Medicare Questions & Answers: Eligibility
Eligibility Q&A
Showing 11 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.
Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?
It depends. There are a lot of factors to consider here, such as the State you reside in, how long you have had your current Medigap policy, and the timeline of when you plan to switch.Unfortunately there are a lot of rules when it comes to Medicare Supplement policies. That’s why it’s important to work with a knowledgeable, trustworthy and licensed professional.
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 processCan I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
Yes, you can switch from a Medicare Advantage plan to Original Medicare and subsequently enroll in a Supplemental/Medigap plan during the Annual Enrollment Period (AEP) without needing to answer health questions, as long as you disenroll from the Advantage plan and return to Original Medicare within the first 12 months of your Advantage plan enrollment
What if I missed my window to sign up?
If you missed your Medicare sign-up window—typically the seven-month Initial Enrollment Period around your 65th birthday—you’re not alone, and I’ve seen this trip up plenty of folks over the years, but you’ve got options to fix it depending on your situation. Without qualifying coverage like an employer plan, you’ll enroll during the General Enrollment Period (January 1 to March 31), with coverage starting the first of the next month, though you’ll face lifelong penalties—10% per year missed for Part B and about 1% per month for Part D—unless a Special Enrollment Period applies, like if you just lost job-based insurance, giving you two months to sign up penalty-free. CMS has been pushing harder lately to educate future beneficiaries about these deadlines and consequences, which I think is a smart move, so fewer people end up blindsided by costs they could’ve avoided with better knowledge upfront.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.What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?
When clients ask about Guaranteed Issue for Medicare Supplement plans, I explain it’s a right that stops insurers from denying coverage or raising rates due to pre-existing conditions. It applies during your initial enrollment at 65—starting the first day of your birthday month and lasting six months—or within 63 days of losing qualifying coverage, like an employer plan, or during your 12-month trial period if you’re new to Medicare Advantage and switch back to Original Medicare. For folks under 65 with disabilities, federal law doesn’t guarantee it, but many states offer a similar six-month window when you enroll in Part B. Missing these windows usually means facing medical underwriting.
If I have been on disabilty due to an accident, do I qualify for Medicare Insurance?
would be on disability for straight 24 month (2 years) to qualify SSI, after 24 month you would be automatically enrolled in Part A and Part B
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?
As long as you are working and your employer medical insurance plan is considered creditable coverage then you don't necessarily have to apply for Medicare Coverage. In general, what will happen is Medicare Part A will automatically become effective once your turn 65 whether you are still working or not. When getting close to age 65 while also working you should do your due diligence and compare your Medicare options, benefits and costs with your employer plan to ensure you are getting the best plan at the most competitive rate that provides the care you need. Sometimes the employer medical insurance is the best option and other times Medicare is the better option.
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
803-730-8368
