A person becomes eligible for Medicare Part B when they turn 65 years of age. Some people may qualify sooner if they have certain medical conditions.
Medicare Part B is the part of Medicare that pays for medical costs, such as doctor visits and durable medical equipment. Most people become eligible for Part B based on their age, but some may qualify earlier due to medical conditions.
This article will explain when and how a person can qualify for Medicare Part B.
Age is the most common way that a person qualifies for Medicare Part B. A person becomes eligible if they are:
- 65 years old
- a United States citizen
- an immigrant lawfully admitted for permanent residence in the United States without a break for 5 years before a person applies for Medicare enrollment
A person does not have to qualify for Medicare Part A (hospital insurance coverage) to get Medicare Part B.
Some people may qualify for Medicare before age 65 if they have certain medical conditions and require more considerable medical care. In these instances, Medicare can help make care more cost-effective.
- a disability as certified by a doctor
- end stage renal disease (ESRD)
- amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease)
A person with these conditions may also seek benefits from Medicaid, which is the state-run insurance program.
A person does not have to sign up for Medicare Part B when they turn age 65, providing they have creditable insurance coverage.
Creditable coverage provides at least the same coverage level as Medicare, and people usually obtain it through an employer.
When a person stops working, and their employer’s insurance no longer covers them, they can usually qualify for a Special Enrollment Period (SEP) where they can sign up for Medicare Part B.
There are some differences between Parts A and B, depending on the amount of tax a person has paid and their income level.
Medicare Part A is premium-free to most individuals, providing a person has paid Medicare taxes for over 40 quarters of work.
Medicare Part A covers hospital-related costs, such as those for a hospital stay or admission to a rehabilitation or skilled nursing facility when a person is recovering from surgery, illness, or injury.
There is a monthly cost for Medicare Part B. The standard premium usually changes each year, but in 2021 it is $148.50.
Medicare Part B usually covers doctor appointments and medically necessary durable medical equipment. Part B may also cover some preventive services, such as Annual Wellness Visits (AWVs).
Enrollment with Medicare Part B can differ depending on a person’s circumstances.
If a person is already receiving benefits from The Railroad Retirement Board, Social Security Administration, or Office of Personnel Management before they turn age 65, enrollment in Part B is usually automatic.
A person with a disability will have automatic enrollment in Part B once they have received Social Security disability benefits for 24 months.
Additionally, those with Lou Gehrig’s disease will receive automatic enrollment to both Medicare Parts A and B on the month their disability benefits begin.
If a person has ESRD, enrollment in Part B can usually take place 3 months after dialysis begins. Enrollment, in this instance, is not usually automatic.
In most other instances, a person must enroll for Medicare themselves. The best time to do this is during the Initial Enrollment Period (IEP). The IEP is the 7-month period that begins 3 months before a person turns 65 years old.
If a person does not enroll with Medicare Part B during their IEP, they may be required to wait until the General Enrollment Period (GEP), from January 1 to March 31.
How to enroll
A person can enroll with Medicare by:
- visiting a local Social Security office
- calling the Social Security Administration at 800-772-1213 (TTY: 800-325-0778)
- applying online at the Social Security Administration’s website
It is important to sign up for Medicare Part B when a person is first eligible. Signing up beyond the IEP could result in late enrollment penalties.
There is a standard monthly fee for Medicare Part B. The premium can change (usually increasing) every year, and for 2021, the monthly premium is $148.50. The following organizations may automatically deduct the premium from a person’s benefits:
- Office of Personnel Management
- Railroad Retirement Board
- Social Security Administration
Otherwise, a person will pay a monthly bill to Medicare for their Part B premium.
Some people pay more for Medicare every month if their modified adjusted gross income on their tax return exceeds $88,000 on an individual return or $176,000 on a joint return.
Medicare refers to this as an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses tax returns from 2 years before to calculate if a person must pay an IRMAA.
In addition to a monthly premium, a person has a $203 Part B deductible. Typically, most services are subject to a 20% coinsurance of the Medicare-approved amount after a person meets their deductible.
An individual may qualify for Medicare Part B based on their age or a specific health condition.
If a person is uncertain whether Medicare will automatically enroll them, they can contact Medicare at 1-800-633-4227 to find out.
A person can avoid late-enrollment penalties by ensuring they sign up during the specified enrollment periods.
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