifying event determines when you must enroll: either during the next general enrollment period (January 1-March 31) or within two months of the qualifying event, whichever comes first. If you don't sign up for Medicare Part B when you become eligible, you may pay penalty of 10 percent for each 12-month period you could have had it. Some exceptions apply.

Most individuals do not have to pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working for at least 10 years (or 40 quarters). If you are not eligible for premium-free Part A, you will have to pay a monthly premium. In addition, there is a premium per month for Medicare Part B. High-income individuals may pay more. Low-income individuals may pay less, or can even qualify for no premium.


Medicare Eligibiltiy - Part C


Medicare Part C (or Medicare Advantage Plan) is an alternative to Medicare Parts A and B and is available through private insurers. Medicare Part C is optional; there is no penalty for not signing up. To be eligible for Medicare Part C, you must already be enrolled in Medicare Parts A and B. Then you can buy a Medicare Advantage (Part C) group plan through your employer, your spouse's employer, or through a qualified insurance agent. Since Medicare Advantage plans typically cover more than Original Medicare (Parts A and B) you will not need a Medigap (supplemental) policy.

Medicare Part C general enrollment period is the same as Original Medicare (Parts A and B). Or you may sign up within two months of your qualifying event. Remember you must have Medicare Parts A and B to get Part C. Monthly rates and plan coverage vary by insurance carrier and specific plan design.


Medicare Eligibility - Part D


Medicare Part D covers prescription drugs and is available through private insurers. To be eligible for Medicare Part D, you must have Medicare Parts A and B and you must live in the service area for the prescription drug plan in which you want to enroll.

When you become eligible for Medicare, you must have creditable prescription drug coverage that covers at least as much as Medicare Part D. This coverage can be through either a private insurance company or through a Medicare prescription drug plan. If you don't have creditable prescription drug coverage when you become eligible for Medicare, you will pay a penalty if you wait to join Medicare Part D later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.

Medigap policies no longer include prescription drug coverage. However, some older Medigap policies still do but it may not be enough to be considered "creditable." You can request that your older Medigap policy drops the prescription drug benefit so you can enroll in a Medicare Part D plan for creditable coverage.

Low-income individuals may qualify for Extra Help with Medicare prescription drug costs. Extra Help is a program that helps cover the costs for copays, coinsurance, deductibles and all or most of your monthly premium.







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