There are three major requirements for Medicare. You must be either 65 or older; have a disability; or have End-Stage Renal Disease to receive benefits. The right way to prepare for Medicare requirements is to start early, review your current plan, and organize your information.
It’s never too early to start preparing for the Annual Enrollment Period (AEP), when you’ll choose your Medicare Advantage plan for next year. However, if you feel overwhelmed by your options, this is normal! Our licensed sales agents are here to help you navigate your choices and select the best option for you.
As you consider the available options, here are some Medicare eligibility requirements you’ll need to take into consideration.
What are the three requirements for Medicare?
According to the U.S. Department of Health and Human Services, Medicare is available for people aged 65 or older; younger people with disabilities; and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Here’s more detail on these Medicare eligibility requirements.
1. People aged 65 or older
There is a Medicare age requirement. Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are available to people who are aged 65 or older. According to the Centers for Medicare & Medicaid Services, most people can receive Part A at no cost, but others may have to pay a premium.
2. People with a disability
If you aren’t yet 65 but you live with a disability, you may still qualify for Medicare. You must have either received Social Security Disability Insurance (SSDI) benefits for 24 months, or have one of the two following conditions:
- End-Stage Renal Disease
- Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease)
You will be individually assessed to determine whether your illnesses and conditions qualify you for Medicare.
3. People with End-Stage Renal Disease
People with End-Stage Renal Disease qualify for Medicare, regardless of age. You must meet the following criteria to receive Medicare under this requirement:
- Your kidneys no longer work
- You need regular dialysis or have had a kidney transplant
One of these applies to you:
- You’ve worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
- You’re already getting or are eligible for Social Security or Railroad Retirement benefits
- You’re the spouse or dependent child of a person who meets either of the requirements listed above
What income do you need for Medicare?
The SSA explains that if you have a higher income, you’ll likely have to pay an additional premium to receive Medicare Part B and Medicare prescription drug coverage.
Most Medicare Part B beneficiaries pay about 25% of the Part B premium. The government covers the rest. But if you are a higher-income beneficiary, you’ll pay a larger percentage of the cost. Depending on how much income you report to the Internal Revenue Service (IRS), your monthly Part B premium might be equal to 35, 50, 65, 80, or 85% of the total cost.
Beginning in 2024, Medicare recipients who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. This law will replace the partial LIS benefit that currently exists.
Another change that will go into effect in 2024: The way the base beneficiary premium is calculated will be adjusted as needed to keep increases in the base premium at no more than 6% higher than the previous year.
How to prepare for Medicare requirements
Annual Enrollment Period may seem as if it has just ended, but it will be here again before you know it. Use these tips to make sure you’re ready.
Start early
The right way to prepare for your Medicare coverage options is to start early. The requirements for Medicare can be confusing. That’s why it’s helpful to do as much research as you can on the Medicare eligibility requirements. The more you know, the better equipped you’ll be to make the decision that’s right for you.
Medicare Open Enrollment for coverage beginning January 1st, 2024, will run from October 15th to December 7th, 2023.
For General Enrollment Period (GEP), people can sign up between January 1st and March 31st each year. Coverage will start the month after you sign up.
Review your current plan
As you take stock of your current plan, consider the following:
- Benefits and coverage
- Total costs
- Convenience
- Your overall satisfaction
What do you like about your current plan and what would you change if you could? This will help you narrow in on what exactly you’re looking for.
It’s also helpful to keep in mind changing costs for 2024. Next year, the average total monthly Part D premium is expected to decrease from $56.49 to $55.50. These stable premiums for Medicare prescription drug coverage are thanks to the Inflation Reduction Act (IRA).
In 2024, other costs will change, too. People who enroll in Medicare Part D will no longer have to pay 5% coinsurance. Part D plans will also pay 20% of the total drug costs in this phase instead of 15%. If you have been considering adding a prescription drug plan to your Medicare coverage, this may be a good time.
Organize your information
Keep important information and documents organized in a single location. Use file boxes to store papers and a dedicated folder on your computer to store digital documents (remember to back up your files using the cloud or an external hard drive). This will help you easily locate these items when needed.
According to the SSA, to apply for Medicare, you will need to gather information on:
- Your current health insurance
- Your marriage and children, if applicable
- Your military service, if applicable
- Your employment or self-employment
- Your bank account
You can enroll online, over the phone, or in person at a Social Security office.
With a little education, planning, and organization, you’ll have everything you need to be ready for Medicare’s Annual Enrollment Period (AEP) this year!
