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Medicare Eligibility
Most people qualify for Medicare Parts A and B once they reach 65 years of age. At that point, you are automatically enrolled in Part A and must register for Part B yourself. The initial enrollment window spans from three months before to three months after your birth month. If you have been receiving Social Security disability benefits for 24 months, have ALS, or suffer from End-Stage Renal Disease (ESRD), you are automatically enrolled in both Parts A and B.
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While you are covered by an employer’s health insurance, you fulfill the criteria for Medicare Part B. Upon retiring or losing employer-provided coverage, you will have the chance to enroll in Part B during a Special Enrollment Period, avoiding any penalties.
Signing Up
To enroll in Medicare Part A & B or only Part B, visit the Social Security website. You'll need some essential details about yourself, such as your Social Security number, birthplace, and any current health insurance information. If you're enrolling solely in Part B, be sure to provide a valid email address and your existing Medicare number.
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After submitting your application, it can take between two to six weeks for processing. Once it's processed, you will receive a Medicare card by mail, or you can access your Benefits Verification Letter through your Social Security Portal. With your Medicare number in hand, you can then register for a supplemental plan.
Medicare & Medicaid
Dual eligibility refers to individuals who qualify for both Medicare and Medicaid. Typically, Medicare covers services first, while Medicaid may cover additional costs like extended care and home services not fully covered by Medicare. Those eligible for both might receive full Medicaid benefits or qualify for Medicare Savings Programs to reduce Medicare-related expenses.​
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Categories of Dual Eligibility include:
- QMB (Qualified Medicare Beneficiary): Assists with Medicare Part A and B premiums, cost-sharing obligations, and deductibles.
- SLMB (Specified Low-Income Medicare Beneficiary): Provides assistance with Part B premiums.
- QDWI (Qualified Disabled Working Individual): Supports those who lost Medicare Part A coverage upon re-entering the workforce.
- QI (Qualifying Individual): Grants access to Medicare Part A benefits.
Medicare Costs
In 2025, the standard monthly cost for Medicare Part B, covering physicians' appointments and various medical services, is $185, with an annual deductible of $257. Part A, which is hospital insurance, has premiums that vary depending on your work history, though many individuals are eligible for it at no cost. The deductible for Part A is $1,676 per benefit period, although this might be presented differently if you possess a supplemental plan or a Medicare Advantage plan.
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To cover all your prescribed medications, you’ll need to include Part D coverage. Failing to have this coverage or experiencing any interruptions could lead to a penalty. The costs associated with Part D differ based on the provider and their agreements with pharmaceutical companies.
IRMAA
IRMAA is an extra fee that you might need to pay in addition to your standard premiums for Medicare Part B (health insurance) and Part D (drug coverage) if your earnings exceed certain limits. The Social Security Administration (SSA) calculates your IRMAA using the modified adjusted gross income (MAGI) reported on your IRS tax return from two years before the year you begin incurring the IRMAA.
How to Pay
​Medicare.gov enables you to learn more about your Medicare benefits, request a replacement card, review your billing information, and pay your Part B premium.
Medicare FAQs
Medicare does not provide coverage for spouses or dependents. Medicare is designed for individual enrollment only.
If you plan to keep working and your employer has a group of 20 or more employees, this could be a option to explore.
Is it necessary for me to enroll in both Part A and Part B of Medicare?
Part “A” is usually set in motion as a vested benefit once you reach the age of 65. On the other hand, Part “B” does not automatically kick in unless you have signed up for Social Security before turning 65. If you have not yet applied for Social Security benefits, it is important for you to take the initiative to enroll in Part “B” benefits and start covering the associated costs.
Is it possible for me to only have "Original Medicare" Parts A and B as my health coverage during retirement?
Yes. Though, you will lack coverage for prescriptions, leading to a possible penalty, and potentially having unlimited expenses as a result of the gaps in Original Medicare.
It is important to confirm that your doctor accepts Medicare. Some physicians may exclusively approve specific Medicare Advantage plans or Supplementary Plans.
Yes, you are covered for a maximum of 100 days following a mandatory hospitalization period lasting three days.
No. Some Advantage plans offer limited dental coverage or you can purchase a separate individual dental plan.
It depends. The relationship between retirement plans and Medicare involves coordinating benefits based on the company size providing retirement benefits. More information is needed to determine which benefits would have priority.
If I happen to miss my scheduled enrollment period for Medicare, what will be the consequences?
Besides experiencing a significant gap in coverage, it is likely that you will incur a penalty from Medicare. This penalty for Part B can amount to 10% of your Part B premium for every 12-month period that you are without Medicare coverage. Additionally, you may face a penalty for Part D which can be up to 1% of the national average of a Part D plan for each month that you do not have Part D”coverage.
What is Part C ?
Medicare Part C, also referred to as Medicare Advantage (MA) or Medicare Advantage Plans, is a healthcare option endorsed by Medicare and provided by private companies. It typically encompasses Part A & Part B benefits along with Part D for prescription medications. Additionally, MA plans may incorporate extra coverage like vision, hearing, dental services, as well as health and wellness initiatives.
Can I have a Medicare Advantage Plan and a Supplemental Plan?
No, you are not allowed to have both.