Medicare Questions & Answers: Eligibility
Eligibility Q&A
Showing 42 questions
I'm retiring next year - do I need to do anything with my Medicare?
If you're retiring next year and turning 65, you'll need to sign up for Medicare (Part A and Part B) through Social Security, either online or by contacting your local office, to avoid potential gaps in coverage or penalties.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
The short answer is no. However, there are always exceptions such as a Special Enrollment Period (SEP) to make a change or within your 12-month trial right period, or you are involuntarily terminated from your Medicare Advantage plan due to moving out of the plan service area, gaining eligibility due to age (turning 65), to name a few. In these cases, I want to discuss the change and ensure we cover all available SEP options.
Am I eligible for a Special Enrollment Period if I lose employer coverage?
Yes, you may be eligible for a Special Enrollment Period (SEP) if you lose your employer health coverage. This SEP typically lasts for 8 months following the loss of your coverage, allowing you to enroll in Medicare without facing penalties. It's important to inform Medicare of your loss of coverage to ensure a smooth enrollment process
Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?
In most cases, yes, you will have to answer health questions when switching from one Supplemental/Medigap plan to another. However, there are certain situations where you may qualify for guaranteed issue rights, which means you can switch plans without having to answer medical questions or go through underwriting.Guaranteed issue rights typically apply if you’re losing other coverage, moving out of your plan’s service area, or switching within your Medigap trial period, among other special circumstances. It’s always best to review your specific situation to determine whether you qualify for guaranteed issue or if underwriting will be required.
I'm turning 65 in three months but still working with employer coverage. Do I need to sign up for Medicare right now or can I wait?
You can wait as long as you are maintaining employer coverage. Medicare part A will still get assigned to you but (as long as you are not receiving SS benefits) not part B. When you do choose to leave employer coverage make sure you visit SSA.gov and “apply for Medicare part B only”. Keep in mind this may take at least a few weeks and you may have to collect some signatures from your employers HR dept so start this process at least a month before you plan on quitting/ leaving employer coverage.
I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?
Medicare and a Medicare supplement are 2 completely different things. Medicare is what you paid into. A Medicare supplement is from a private insurance company. They have underwriting questions that you have to be able to answer correctly or they can deny you. They are completely separate things. The supplement works with Medicare to pay what Medicare doesn't pay. Medicare is what you paid into all these years. A Medicare supplement is something you have to purchase. Different companies have different questions so depending on your health situation, you may or may not be able to by one. Hope this helps explain.Cleo Martin
Who qualifies for Medicare coverage if they are under 65?
If you’re under the age of 65 and have a disability, you may qualify for Medicare coverage. A qualifying disability is almost any health condition that prevents you from being able to work enough to access employer-sponsored health care benefits. Before you can enroll in Medicare, you must receive Social Security Disability Insurance for two years. If you have end-stage renal disease or amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, that 24-month waiting period is waived.
If I have been on disabilty due to an accident, do I qualify for Medicare Insurance?
Yes, if someone has been on disability for 24 month or more, they are eligible for Medicare. Once someone has Part A and B in place, we can shop different plan options to ensure they have all of their puzzle pieces in place and have access to the care that they need!
Can Medicare drop me for health reasons?
Medicare can NOT drop you because of health reasons. If you have a Medicare supplemental plan and drop the plan because you want to change to a Medicare Advantage and you are on the Medicare Advantage for more than 12 months you will be asked health questions to go back to a Medicare Supplemental plan and some people can not qualify. Or if you missed a monthly premium and have a lapse of coverage, you may have to answer health questions to get back and you may not qualify.
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
You will be considered “guaranteed issue” as long as your employer coverage is considered credible coverage, which in most cases it is. There are a few other instances where you can be considered guaranteed issue.
I have Medicare Part A and B since 06/01/2006 because of disability. My husband retired on 4/1/2024, and I now have no other coverage except for Medicare Parts A and B because I missed open enrollment for insurance coverage. Note: SS dropped SSI and changed it to straight SS. Please help.
I assume you are still under age 65 and that you implied that you had Medicare Part A&B PLUS your husband's employer provided healthcare (as additional coverage). Since he's now retired, and you've lost his coverage, you may have "guaranteed rights" to purchase additional private medicare supplemental insurance (like a medicare supplement), as long as you can prove that you had creditable coverage from his employer all this time. Any insurance company is going to want additional written evidence to prove this information. I suggest you reach out to a local medicare agent directly for more details and instruction.
Do I have to apply for Medicare if I am still working past 65?
If you are happy with your creditable employer plan, or if you are carry dependants on that plan, you can delay Medicare without penalties. You will get a special election to enroll in Medicare when you retire or when your dependants are eligible for other coverage. You can enroll in Medicare Part A only this time since it is generally free of premium. If you contribute to an HSA, delay Part A for now -IRS rules do not allow HSA contributions once you have a Medicare number!
What if I missed my window to sign up?
If you missed your window to sign-up for Medicare you could qualify for a Special Enrollment Period (SEP) , such as when you loose employers insurance (or other reasons). If you do not qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the Open Enrollment Period which runs from January 1 through March 31 each year. Check the medicare.gov website or talk to a Medicare Insurance agent to find out what applies for you and how to go about the application process.
What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?
Guaranteed issues for Medicare supplement plans ensure you can purchase a Medicare supplement/Medigap plan that picks up the gaps that Medicare Part A and B leave behind. A guaranteed issue means you do not have to be questioned about your health conditions with the insurance underwriters, and the policy will not be denied. Guaranteed issue applies to the six months around your 65th birthday. Three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday, you have the right to get a guaranteed issue policy for your Medigap plans. After that, there are some special guarantee issues when retiring from a group insurance plan, but that would be for another discussion.
What happens if I am unable to provide creditable coverage?
If you are unable to provide credible coverage after 63 days then you will begin to accrue a late enrollment penalty. This penalty will be attached to your part d plan for the remainder of your lifetime unless you receive Medicaid or LIS for lower earners.
If I live part of the year abroad, do I still have to pay for Medicare if I don’t use it?
Yes. A half year out of the country does not allow you to stop paying for Medicare. A longer period depending on its length can be considered.
I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?
You must have lived in the US for a min of 5 years. At that time you will likely have a Premium for Part A as well as the normal Part B premium since you have not lived her and worked at least 40 Quarters.Do I qualify for SEP if my health dramatically gets worse out of nowhere?
You might be able to switch your plan to a chronic condition advantage plan if your health concerns are upon those qualified. These are allowed to switch 1x per year (for each chronic condition) and might actually reduce the copayments and medication costs of the specific chronic condition. You would want to check with your local independent broker to see what is available and how it would cover.
Should I worry about my income effecting my Medicare eligibility?
Your income will not affect your Medicare eligibility. What it could affect is how much your part B premium would be. That is based on your annual income and the standard is $185 a month , but if your income is over a certain amount that premium can go up and also if your income is low enough, you can also get extra help to help pay for that premium. But your income loan will not affect your eligibility for Medicare that is based on age, and if you have paid in enough over the years to qualify for itWhat happens to my Medicare coverage if I move to a U.S. territory like Guam or the Virgin Islands?
Original Medicare will work in U.S. territories. If you have a Medicare Advantage plan, you will likely need to change plans when you move. Medicare allows a Special Election Period when you move to a new area.
I’ll be turning 65 in April. I have full VA coverage and good hospital and doctor coverage through Eisenhower here in the desert. The VA doesn’t provide dental care. Do I still need to enroll in Medicare, and if so, which part makes sense for my situation?
I always advise Veterans to pick up both A and B. Having Part B gives you options and choices outside the VA. I am a Vietnam Veterans widow and understand some of the challenges and limitations when using and dealing with the VA. I hear Vets complain about the Part B premium but there could be ways to minimize that cost depending on what is available in your area. If you delay your Part B, if you want to add it in the future you will have to pay a penalty so I never advise that because it could cost even more with the penalty.
Does everyone over the age of 65 qualify for Medicare?
I am a resident in another country outside of America, will I still be covered living abroad?
Original Medicare generally doesn’t cover you outside the United States, except in very limited situations—like certain emergencies close to the U.S. border. Some Medicare Advantage plans or Medicare Supplement (Medigap) policies may offer emergency coverage abroad, but it’s usually for a limited time and amount. If you plan to live outside the U.S., it’s important to look into private international health insurance or a plan in your country of residence so you’re protected wherever you are.
How to enroll in Part D plan for RX coverage?
Unfortunately, the carriers have removed the ability for agents and brokers to help individuals determine and enroll in their PDPs. So now the best way to compare plans is to use the Medicare.gov site.This site allows you to enter your medications and compare plans in your area. You can then enroll in the plan you select, or you can contact the carrier directly.
Can eligibility for certain Medicare Advantage plans depend on where I live?
Yes all plans have different plans, it goes by your county and zip codes.If you relocate be sure to check and see if your current plan is in your new zip code
If I qualify for both Medicare and Medicaid, how does that eligibility work together?
Sif you have both Medicare and MedicaidMedicare pays 1st and then Medicaid picks up 100% of what medicare does not pay but you must use doctors who accept medicaid
You can enroll in a dual eligible plan thru a Medicare Advantqge plan to get the most benefits
How does divorce affect my Medicare eligibility, premiums, or benefits?
Divorce has no effect on eligibility but if your incomes is now less after the divorce you may be able to save on your part b premiums.File an SSA 44 after your divorce
Will I lose my Medicare benefits if I get married?
You will not lose your Medicare benefits just because you get married, but marriage can affect your premiums, eligibility for certain low-income programs, and a few special situations. Medicare is individual coverage, not a family policy, so your own Medicare eligibility and basic coverage do not stop when you marry.
Can You Be Denied a Medicare Advantage Plan?
There are times you cannot change plans, if you have an enrollment period, you should be able to do that..Daniel Brechin
Contact me.
What if you have Medicare and SSI or you have both Medicare and Medicaid how do you qualify for LIS or Extra Help?
If you have Medicaid, SSI, or a Medicare Savings Program, you typically qualify automatically for Extra Help (Low-Income Subsidy) with your Medicare Part D drug costs. This means your premiums, deductibles, and copays for prescriptions are significantly reduced. You usually do not need to apply separately because the benefit is assigned automatically through the Social Security Administration. If someone does not automatically qualify, they can apply directly through Social Security based on income and asset limits. Extra Help can substantially lower prescription drug costs for eligible Medicare beneficiaries.
If I don't have a primary physician will my new carrier assign me to one?
Some Medicare Advantage plans may automatically assign you a primary care doctor if you do not choose one when you enroll. In many cases, you can change that doctor later if you prefer someone else. Original Medicare does not require you to select a primary care doctor. It is always a good idea to review the doctors available in a plan’s network before enrolling.
Does moving to a new state let me switch from Medicare Advantage to Medigap without health questions?
Yes. If you move out of your Medicare Advantage plan’s service area, you have a guaranteed issue right to buy certain Medigap plans without health questions. That usually includes Plans A, B, D, G, and in some cases C or F if you were eligible for Medicare before 2020. You may have additional rights under state law.
Can you get Medicare if you never worked or didn't pay into the system?
Yes, you can get Medicare, but you will have to pay for Medicare Part A and Medicare part B out of your own pocketWhat is the cost and value of a supplemental plan, and what plans are available?
The value of a Medicare supplement is outstanding. They allow you to see any provider that accepts Medicare without regard for network adherence. They also have a low annual deductible before the benefits kick in.The cost for Medicare supplements vary based on your zip code, your gender and your age as well as the carrier. Carriers charge different amounts for the same plans.
There are many plans available. Different locations may have different carriers available. You will see different costs for the same plan name from different carriers. The biggest carriers may not be worth the cost increase compared to a smaller carrier. The best thing to do is to find a local broker that represents multiple carriers. They can quote the different carriers and different costs in your area.
Are Medicare Advantage plans guaranteed issue?
Yes — Medicare Advantage plans are generally guaranteed issue as long as you are enrolled in Medicare Part A and Part B and live in the plan’s service area. Unlike Medigap plans, Medicare Advantage plans typically do not use medical underwriting, so you cannot be denied because of health conditions.However, you must enroll during a valid enrollment period, such as your Initial Enrollment Period, Annual Election Period, or a qualifying Special Enrollment Period.
The main exception is for people with End-Stage Renal Disease (ESRD), though most ESRD restrictions have been removed in recent years.
Does life insurance affect my Medicare eligibility or premiums?
Having life insurance does not affect your Medicare eligibility or premiums. Life insurance is separate from your Medicare as Medicare is health insurance.
How to sign up for A & B?
You can sign up for Medicare Part A and Part B online through the Social Security Administration (SSA) website during your 7-month Initial Enrollment Period (3 months before to 3 months after your 65th birthday). The process takes about 10 minutes, and you will need to create a login.gov account.Several ways to Enroll:
- Online, visit SSA.gov and click "Sign up for Medicare".
- Phone: Call Social Security at 1-800-772-1213
- In-Person: Visit your local Social Security office.
Can I cancel or drop Medicare Part B if I move abroad?
Yes, you can drop Medicare Part B if you move abroad, since Medicare generally doesn’t cover care outside the U.S. To do this, you must contact the Social Security Administration and submit a request to disenroll.Keep in mind, if you later return to the U.S. and want Part B again, you may face a late enrollment penalty and have to wait for an appropriate Enrollment Period.
Before dropping Part B, make sure you’ll have adequate health coverage in the country you’re moving to.
How do eligibility rules differ for those on TRICARE or Veterans Affairs (VA) benefits?
Tri care is for retired career Military and is a part of theirMilitary benefits. It acts as secondary coverage to medicare.
VA care is for Veterans who have served in the military but are not career military,
They get use of Va facility
For medical care. It acts alone and they can also have medicare ans an advantage plan also
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