In 1965, when Medicare was initially created, it was designed to provide health insurance to people 65 and older in the United States. However, since then, Medicare has made a few changes, extending eligibility to certain individuals under age 65 with qualifying disabilities. . Today, more than 44 million people are eligible for Medicare.
Becoming eligible for Medicare by age
If you’re eligible for Medicare due to age, the earliest your Medicare can start is the first day of your 65th birthday month. If your birthday falls on the first of the month, your start date can be as early as the 1st of the month before your 65th birthday month.
However, you can apply for Medicare a few months before your 65th birthday month. When you age into Medicare, you will get a seven-month Initial Enrollment Period (IEP), and that is when you’ll want to apply for Part A and Part B, as well as Part D, to avoid late penalties. However, you may be able to delay Medicare if you have creditable coverage.
Your IEP starts three months before your 65th birthday month unless your birthday falls on the 1st, in which case, your IEP starts four months before your 65th birthday month. For example, if your birthday is July 15th, your IEP begins on April 1st. But if your birthday is July 1st, your IEP starts on March 1st.
Your IEP will end three months after your 65th birthday month or two months after your 65th birthday month if your birthday falls on the 1st. For example, if your birthday is July 15th, your IEP ends October 31st. However, if your birthday is July 1st, your IEP ends September 30th. Either way, you get a full seven months to apply for Medicare without penalty.
Becoming eligible for Medicare by disability
Medicare is also available for those under age 65 who have been receiving Social Security Disability Income (SSDI) for at least 24 months or those under 65 with End-Stage Renal Disease (ESRD).
Medicare and SSDI
After you have received disability income for at least 24 months from the Social Security Administration (SSA) or Railroad Retirement Board (RRB), you will be automatically enrolled in Part A and Part B. Once you have Part A and Part B, you will also be able to add on other Medicare plans.
People under 65 on Medicare usually pick up a Medicare Advantage plan rather than a Medigap plan as Medigap plans can be extremely pricey when you’re under 65 years old. In addition, some states don’t require insurers to sell Medigap to people under age 65.
However, once you turn 65, you will have a second six-month Medigap Open Enrollment window that allows you to enroll in a Medigap plan and you won’t be charged a higher rate because of your disability.
Medicare and ESRD
If your kidneys no longer function properly and you need dialysis or a kidney transplant, you are eligible for Medicare regardless of your age. Your Medicare start date depends on many factors. However, if you apply after you become eligible, your Medicare start date will be retroactive to the month you were qualified or 12 months before applying, whichever is shorter.
For example, if you become eligible for Medicare due to ESRD in January 2020 but didn’t apply until September 2020, your Medicare will be retroactive back to January 2020. However, if you didn’t apply until June 2021, your Medicare will only be retroactive to June 2020, not January 2020.
If you are on dialysis, your Medicare will typically start on the first day of the fourth month of your dialysis treatment. In some cases, it can begin as early as the first month of dialysis. If you’re scheduled to receive a kidney transplant, your Medicare will start the month you are admitted to a Medicare-approved hospital for your transplant, but only if your transplant occurs within two months of admittance. If your transplant is delayed, so is your Medicare start date.
However, in these two circumstances, Medicare coverage can be temporary and may end after a specific timeframe.
Choosing to delay Medicare past your eligibility date
You may decide to delay Medicare past your eligibility date. However, to do this without a future late penalty, you must have creditable coverage.
If you qualify for Medicare based on age, you can delay Medicare past your IEP if you or your spouse actively work for an employer with 20 or more employees and you are enrolled on their creditable health insurance. However, if you start Social Security benefits, you must at least take Part A at 65, and in which case, you’ll want to make sure no contributions are made on your behalf to a health savings account.
If you qualify for Medicare based on SSDI and are under 65, you can delay Medicare if you or your spouse actively work for an employer with 100 or more employees and you are enrolled on their creditable health insurance.
If you are unsure whether you are eligible for Medicare or not, call your local Social Security office, and they can investigate your situation for you.