Medicare Eligibility & Qualifications for San Diego Residents
To become eligible for Medicare, you typically need to meet certain requirements. If you or your spouse worked in Medicare-covered jobs for at least 10 years and you’re 65 years old or older, as well as a U.S. citizen or permanent resident, you’ll generally qualify. If you’re under 65, you may also be eligible if you have a disability or End-Stage Renal disease (a serious kidney condition that needs dialysis or a transplant).
You can get Part A at age 65 without having to pay premiums if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to get Social Security or Railroad benefits but haven’t yet filed for them.
- You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if you have:
- Received Social Security or Railroad Retirement Board disability benefits for 24 months.
- End-Stage Renal Disease and meet certain requirements.
If you meet certain conditions, you won’t have to pay a premium for Medicare Part A Coverage. However, if you want a Medicare Part B Plan, you’ll need to pay for it. The monthly premium for Part B in 2015 is $104.90. You can find more information at www.medicare.gov. The premium amount is taken out of your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t receive any of those payments, Medicare will send you a bill every three months for your Part B premium.
Note: You will reach Medicare eligibility in San Diego and nationwide when you turn 65 even if you are not eligible for Social Security retirement benefits.
How & When to Sign Up for Medicare:
When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. This window begins 3 months before you turn 65, includes the month of your 65th birthday, and ends 3 months after the month you turn 65.
If you didn’t sign up for Part A and/or Part B (for which you must pay premiums) when you were first eligible, and you aren’t eligible for a Special Enrollment Period (see below), you can sign up during the General Enrollment Period between January 1–March 31 each year. In this instance, your basic Medicare coverage will start July 1. You may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.
If you miss your Initial Enrollment Period, you may have the chance to sign up for Medicare during a Special Enrollment Period. For example, if you’re covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse (or family member if you’re disabled) is working, and you’re covered by a group health plan through the employer or union based on that work.
You also have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first. Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period.
You may also qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer who is serving in a foreign country.
Do you have more questions on Medicare eligibility, qualifications, and age requirements? Our San Diego team can help!
