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  4. Medicare Eligibility
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Medicare Eligibility

Check to see if you're eligible for Medicare

 

Typically, Medicare is available for U.S. citizen ages 65 and older. However, people with certain disabilities may be eligible at any age. Keep reading to see if and when you’ll be eligible to enroll in Medicare.

To qualify for Medicare, you must be

— A U.S. resident or a legal resident living in the U.S. for at least 5 consecutive years

— Age 65 or older

— People under 65 who have qualifying disabilities like:

— Permanent kidney failure (end-stage renal disease) requiring dialysis or a kidney transplant

— Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease

Special enrollment periods for Medicare

Most people enroll in a Medicare Advantage plan during the 7 month period around their 65th birthday (3 months before, 3 months after, plus birth month). Outside of that time period, you usually have to wait for the annual enrollment period to begin on October 15th. However, you may be able to enroll in a plan through a special enrollment period if you:

— Retired after 65

— Moved and your current plan is not available in your new region

— Became a resident of a nursing home

— Need to leave your employer health plan

— Involuntarily lost prescription drug coverage

— Meet certain low-income guidelines

Eligibility for other parts of Medicare

To be eligible for other parts of Medicare, you must meet a few requirements:

  1. Medicare Advantage
  2. Prescription Drug Plan
  3. Medigap Plan

— You must be eligible for Medicare and already enrolled in both Part A and Part B.

— Except in certain circumstances, if you’ve been diagnosed with end stage renal disease  (ESRD) at the time of enrolling, you will not be eligible for Medicare Advantage. If you are diagnosed while enrolled in a Medicare Advantage (MA) plan, you can continue to be enrolled.

— Your permanent address must be in the plan’s service area.

— You cannot be enrolled in a stand-alone Part D prescription drug plan and a Medicare Advantage plan, even if you choose a plan that doesn’t cover prescription drugs.

— You must be eligible for Medicare and already enrolled in both Part A and Part B.

— You still qualify for Part D coverage even if you’ve been diagnosed with end stage renal disease (ESRD), have amyotrophic lateral sclerosis (Lou Gehrig’s Disease) or certain disabilities.

— Your permanent address must be in the plan’s service area.

— You cannot be enrolled in a stand-alone Part D prescription drug plan and a Medicare Advantage plan at the same time, even if your Medicare Advantage plan doesn’t cover prescription drugs.

 

— Because Medigap Blue policies supplement your Medicare coverage, you must be eligible for Medicare and already enrolled in both Part A and Part B.

— Your permanent address must be in the plan’s service area.

— In most cases, Medicare supplement policies are “underwritten.” This means that some companies may charge more for a Medigap Blue policy or deny coverage for preexisting conditions.

— There are certain times, however, when an insurance company must sell you a Medigap Blue policy, even if you have health problems. Listed below are times that you’re guaranteed the right to buy a Medigap Blue policy:

        • When you’re in your Medigap Blue open enrollment period.

        • If you have a guaranteed issue right.

— In some cases it may be illegal for the insurance company to sell you a Medigap Blue policy (such as if you already have Medicaid or a Medicare Advantage Plan).

 

Ready to enroll?

If you meet the qualifications, then let's get started on the enrollment process.

 

 

Do you need more information on Medicare eligibility?

Contact Social Security at 800-772-1213, 24 hours a day, 7 days a week, or visit the

Social Security Administration website.

 

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Last updated on December 18, 2023

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®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.

Benefits and/or benefit administration for the Medigap, Medicare Advantage HMO, PPO, and/or Part D plans may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association:

Western and Northeastern Pennsylvania:  Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, or Highmark Senior Health Company.

Central and Southeastern Pennsylvania:  Highmark Inc. d/b/a Highmark Blue Shield, Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.

Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.

West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.

Western New York: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. 

Northeastern New York: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield. 

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

Blue Edge Dental may be offered by the following entities, which are indepedent licensees of the Blue Cross Blue Shield Association: 

Western and Northeastern Pennsylvania: Highmark Health Insurance Company and First Priority Life Insurance Company.

Central and Southeastern  Pennsylvania: Highmark Health Insurance Company.

Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.

West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.

Western New York: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.  

Northeastern New York: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

United Concordia is a separate company that provides the provider network for Blue Edge Dental and administers dental benefits.