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Medicare Eligibility

Who is eligible for Medicare?

Medicare was established in the United States in 1965 through the Social Security Act of 1965. Medicare is a social insurance program administered by the United States government and provides health insurance coverage to people who are 65 years of age or older and to individuals under age 65 in certain circumstances.

We’ll show all Medicare plans in your area with just a ZIP code.

Medicare is financed by a portion of the payroll taxes paid by workers and their employers. The program is also financed in part by monthly premiums deducted from Social Security checks. Medicare is broken into four main parts; Part A, hospitalization insurance; Part B, medical insurance; Part C, Medicare Advantage plans; and Part D, Prescription Drug Plans. Medicare Supplement plans are also available.

It is recommended that eligible individuals apply for Medicare three months before the month of their 65th birthday or the month they become eligible due to disability because the Initial Enrollment Period for Medicare ends three months after that month.

How do you know if you’re eligible for Medicare?

Individuals who are 65 or older, who are citzens or permanent residents of the U.S., are eligible for Medicare Part A at no cost if:

  • The individual is eligible for or receives Social Security Benefits;
  • The individual is eligible to receive Railroad Retirement Benefits;
  • An individual’s spouse receives or is eligible to receive Social Security or Railroad Retirement Benefits;
  • An individual or spouse worked long enough in a government job through which Medicare taxes were paid; or,
  • An individual is the dependent parent of a fully insured deceased child.

If you are under 65, you get Medicare Part A without having to pay premiums if:

  • You got Social Security or Railroad Retirement Board disability benefits for 24 months.
  • Second bullet should be: “You have End-Stage Renal Disease (ESRD) and meet certain requirements.

You do not have to pay a premium for Medicare Part A if you meet these specific conditions, but you have to pay the Medicare Part B premium once you enroll.

Any participant who has Medicare Part A or Medicare Part B is eligible for Prescription Drug coverage. Joining a Medicare Prescription Drug plan is voluntary, and a consumer must typically pay an additional monthly premium for the coverage.

If you don’t enroll in a Medicare drug plan when you’re first eligible, you may pay a late enrollment penalty if you join a plan later. You’ll have to pay this penalty for as long as you have Medicare prescription drug coverage.

What about individuals under age 65?

Receiving Medicare benefits before age 65 is largely associated with the Social Security Administration with regards to disability of the participant, dependency status, and work credits earned.

How do you get your Medicare coverage?

People who receive Medicare coverage from a private health insurance company or from an employer-sponsored health plan should talk to a licensed sales agent. A licensed sales agent can help a consumer  learn about available plan options so that they can decide which plan offers the best benefits and coverage. Individuals who wait to purchase Medicare coverage outside of the enrollment dates may face higher Medicare premiums.

Individuals who meet requirements for Medicare eligibility can also apply for Medicare Advantage plans and Medicare Prescription Drug plans within their enrollment dates. These plans are administered through private insurance companies and require additional premiums because of the extra benefits that the plans provide.

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GoHealth is a licensed and certified representative of Medicare Advantage [HMO, PPO and PPFS] organizations [and stand-alone prescription drug plans] with a Medicare contract.  Enrollment in any plan depends on contract renewal.   •   This information is not a complete description of benefits. Contact the plan for more information.   •   Limitations, copayments and restrictions may apply.   •   Benefits, premiums, and member cost-share may change on January 1 of each year.   •   You must continue to pay your Medicare Part B premium.   •   A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.   •   This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.   •   Medicare has neither reviewed nor endorsed this information.   •   Not connected with or endorsed by the U.S. government or the federal Medicare program.   •   Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability, or sex. English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call Toll Free: 1-877-493-9307 TTY Users: 711 Hours: 7 days a week 8 a.m. – 8 p.m.  •   Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al Toll Free: 1-877-493-9307 TTY Users: 711 Hours: 7 days a week 8 a.m. – 8 p.m.  •   繁體中文 (Chinese): 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 Toll Free: 1-877-493-9307 TTY Users: 711 Hours: 7 days a week 8 a.m. – 8 p.m   •  Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and in some states to those under age 65 eligible for Medicare due to disability or End Stage Renal disease.   •   Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.   •   Legislation: If you are already a member of a Medicare Advantage plan, you are not allowed to purchase a Medicare Supplement policy. You also cannot have prescription drug coverage under a Medicare Supplement policy and a Medicare Part D plan at the same time.    •    Y0040_MULTIPLAN_GHHJQU7EN_17 (Pending)   •   Last Update 8/1/2017