Who qualifies for Medicare
You're qualified for Original Medicare (Part A & B) if:
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To be eligible for Medicare, you must be 65 or older. If you are under 65, you may qualify if you have been receiving Social Security Disability Insurance (SSDI) for at least 24 months. Individuals with End-Stage Renal Disease (ESRD), which involves permanent kidney failure requiring dialysis or a transplant, are also eligible regardless of age. Additionally, people diagnosed with Amyotrophic Lateral Sclerosis (ALS) qualify immediately upon diagnosis. You must also be a U.S. citizen or legal resident who has lived in the U.S. for at least five years.
Initial Enrollment Period (IEP) Part A & B
If you plan to enroll at 65, your initial Enrollment Period (IEP) begins three months before, and ends three months after, your 65th birth month. Coverage can begin as soon as the first day of the month you turn 65.
Annual Enrollment Period (AEP) Oct 15 - Dec 7
During this time you can apply for any type of Medicare plan - Part A, B, C (Medicare Advantage), D (Prescription Drug) and Medigap. It is also the time when you can freely move between plan types.
Open Enrollment Period (OEP) Jan 1 - Mar 31
This period is limited to those enrolled in a Medicare Advantage Plan. During this time you can switch from your current Medicare Advantage plan to another Medicare Advantage plan (with or without drug coverage) or to Original Medicare (with or without a Part D drug plan)
Special Enrollment Period (SEP)
Certain events may qualify you for a change in your Medicare coverage,
such as leaving your plan service area or changes to your financial
eligibility. To find out if you quality for a SEP request
a no cost consultation.
General Enrollment Period (GEP) Jan 1 - Mar 31
The General Enrollment Period (GEP) is the time period every year when a beneficiary may enroll in Medicare for the first time if they missed their Initial Enrollment Period (IEP) and do not qualify for the Special Enrollment Period (SEP). Your coverage starts the month after you sign up. You might pay a monthly late enrollment penalty.
The different parts of Medicare
Medicare Part A - Hospital Insurance
What it helps cover:
- Inpatient care in hospitals, including the room, nursing services and supplies.
- A stay in a skilled nursing facility (SNF).
- Home health and hospice care if they are medically necessary.
What it costs:
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There is no monthly premium for Part A as long as you or your spouse paid into Social Security for at least 10 years.
Medicare Part B - Medical Insurance
What it helps cover:
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Services doctors provide in their office and in hospitals.
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Services from other health care providers.
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Outpatient care and home health care.
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Durable medical equipment, like wheelchairs and walkers
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and more
What it costs:
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You pay a monthly premium, which has a minimum cost and can increase based on Income-Related Monthly Adjustment Amount (IRMAA). The premium is usually taken out of your Social Security Check if you already take your social security benefits. To determine your Part B Premium go to:
Medicare Part C - Advantage Plan
How it works:
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Medicare Advantage plans combine Medicare Part A and Part B coverage into one plan offered by a private insurance company, so you get all your hospital and medical benefits from one source. Most Medicare Advantage plans are Health Maintenance Organizations (HMO) plans, Preferred Provider Organization (PPO) plans or Medical Savings Account (MSA) plans.
What it covers:
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You get all the benefits of Original Medicare, and most plans also include Part D prescription drug coverage. They may also cover extra days in the hospital; dental, vision and hearing benefits; fitness program memberships; and other wellness benefits. Benefits, plan coverage areas and provider networks can vary widely.
What it costs:
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Monthly premiums vary by plan; most Medicare Advantage plans include Part D drug coverage as part of their monthly premium. You must enroll in Parts A & B and pay your Part B premium. You may have to pay a copay or coinsurance for some services, but you can typically save money by using a provider in the plan's network.
Medicare Part D - Prescription Drug Plan
How it works:
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Medicare Part D covers prescription drug costs. You are eligible to enroll in Part D once you are entitled to Medicare Part A or enrolled in Part B. You can pair a stand-alone Part D plan with Original Medicare, Medicare Supplement (GAP) Plan or a Medical Saving Account MSA plan.
What is covers:
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Benefits will vary by plan. Each drug plan maintains a list of covered drugs (known as a formulary) and has their own unique rules and cost.
What it costs:
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Monthly premiums vary by plan, and your out-of-pocket cost will depend on the type and quantity of prescription drugs you take.
Inflation Reduction Act:
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The IRA was passed in 2022 and was designed to help meet climate goals as well as to benefit many vulnerable populations – including Medicare beneficiaries. Changes to Prescription Drug Plans went into effect in 2023 with a cap of $35 on Part D covered insulin. In 2025, three more changes arrive for Medicare plans with prescription drug coverage – with notable consumer benefits.
Medicare Supplement (GAP) Plan
Available Plans A B C D F G K L M N
How it works:
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Medigap plans help close the gaps in Original Medicare by paying for many of the costs that Original Medicare doesn't cover, like copays, coinsurance and deductibles. There are no networks, so you have the freedom to choose your own providers as long as they accept Medicare.
What it costs:
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Monthly premiums can vary greatly depending on the plan you choose and the insurance company you buy from. Although monthly premiums for Medigap plans are usually higher than those for Medicare Advantage plans, you will typically have fewer out-of-pocket costs when receiving medical services under Medigap coverage.
Keep in mind:
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No matter which insurance company you buy from, you'll get the same basic benefits. Some companies may include extras such as fitness club membership and discounts.
Medicare Dual Eligible Plans (DSNP)
Medicare & Medicaid
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Medicaid is a joint federal and state program that helps pay health care costs if you have limited income and (in some cases) resources and meet other requirements. Some people qualify for both Medicare and Medicaid.
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How do I qualify? Medicaid programs vary from state to state. They may also have different names, like “Medical Assistance” or “Medi-Cal.” Each state has different income and resource requirements. Contact your Medicaid office for more information and see if you qualify.
Extra Help - Low-Income-Subsidy (LIS)
Get Extra Help Paying For Your Medicare Drug Costs
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Extra Help, also called Low-Income-Subsidy, is a program to help people with limited income and resources pay Medicare drug costs.
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You may qualify for Extra Help if your yearly income and resources are below certain annual limits.
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You may qualify even if you have a higher income (like if you still work, live in Alaska or Hawaii, or have dependents living with you).
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Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs).
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Resources don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies.
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If you qualify for Extra Help and join a separate Medicare drug plan or Medicare Advantage Plan with Medicare drug coverage (Part D):
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You'll get help paying your drug coverage cost. You won't pay a late enrollment penalty.