Original Medicare Eligibility and Enrollment

An individual is entitled to receive Medicare based on their earnings or those of a spouse, parent, child, or dependent relative to be eligible for premium-free Part A. The worker must have a certain number of quarters of coverage (QCs) and apply for Social Security or Railroad Retirement Board (RRB) benefits to be eligible for premium-free Part A. Whether someone is applying for Part A due to age, a disability, or end-stage renal disease will determine how many QCs are necessary (ESRD). During the person’s working years, QCs are acquired by paying payroll taxes by the Federal Insurance Contributions Act (FICA). Most people pay the entire FICA tax for their QCs to be eligible for monthly Social Security benefits and premium-free Part A.

A person must be over 65 years and enrolled in Part B to be eligible for premium Part A. Only specified times are allowed for premium Part A and Part B enrollment. The window of opportunity to enroll is described in the section headed Enrollment Periods and When Coverage Begins.

More details about signing up for Part A

Except for Puerto Ricans, those who lived in the country and received Social Security or RRB benefits for at least 4 months before turning 65 are automatically enrolled in Parts A and B with no monthly premiums. Puerto Rican residents who qualify for automatic enrollment are exclusively enrolled in Part A, which is premium-free.

No one has enrolled automatically if they do not receive Social Security or RRB benefits. These people must apply by getting in touch with Social Security.

Part B of Medicare (Medical Insurance)

Whether a person is qualified for premium-free Part A coverage or must pay a premium for Part A coverage determines the eligibility requirements for Part B.

Once a person is eligible for Part A and pays no premiums, they are also qualified to enroll in Part B. There are specific instances when Part B enrollment is permitted. At Medisupps.com you can check all the Medicare plans and enrollment details. 

To be eligible for Part B, anyone who must pay a premium amount for Part A must fulfill the following criteria:

• Age 65 or older, residency in the United States, 
• Either should be a citizen of the United States 
• be a person who has been legitimately admitted for permanent residence and has lived in the country continuously for five years before the month of submitting a Medicare application.

More details on signing up for Part B

Except for Puerto Ricans, those residing in the United States and receiving Social Security or RRB benefits for at least 4 months before being eligible for Medicare are automatically enrolled in both premium-free Parts A and B. Those who are automatically enrolled may elect to maintain or decline their Part B coverage. People who reside in Puerto Rico and are qualified for automatic enrollment are only signed up for the premium-free Part A; they are not automatically signed up for Part B.

No one has enrolled automatically if they do not receive Social Security or RRB benefits. Only during specific enrollment periods are people who previously declined Part B or canceled their Part B registration eligible to enroll (or re-enroll) in Part B. Most of the time, if someone does not sign up for Medicare Part B (Medical Insurance) when they first become eligible, they will be charged a late enrollment fee for their Part B coverage.

Recognizing the Laws for Those 65 or Older

To qualify for premium-free Part A based on age:

• One must be 65 years of age or older; and
• Be qualified for monthly cash benefits from the Railroad Retirement Board (RRB) or Social Security.
• It is unnecessary to submit a new application to be eligible for premium-free Part A if the applicant has received monthly Social Security or RRB payments for at least 4 months before turning 65. In this situation, at 65, the person will automatically receive Part A.

Anyone not receiving Social Security or RRB benefits every month must apply for Medicare by getting in touch with the Social Security Administration.

If a person applies for Part A or Social Security or RRB payments within six months of the month they turn 65, Part A coverage will start the month they turn 65. Part A coverage will go back six months if the application is submitted more than six months after turning 65.

More details for those who must pay a premium for Part A and are over 65

When a person turns 65, they do not automatically receive Medicare if they must pay a premium for Part A. They should:

• Call the Social Security Administration to submit an enrollment application;
• Enroll within a legitimate enrollment period and add Part B if you don’t already have it.
• The individual must keep paying all monthly premiums and be registered in Part B to maintain premium Part A. To maintain this coverage, the person must timely pay both the Part B and Part A premiums.

Disability-Based Medicare

After obtaining disability benefits for 24 months, a person who qualifies for monthly Social Security or Railroad Retirement Board benefits based on disability is automatically qualified for Part A. Employees of the federal, state and local governments who are disabled and who are not qualified for Social Security or RRB payments every month may be presumed to be entitled to disability benefits and, after being disabled for 29 months, become automatically eligible for Part A.

Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS), is a special rule.

The first month a person is eligible for cash disability benefits from Social Security or the RRB and has an ALS disability qualifies them for Part A. No waiting period exists.

SSA regulations prohibit the start of child disability benefits before age 18. This is a particular restriction for people requesting child disability benefits. As a result, Part A eligibility based on child disability benefits can never start before the month the person turns 20 (or 18 if the person has ALS).

First Period of Enrollment (IEP)

The IEP is a 7-month term that starts three months before the month a person reaches 65 and concludes three months after that. The 25th month after becoming eligible for disability benefits marks the start of a person’s eligibility for Medicare if they are under 65. For these people, the IEP starts three months before the 25th month of being eligible for disability benefits covers the 25th month, and concludes three months later. Depending on their circumstances, patients with ESRD and ALS have different IEPs.

Conclusion

Medicare Part A complies with the law’s requirement that people have health insurance and counts as minimal essential coverage. Visit our Medicare & Marketplace website for more details on minimum essential coverage (MEC) for those with Medicare.