Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.

  • You are eligible to get Social Security or Railroad benefits but have not yet filed for them.

  • You or your spouse had Medicare-covered government employment.

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

  • You have received Social Security or Railroad Retirement

  • Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Medicare: What you need to know

Medicare is a health insurance program for:

  • people age 65 or older,

  • people under age 65 with certain disabilities, and

  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Has:

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. In January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. This coverage is to help you lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

This information comes from www.cms.gov

Medicare-Related Enrollment Dates and Guidelines

September & October—Review And Compare Medicare Advantage Plans

  • Review any notices from your plan about changes for next year. To learn more about your options download Medicare and You 

Compare: In October, use Medicare’s tools to find a plan that meets your needs.

  • This is the one time of year when ALL people with Medicare can make changes to their health and prescription drug plans for the next year.

Between: October 15- December 7

  • Change from Original Medicare to a Medicare Advantage Plan.

  • Change from a Medicare Advantage Plan back to Original Medicare.

  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.

  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.

  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.

  • Join a Medicare Prescription Drug Plan.

  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.

  • Drop your Medicare prescription drug coverage completely.

January 1—Coverage Begins

  • Your new coverage begins if you switched to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1.

Between January 1–March 31

  • If you’re in a Medicare Advantage Plan (like an HMO or PPO), you can make one change to a different plan or switch back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.

When To Buy A Medicare Supplement Policy

  • The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month in which you turn 65 or older and have enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you are able to buy one, it may cost more.

  • If you delay in Part B because you have group health coverage based on your (or your spouse's) current employment, your Medigap Open Enrollment Period won't start until you sign up for Part B.

If need have questions about enrollment please give us a call (855)866-3664. We're here to help.

This information comes from www.medicare.gov and Medicare and You.

By contacting the phone number on this website you will be directed to a licensed agent.

Medicare 2025 costs at a glance

2025 costs at a glance

Part A premium -Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $518 each month in 2025. Part A hospital inpatient deductible and coinsuranceYou pay:

  • $1,676 deductible for each benefit period

  • Days 1-60: $0 coinsurance for each benefit period

  • Days 61-90: $419 coinsurance per day of each benefit period

  • Days 91 and beyond: $838 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)

  • Beyond lifetime reserve days: all costs

Part B premium - The standard Part B premium amount is $185.00 (or higher depending on your income).

Part B deductible and coinsurance - $257. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment (dme)

Part C premium -The Part C monthly premium varies by plan. Compare costs for specific Part C plans.

Part D premium -The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.


By contacting the phone number on this website you will be directed to a licensed agent.
 This information comes from www.medicare.gov/your-medicare-costs

Where to Get Your Medicare Questions Answered

 

To get general or claims specific Medicare information and important telephone numbers. If you need help in a language other than English or Spanish, say “Agent” to talk to a customer service representative.

State Health Insurance Assistance Program (SHIP)
To get free personalized Medicare counseling on decisions about coverage; help with claims, billing, or appeals; and information on programs for people with limited income and resources.

  • Call 1 800 MEDICARE to get the telephone numbers of SHIPs in other states.

Social Security
To get a replacement Medicare card; change your address or name; get information about Part A and/or Part B eligibility, entitlement, and enrollment; apply for Extra Help with Medicare prescription drug costs; ask questions about premiums; and report a death.

Coordination of Benefits Contractor
To get information on whether Medicare or your other insurance pays first and to report changes in your insurance information.

  • 1 800 999 1118

  • TTY 1 800 318 8782

Department of Defense
To get information about TRICARE for Life and the TRICARE Pharmacy Program.

Department of Health and Human Services
Office of Inspector General—If you suspect Medicare fraud.

Office for Civil Rights
If you think you were discriminated against or if your health information privacy rights were violated.

Department of Veterans Affairs
If you’re a veteran or have served in the U.S. military.

Office of Personnel Management
To get information about the Federal Employee Health Benefits Program for current and retired Federal employees.

Railroad Retirement Board (RRB)
If you have benefits from the RRB, call them to change your address or name, check eligibility, enroll in Medicare, replace your Medicare card, and report a death.

  • Local RRB office or

  • 1 877 772 5772

Quality Improvement Organization (QIO)
To ask questions or report complaints about the quality of care for a Medicare covered service or if you think your service is ending too soon. Call 1 800 MEDICARE to get the telephone number for your QIO.