Eligibility for Medicare Part A & Medicare Part B

In order to be Eligible for Medicare Part A and Part B, you must be a Permanent Legal Resident or a US Citizen for a minimum of five continuous years. Additionally, you must meet one the other qualifier for eligibility listed below :

• Be 65 years or older and be eligible for Social Security

If you are 65 years or older ,and automatically enrolled in Social Security you may also be automatically enrolled into Medicare part A. If you are receiving Social Security or Railroad Retirement Benefits prior to being 65 you will likely be automatically enrolled into Medicare on the 1st day of the month that you turn 65 year old. This is not always the case if you are 65 years old and not receiving, or claiming, your retirement benefits. In this case you would need to request enrollment from Medicare. 

• Have permanent disability benefits (SSDI) for at least 24 months

For people who are under the age of 65 but are receiving Social Security Disability Benefits for 24 months, they will also be eligible for Medicare once they reach their 24th month of disability. In most cases Medicare will automatically enroll you into Medicare once they reach their 24th month of disability. 

• Having Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis, or ALS)  

The third reason that somebody may be eligible for Medicare is they have specific medical illnesses one of these illnesses is Lou Gehrig’s Disease (ALS). Having this disease will qualify somebody for Medicare benefits. If they have worked in the US for a minimum of 10 years or 40 working quarters, they may be eligible for free Medicare part A and Part B for a monthly premium. In 2020 the Medicare Part B premium is $144. Additionally, if your income is higher you may have to pay a higher amount for your Medicare Premiums. 

• Having End Stage Renal Disease (Kidney Failure) 

Having End Stage Renal Disease may qualify for enrollment into Medicare prior to being over the age of 65. You would need to meet the time worked qualification (10 years or 40 quarters) and be diagnosed with the disease.

Medicare Part C Eligibility 

Another way that you can utilize your Medicare Part A and Mart B benefits is through a Medicare Advantage plan, also called a Medicare Part C plan or MAPD. To be eligible for a Medicare Part C plan you must live in the area that offers a Medicare Part C plan and be enrolled into both Medicare Part A and Part B by the time your Medicare Advantage plan starts. You can get more information about the Medicare Advantage plans in your area by: 

• Calling Neighborhood Health Insurance Center ( 844-367-6555)
• Calling 1-800- Medicare (1-800-633-4227) 
• Or visiting the www.Medicare.gov website 

Usually the Initial Coverage Election Period for someone to enroll into Medicare Part C is triggered once they become eligible for Medicare Part A and B for the first time. During this Initial Coverage Election Period (ICEP) , it is possible to enroll into a Medicare Part C plan for a 7-month period. This period starts three months before a person’s 65 birthday and ends three months after.  Additionally, every year there will be an Annual Election Period (AEP) that happens from October 15th through December 7th for Coverage effective January 1st in the next year.  Finally, if somebody has a qualifying life event, they may have a Special Enrollment Period (SEP) that can qualify them to enroll into a Medicare Advantage plan within a specific period after the life change happened. 

Medicare Part C plans are not mandatory, and there is no government penalty for not enrolling into a Medicare Advantage plan. But the core requirement to be eligible for Medicare Part C plans is enrollment into both Medicare part A and B plans. Although Medicare Advantage plans in some areas of the country do not have monthly premiums, some plans may still have a monthly premium in addition to the monthly Medicare Part B premium. This will depend on where somebody lives. 

It is also possible to qualify for Medicare Part C based on having End Stage Renal Disease (ESRD). You may qualify for a Medicare Advantage plan starting in 2021 even if you have End Stage Renal Disease. This is in addition to specific Medicare Advantage plans called Special Needs Plans (C-SNP ) that are specifically for people with ESRD or other chronic disease. 

Medicare Part D Eligibility 

Medicare Part D covers medications that you generally purchase at a pharmacy. It is similar to Medicare Part C, and is managed by private health insurance companies that have been approved by Medicare to provide the services. To enroll into a Medicare Part D plan or Medicare Prescription Drug Plan (PDP), the rules are less strict than a Medicare Advantage plan. You must be entitled to Medicare Part A or be enrolled into Medicare part B. You will only be able to enroll into a Medicare Part D plan that provides services in the area you live.  You do not have to be in both Medicare Part A and Medicare Part B to be a part of a Prescription drug plan (PDP). 

Medicare Monthly Costs

Paying for Medicare Part A premiums

Medicare Part A provides coverage for Hospitalization.  How much you pay for Medicare Part A depends on how many years you have worked in the United States. For most people who work in the US for a minimum of 10 years or 40 working quarters, Medicare Part A does not have a premium. It is what they paid into all those years while they were working. If you have not worked in the U.S. and are not married to a spouse who has worked in the U.S. then you may have to pay a monthly premium for your Medicare Part A. In 2020 your Medicare Part A premium is $458. This will decrease if you have worked more time in the U.S. down to $0 if you work the full 40 quarters a month.

Paying for Medicare Part B premiums

Medicare Part B, which covers your normal day to day medical visits like doctors’ visits, has a standard monthly premium of $144.60 a month for most people. If your income is higher than $87,000 a year for an individual or $174,000 a year for a couple who are married your monthly Medicare Part B premium may be higher. 

Paying for Medicare Part D Premiums

Medicare Part D drug coverage has a monthly premium in addition to the Part A or Part B premium. This cost will vary from plan to plan and there is not a set cost for Part D Prescription Drug Coverage. 

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.