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Medicare Eligibility

There are several ways to become eligible for Medicare, but many become eligible as soon as they turn 65. These individuals will enter what is known as the Initial Enrollment Period, which starts three months before turning 65 and ends three months after, giving them a total of seven months to enroll in Medicare.

Here are the other ways to qualify for Medicare.

Eligibility Requirements

Besides being 65 or older, other ways to qualify for Medicare include:

  • Being a U.S. citizen or legal permanent resident
  • Being under 65 and having a disability and getting disability benefits for 24 months
  • Being under 65 and having an illness (End-Stage Renal Disease or Amyotrophic Lateral Sclerosis, for example)
  • Having a stable home address
  • Not being imprisoned or in a correctional facility

Another important thing to note is if you are currently getting Social Security or Railroad Retirement Board benefits, you will most likely be automatically enrolled in Original Medicare (Part A and B). If you are not automatically enrolled, you will have to manually enroll during the Initial Enrollment Period and do so through the Social Security Administration.

If you qualify because of End-Stage Renal Disease, it is because you either need dialysis or a kidney transplant. If you need regular dialysis, your Medicare coverage will start soon after you receive your first treatment. If you get a transplant and, as a result, no longer need dialysis, you will lose your Medicare eligibility.

If you qualify because of ALS, your eligibility will start immediately.

Other Medicare Plans

To be eligible for Medicare Advantage, or Part C, there are some criteria you must meet:

  • Be enrolled in Original Medicare
  • Live in the plan’s service area to receive coverage
  • Pay your Original Medicare premiums on top of the Medicare Advantage premium
    • However, many beneficiaries get premium-free Part A, and many Medicare Advantage plans have premiums as low as $0. This will leave the Part B premium, which is $148.50 as of 2021.

To be eligible for Part D, which is the prescription drug coverage plan, you must:

  • Be enrolled in Original Medicare
  • Pay your premiums to keep coverage active
  • Live where plans are available

To be eligible for a Medicare Supplement plan, which works alongside Original Medicare to cover out-of-pocket costs, you must be enrolled in Original Medicare.

Do You Need Coverage?

For assistance in choosing a Medicare plan, contact Avila Medicare Solutions in Austin, Texas, for guidance. We have a team of Medicare professionals available to help walk you through the eligibility and enrollment process. All you have to do is give us a call today at 855-GO-AVILA, and we will answer any questions you may have.

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