Most people qualify for Medicare at age 65. You may also qualify for Medicare health insurance benefits at a younger age if you have a specific disability or End Stage Renal Disease. Learn more about Medicare coverage and Medicare Advantage in this guide.
If you are already receiving benefits through the Social Security Administration or the Railroad Retirement Board (RRB) for four months, you will typically be automatically enrolled in Original Medicare (Part A and Part B) as soon as you turn 65 years old.
If you continue to work past age 65, you may not need to enroll in Medicare until you are ready to retire and cease getting your health insurance benefits from your employer.
Original Medicare consists of Part A and Part B. Original Medicare provides coverage for hospital stays, doctor services, labs, medical supplies and other health care services.
Medicare Advantage plans are sold by private insurance companies and often use coverage models such Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO) to deliver Medicare services through a network of doctors and hospitals.
A Medicare Advantage plan offers the same basic benefits as Original Medicare (except for hospice care, which is still covered by Medicare Part A) and may offer some additional benefits that can include coverage for dental, hearing, vision and prescription drug costs.
Individuals under age 65 who have certain disabilities, have End Stage Renal Disease (ESRD) or have Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease) may qualify for Medicare benefits.
Benefits for ESRD typically begin on the first day of your fourth month of dialysis treatment. Patients with ESRD are not usually eligible for Medicare Advantage, unless they develop the illness while on Medicare.**
If you live with ALS, benefits begin as soon as your Social Security Disability Insurance (SSDI) benefits start.
People under age 65 who receive Social Security Disability Insurance (SSDI) benefits for reasons other than ALS can also qualify for Medicare. Once you have been receiving SSDI for 24 months, you will automatically be enrolled in Original Medicare.
Qualification for Medicare benefits — at any age — can make a huge difference in many people’s health care. Medicare Advantage plans help lower out-of-pocket costs and can help simplify coverage.
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**Medicare.gov, “What if I have End-Stage Renal Disease?” Published 2018. https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/esrd-and-medicare-advantage-plans.html
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Plan availability varies by region and state. For a complete list of available plans, 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.
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