What is Medicare health insurance and how do I apply?

Medicare is a federal health insurance program available to qualified individuals and certain dependents (spouses and/or adult disabled children). It includes:

• Older adults aged 65 or older;
• People with disabilities who receive Social Security Disability Insurance (SSDI) for 24 months;
• Individuals with End Stage Renal Disease or ALS/Lou Gehrig’s disease. 

Medicare health insurance consists of several parts: 

• Medicare Part A is hospital insurance; 
• Medicare Part B is medical insurance;
• Medicare Part D is prescription drug coverage, which requires an individual to enroll directly with a health Insurance company that offers Medicare drug plans
• Medicare Part C also known as Medicare Advantage is a type of health plan offered by Medicare-approved private health insurance companies that must follow Medicare rules. Most Medicare Advantage plans include drug coverage. With Part C, Medicare pays the Medicare Advantage plan a fixed payment per member, and then the Medicare Advantage plan pays for the health care expenses for the member. 

For people with 40 quarters of coverage, Medicare Part A will be free. Medicare Part B isn’t free and costs $174 per month (see section on the Medicare Savings Program for details on whether you qualify for a program that pays the Medicare Part B premium). The cost of Medicare Part D varies by plan. The average monthly premium for a Part D plan is $55 per month.   

How do I know if I qualify for Medicare?

To qualify for Medicare, you must have worked and paid Medicare taxes for a certain period of time and also have a qualifying immigration status. 

• You or your spouse must have 40 quarters of coverage where you paid Medicare taxes (less quarters of work required for those younger than 65). 
• You must typically be a United States citizen or a non-citizen who has legally worked in the United States, paid Medicare taxes for at least 40 quarters, and resided continuously in the US for five years prior to applying for Medicare. 

How do I apply for Medicare?

Medicare Part A & B enrollment is automatic for those individuals who are receiving Social Security benefits before age 65, Railroad Retirement Board benefits, or have ALS. If you are enrolled in Medicare automatically, you will receive a Medicare Initial Enrollment Period package three months before one’s 65th birthday, on the 25th month of receipt of Social Security disability benefits, or for those with ALS, the month their disability begins.  

Many people will have to apply and enroll in Medicare on their own through the Social Security Administration, which is the government agency that handles Medicare enrollments.  If you do not enroll in Medicare when you first become eligible, you may face a late enrollment penalty when you later enroll, which means you will pay more for Medicare Part B & D coverage. If you are 65 years of age and are not collecting Social Security benefits at age 65, you will not be automatically enrolled and must apply forMedicare.

If you have insufficient work quarters (less than 40), you can still apply for Medicare Part A & B but the premiums may be much higher. Medicare has complicated rules for those who are still working. If you are working and you become eligible for Medicare or if you want to apply for Medicare but don’t have enough work quarters, you should reach out to a health insurance counselor to discuss your options. 

Sign up for Medicare here

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* The information does not constitute legal advice. You should always consult an attorney regarding your matter. Legal help subject to capacity and location.