Eligibility and Enrollment


Medicare provides some of the best healthcare insurance out there to those who are eligible. But what determines eligibility?

Eligibility for Original Medicare

Original Medicare (Parts A and B) is the most important coverage you can purchase, and is necessary before enrolling in any other Medicare plans. This means that these qualifiers also apply to other policies. To be eligible for Medicare, you must meet at least one of these qualifications:

  • You are a U.S. Citizen and 65 or Older
  • You have End-Stage Renal Disease (ESRD)
  • You have Lou Gehrig’s Disease
  • You are receiving/can receive Social Security or Railroad Retirement Benefits
  • You or your spouse is a government employee
  • You are under 65 and have received disability benefits from Social Security or the RRB for at least 24 months

Medicare Eligibility Enrollment

In order to fully understand your Medicare eligibility, you also have to understand how the process at sign up will work. For Original Medicare, you can sign up starting 3 months before your 65th birthday. This is known as your Initial Enrollment Period (IEP). If you wait to enroll until 3 months past your 65th birthday, you may be charged a late enrollment fee unless you were working at the time.

Part C Eligibility

The eligibility requirements for each Medicare part do not look the same. However, the basic requirements listed above do apply to each, as you must have both Parts A and B before enrolling.

Medicare Part C is easy to qualify for. Once you have Original Medicare, all you have to do is find a plan that you like and enroll, no additional requirements. Special Needs Plans (SNPs) do, however, have limited eligibility.

Part D Eligibility

Medicare Part D covers prescription drugs. It is available to those with Original Medicare coverage, or may be included in your Part C plan. 

Almost all Advantage plans include Part D. Keep in mind that this rule also applies to supplement plans, meaning that you cannot have Part D and a supplement plan at the same time.

You also don’t have to be enrolled in both Parts A and B to get Part D. You can be enrolled in Part A and/or Part B.

Supplement Eligibility

You do have to be enrolled in Original Medicare to get a Medicare Supplement. The enrollment period for these plans will start as soon as you’re enrolled in Part B and are 65. This becomes known as the Medigap Open Enrollment Period and lasts for six months. During these six months, you will have a guaranteed issue right to enroll in any Medicare Supplement.

Past these 6 months, however, eligibility gets a bit more tricky. Health insurance companies can now consider your health for eligibility with a process known as medical underwriting. If you are deemed unfit to insure, you will not be eligible. Plans may also cost more the older you are at enrollment, so it is best to enroll as soon as possible.

Learn Your Medicare Eligibility and Sign Up Today—Call the Coleman Agency

Medicare enrollment is always right around the corner. Whether you are planning in advance or need to figure it out past age 65, we have the know-how to help you. To learn more, call The Coleman Agency today.

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