For the majority of Americans, Medicare benefits will be available beginning at the age of 65. Of the approximately 65 million Americans who were covered by Medicare in 2022, about 57 million were age 65 or older. U.S. citizens are eligible to enroll in a Medicare program three months before their 65th birthday or at any time during the 3-month window after the citizen’s 65th birthday. Signing up before one’s 65th birthday is encouraged, because this ensures that the coverage will begin the same month that the person turns 65.
It’s possible, in a small number of cases, to start receiving Medicare benefits before the age of 65, though. The determining factor has to do with disability status. The Social Security Administration (SSA) has the ability to allow a person under age 65 to begin Medicare coverage if the person is determined to have certain disabilities, including end-stage renal disease and ALS (also known as Lou Gehrig’s disease). Everyone who receives Medicare benefits due to a disability must first be registered with the SSA and have a Social Security number.
Not every permanently disabled person who received Social Security benefits is eligible to enroll in Medicare before age 65. The SSA maintains guidelines on who is eligible. Generally, this includes people who are unable to work for at least one year due to a health condition. The SSA guidelines include diseases and medical conditions in 14 categories, but the SSA must determine that the individual’s condition is severe enough to qualify that person for benefits. Conditions not included in the 14 categories, if severe enough to impair work and other daily activities, can still qualify the patient to be eligible for Medicare coverage. In 2022, about eight million Americans under the age of 65 receive Medicare coverage.
End-Stage Renal Disease (ESRD)
U.S. citizens become eligible for Medicare at any age if a doctor diagnoses the patient with ESRD. This condition applies when the patient’s kidneys no longer work, the patient needs either regular dialysis treatment (for at least four months) or a kidney transplant, and the patient has either worked the amount of time required under Social Security rules, is at least 65 years of age, or is the dependent child or spouse of a person who meets the age or work requirement.
Patients with ESRD are automatically eligible to enroll in Medicare Part A, which covers hospital stays. They also have the option of enrolling in Medicare Part B, which is the medical insurance policy that covers costs not associated with hospitalization. Part B includes coverage for the immunosuppressive prescription drugs required by people who’ve had an organ transplant, as well as most of the medications required for dialysis, although the policy may not cover prescriptions for other conditions unrelated to kidney disease.
Those who choose to enroll in Medicare Part B will be charged quarterly insurance premiums for this additional coverage. Policies also charge an annual premium. Some Americans who require Medicare Part B coverage due to ESRD may be eligible for financial help to make sure their Part B insurance policy stays in effect during their treatment.
Note that patients who are eligible for Medicare due to ESRD won’t necessarily be covered by Medicare until they reach the age of 65, assuming they’re younger than 65 when diagnosed. Patients are no longer eligible for Medicare coverage 12 months after they stop dialysis treatments or three years (36 months) after they receive a kidney transplant. If the patient would need dialysis treatments or another kidney transplant after that time, they would become eligible for Medicare benefits again.
How Do I Sign Up for Medicare?
If your 65th birthday is at least four months away and you receive disability benefits through the SSA, you don’t need to do anything to start receiving Medicare coverage. The SSA will automatically enroll you in both Medicare Part A and Medicare Part B.
For those more than four months away from their 65th birthdays, signing up for Medicare benefits requires contacting the SSA by phone or online. You’ll need to provide your Social Security number, your place of birth, and information about any other health insurance coverage you may have. To fill out an application for Medicare benefits online, go to the official U.S. government Social Security website at https://www.ssa.gov/medicare/sign-up.
Where Can I Find Medicare Rules?
To find accurate, reliable information about Medicare eligibility published by the U.S. government, you can visit the medicare.gov website. If you prefer to talk to someone over the phone, the telephone number for Medicare questions is 1-800-MEDICARE (or, in digits, 1-800-633-4227). For those deaf and hard-of-hearing individuals who use text telephone/TTY, the phone number is 1-877-486-2048. You can also direct questions to your state’s State Health Insurance Assistance Program (SHIP).
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