Who is eligible for Medicare?

AGE 65. All US citizens become eligible for Medicare when they turn 65. Non-citizen permanent residents are eligible at 65 also, provided they have lived in the country for at least five years.

​UNDER 65. If you are under 65, you might qualify for Medicare if:

• You are permanently disabled and have received Social Security Disability benefits for at least 24 months

• You have been diagnosed with end-stage renal disease (kidney failure)

• You have been diagnosed with Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) and are receiving Social Security Disability benefits

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When should you apply for Medicare?

1. If claimed SSB before 65: If you have already claimed your Social Security benefits (SSB) before reaching 65, you will be automatically enrolled in Medicare and should receive your Medicare card in the mail (3 months before your 65th birthday). To enroll in other Medicare programs, such as Part C (Advantage) or Part D (prescription), please contact us to assist you with the enrollment.

2. If haven’t received SSB at 65: If you have not already begun to draw Social Security benefits, you need to APPLY for Medicare preferably 3 months before 65th birthday. The Initial Enrollment Period (IEP) begins three months before your 65th birthday, lasts throughout the month of your birthday, and then for three months after that. So, you have seven months in total to complete the enrollment process.

   • SUPER important: If you don’t sign up for Medicare Part B when you’re first eligible at age 65, you may have to pay a late enrollment penalty for as long as you have Medicare coverage.

3. If you are still working at 65, you can:

a. APPLY for Medicare 3 months before 65th birthday; OR

b. Stay with your employer’s coverage

NOTE: Once you retire from your job and/or your employer’s coverage ends, you may be eligible for an 8-month Special Enrollment Period (SEP) to sign up for Medicare Part B. If you enroll in Medicare part B during this time, you won’t have to pay a late enrollment penalty.

NOTE: The 8-month SEP does not apply to retiree coverage or COBRA.

Medicare VS Employer’s Coverage. Which is better?

It is better to compare the differences in premiums, coverages, and additional benefits between the two to know which one is more suitable according to your needs. You should do the comparisons 3 months before your 65-birthday to decide your next steps.

IMPORTANT! You should apply for Medicare at age 65, even if you aren’t claiming your Social Security benefits yet. In fact, you must apply for Medicare during this initial enrollment period. Otherwise, if you sign up later you will face higher premiums for the rest of your life. Only under very specific conditions can you delay enrollment without incurring a penalty.

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Steps to choosing a Medicare Plan

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1. Decide if you want Original Medicare OR Medicare Advantage

Original Medicare

Original Medicare is made of Medicare Part A & Medicare Part B.

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Medicare Part A is commonly considered hospitalization insurance. Part A covers costs related to:

• ​Inpatient care in a hospital

• Skilled nursing home care Inpatient care in a skilled nursing facility that is not custodial or long-term

• Hospice care

• Home health care

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Medicare Part B provides for the rest of your non-hospitalization healthcare needs. Under Part B you receive coverage for:

• Medically necessary services such as doctor visits, tests, and other services as needed to diagnose or treat your condition

• Preventive services like routine screenings, check-ups, vaccinations, and more

• Clinical research

• Ambulance services

• Durable medical equipment

• Mental health services

• Limited outpatient prescription drugs

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*Medicare generally pays 80% of approved charges (Medicare Part B) and you pay about 20%. On top of that, you need to pay your deductibles and there is no out-of-pocket maximum.

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Medicare Advantage (Part C)

• Combines Original Medicare, Part A and Part B, into 1 plan.

• Often includes Medicare Part D prescription drug coverage.

• May come with extra programs and services not offered by Original Medicare.

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These plans are part of the government’s Medicare program, but they are offered and managed through private insurers and may offer extras benefits not found in Original Medicare.

NOTE: You must be enrolled in Medicare Part A and Part B to join.

2. If you choose Original Medicare, decide if you want to supplement it with Medicare Supplement (MediGap)

​Medicare Supplement

• It is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.

• Helps pay approximately 20% of the health care costs (co-payments, co-insurance and deductibles) that Original Medicare does not cover, after the Part B deductible is met.

• Works with Original Medicare (Part A and Part B) and Medicare Part D prescription drug plans, but NOT with Medicare Advantage plans (Part C).

• Offers nationwide coverage with no network restrictions.

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3. Decide if you need to add prescription drug coverage to either Original Medicare or Medicare Advantage

​​Part D: Prescription Drug Coverage

• Helps lower prescription drug costs.

• All Part D plans must offer at least a standard level of coverage set by Medicare.

• Some Medicare Advantage Plans come with built-in prescription drug coverage.

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Part D plans are part of the government’s Medicare program, but they’re offered and managed through approved private insurers. Enrollment in a separate Part D plan is not automatic. You need to select and enroll in a plan.​

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Did you know?

Those who have a Medicare Advantage Plan could also decide if they want to add an optional policy (at an extra cost) designed to help cover the out-of-pocket expenses for:

• Hospital Confinement (choose the benefit amount that works best for you)

• Short Duration Hospital Stay (between 6hrs and 24hrs)

• Emergency room

• Mental Health

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This policy also has many additional riders (options that you can add at an additional cost) such as:

• Skilled Nursing Facility Benefit Rider

• Ambulance Benefit Rider

• Outpatient Therapy Benefit Rider

• Cancer Lump Sum Benefit Rider

• Outpatient Surgical Benefit Rider

• Critical Accident Benefit Rider

• Lump Sum Hospital Benefit Rider

• Dental and Vision Benefit Rider

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Contact us for any questions. Our goal is that you are educated and well-informed. We are here to answer your concerns at no cost and without pressure to apply or commit. We give you our word.