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Who's Eligible for Original Medicare?

| September 29, 2022
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Who is Eligible for Original Medicare? 



       Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are available to three separate groups of people. Those eligible are classified as Medicare beneficiaries. Because Part B is optional, we will be assuming Part A eligibility throughout this topic. 

Person(s) age 65 and older 

  • You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years. 

  • You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working. 

  • An individual becomes Original Medicare eligible beginning the month that individual turns age 65 if they also qualify for monthly Social Security or Railroad Retirement Board (RRB) cash benefits. 

     

       Is this process automatic? Yes, for some. Beneficiaries that receive a Social Security benefit or RRB are automatically enrolled into Medicare provided they received said benefits for a minimum of 4-months prior to turning 65. If not, the beneficiary would follow the same process as the non-automatic process further down in your reading. The Center for Medicare & Medicaid Services (CMS) will mail a “Welcome to Medicare” package 90-days prior to your birth month. This package will contain a welcome letter, booklet, and your Medicare card. The booklet explains important decisions you need to make before your Medicare coverage starts.  

       This is not an automatic process for everyone, however. An individual who is not receiving monthly Social Security or RRB benefits must file an application for Medicare by contacting the Social Security Administration. It is usually recommended to file said application about 100 days (about 3 and a half months) away from your 65th birthday month. As I mentioned, you can contact Social Security, or you can go to www.Medicare.gov and register and complete your online application electronically. After registering, you will also receive the same “Welcome to Medicare” package. 

When does my coverage begin?

Part A begins for an individual the month of their 65th birthday, for a beneficiary whose 65th birthday is on the first of the month, Part A coverage begins on the first day of the preceding month. Example, your birthday is March 1, Part A begins on February 1.  

Disabled individuals

 

  • A person who is entitled to monthly Social Security or Railroad Retirement Board (RRB) benefits based on disability is automatically entitled to Part A after receiving disability benefits for 24 months (about 2 years). Disabled Federal, State, and local government employees who are not eligible for monthly Social Security or RRB benefits may get deemed entitlement to disability benefits and automatically entitled to Part A after being disabled for 29 months (about 2 and a half years). 

  • There are special rules for people with certain disabilities. 

  • One is Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s disease). Individuals whose disability is ALS are entitled to Part A the first month they are entitled to Social Security or RRB disability cash benefits. There is no waiting period. 

  • A second is for Claiming Child Disability Benefits. The Social Security Administration rules do not allow for child disability benefit to begin earlier than age 18. Thus, Part A entitlement based on child disability benefit entitlement can never begin before the month the person attains age 20 (or age 18 if the individual’s disability is ALS). 

Individuals diagnosed with End-Stage Renal Disease (ESRD). 

  • Individuals are eligible for premium-free Part A if they receive regular dialysis treatments or a kidney transplant, have filed an application for Medicare, and meet one of the following conditions: 

  • Have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee; or 

  • Are getting or are eligible for Social Security or RRB benefits; or 

  • Are the spouse or dependent child of a person who has worked the required amount of time under Social Security, the RRB, or as a government employee; or are getting Social Security or RRB benefits. 

Part A coverage begins:  

  • The 3rd month after the month in which a regular course of dialysis begins; or 

  • The first month a regular course of dialysis begins if the individual engages in self-dialysis training; or 

  • The month of kidney transplant; or 

  • Two months prior to the month of transplant if the individual was hospitalized during those months in preparation for the transplant. 

 

 

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