Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment, and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits, but have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement
  • Board disability benefits for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every three months.

Medicare: What You Need to Know

Medicare is a health insurance program for:

  • People age 65 or older,
  • People under the age of 65 with certain disabilities, and
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
A man and woman shaking hands over a table.

Medicare Has

Part A Hospital Insurance

Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance

Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage

Most people will pay a monthly premium for this coverage. On January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage helps you lower prescription drug costs and protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

This information comes from www.cms.gov

September & October: Review and Compare Medicare Advantage Plans

  • Review any notices from your plan about changes for next year. To learn more about your options, download Medicare and You 2023

Compare: In October, use Medicare’s tools to find a plan that meets your needs.

  • This is the one time of year when ALL people with Medicare can make changes to their health and prescription drug plans for the next year.

Between: October 15–December 7

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

January 1—Coverage Begins

  • Your new coverage begins if you switch to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1.

Between January 1–March 31

  • If you’re in a Medicare Advantage Plan (like an HMO or PPO), you can make one change to a different plan or switch back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.

When to buy a Medicare Supplement policy

  • The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month in which you turn 65 or older and have enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you are able to buy one, it may cost more.
  • If you delay in Part B because you have group health coverage based on your (or your spouse's) current employment, your Medigap Open Enrollment Period won't start until you sign up for Part B.

Medicare 2024 Costs at a Glance

2024 Costs at a Glance
Part A premium Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $505 in 2024. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278 in 2024.
Part A hospital and inpatient deductible You pay:
  • $1,632 is deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $408 coinsurance per day of each benefit period
  • Days 91 and beyond: $816 in coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs
Part B premium Most people pay $174.70 each month (or higher, depending on their income).
Part B deductible and coinsurance $240. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.
Part C premium Part C monthly premium varies by plan
Part D premium The Part D monthly premium varies by plan (higher-income consumers may pay more)