By understanding these four parts, you can be better prepared to choose the combination of Medicare services that best meets your healthcare needs. Ready to learn how to qualify and enroll in Medicare? Let’s explore the requirements in the next slide.

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How to Qualify & Enroll in Medicare
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Enrolling in Medicare may seem complex, but understanding the eligibility requirements and the steps involved can help to simplify the process. 

Whether you’re approaching 65, have a qualifying disability, or need specific medical coverage, here’s how to qualify and enroll in Medicare.

If you belong to one of the groups below, you may be able to enroll in Medicare coverage:

  • Age 65 and Older: Most people become eligible for Medicare when they turn 65, regardless of their income or work history. If you’ve worked and paid Medicare taxes for at least 10 years (40 quarters), you typically qualify for premium-free Medicare Part A. If not, you can still enroll but may have to pay a premium for Part A.
  • Younger Individuals with Disabilities: If you’re under 65 and have received Social Security Disability Insurance (SSDI) for at least 24 months, you’re eligible for Medicare. Some individuals qualify sooner if they have certain conditions, like Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD).

Knowing when to enroll in Medicare is just as important as knowing how to qualify. Here’s when you can enroll in Medicare:

  • Initial Enrollment Period (IEP): This is the first time you can sign up for Medicare, and it begins three months before your 65th birthday, includes your birthday month, and lasts three months after. This seven-month window is the best time to enroll to avoid penalties.
  • Special Enrollment Period (SEP): If you’re still working and covered by an employer’s health insurance plan when you turn 65, you may qualify for a Special Enrollment Period once you stop working. This allows you to sign up for Medicare without facing late penalties.
  • Open Enrollment Period (OEP): You can join, drop, or switch to another Medicare Advantage Plan between October 15 and December 7 each year. During this time, you can also switch from Original Medicare to a Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare.
  • Medicare Advantage Open Enrollment Period (GEP): During the GEP, which runs from January 1 to March 31 each year, you can switch to another Medicare Advantage Plan (with or without drug coverage) or drop your Medicare Advantage Plan and return to Original Medicare.

There are a few ways to enroll in Medicare, depending on whether you’re automatically enrolled or need to sign up manually:

  • Automatic Enrollment: You’ll be automatically enrolled in Medicare Part A and Part B if you’re already receiving Social Security or Railroad Retirement benefits when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. If you don’t want Part B, you can opt-out by following the instructions on your card.
  • Manual Enrollment: You must enroll manually if you’re not receiving Social Security benefits when you turn 65. Here’s how:
    • Online: The easiest way to enroll is through the Social Security Administration’s website
    • By phone: You can also enroll by calling the Social Security Administration at 1-800-772-1213.
    • In-person: Visit your local Social Security office to apply in person.

To complete your application for Medicare, be prepared to provide the following documents when enrolling:

  • Your Social Security number
  • Proof of U.S. citizenship or residency status
  • Information about your current health insurance, if applicable

Next, let’s break down the costs associated with Medicare, so you’ll know exactly what to expect when you enroll:

  • Medicare Part A: Most people don’t pay a premium for Part A if they’ve worked and paid Medicare taxes for at least ten years. If not, you may need to pay a premium.
  • Medicare Part B: Part B requires a monthly premium based on your income.

Medicare Part D or Medicare Advantage (Part C): These optional plans may also have premiums and out-of-pocket costs, depending on the plan you choose.

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