top of page

Medicare

and Medicaid

​​​​Medicare Under 65​​​​

Eligibility for Medicare under 65

​You are eligible for Medicare under 65 years old if:

  • You have been diagnosed with End-Stage Renal Disease (ESRD)

  • You have received Social Security Disability Insurance (SSDI) checks for at least 24 months


For ESRD Medicare coverage to begin, you must currently be receiving dialysis treatments or have had a kidney transplant.


You must also have at least one of the following:

  • SSDI Eligibility

  • Railroad Retirement Benefits Eligibility

  • You, a Spouse, or a Parent Have Paid Medicare Taxes for a Sufficient Amount of Time


You are automatically enrolled in Original Medicare after you receive your 25th month of Social Security Disability Insurance (SSDI). However, if you suffer from Amyotrophic Lateral Sclerosis (ALS), your Medicare coverage will start without the two-year waiting period.


Those who qualify for SSDI will receive a Medicare letter when the required 24-month period has passed. We recommend contacting the local Social Security office if this does not happen.


Because Medicare under 65 is health needs-based, you will not be denied coverage for any underlying health conditions. Even if your condition remains the same or degrades, your coverage will not change.​​​​

Medicare vs Medicaid_edited.jpg

Assistance with the Medicare Application Process

​​​​Understanding your Medicare application process can seem impossible. The paperwork, applications, and phone calls feel unending. Let me help you!

​

I will walk you through the entire application process to ensure that you are well taken care of. For a free quote and consultation, call me at (843) 212.6395. ​​​​

Important Medicare Enrollment Dates​​​​

​Initial Enrollment Period (IEP) 

You have seven months to sign up when first eligible for Medicare. This seven-month period begins three months before your 65th birthday, includes the month you turn 65, and ends three months after you turn 65.

​

If you are collecting Social Security or Railroad Retirement benefits before your IEP starts, you will automatically be enrolled in Original Medicare. You are also automatically enrolled if you have received at least two years of disability benefits or if you suffer from Lou Gehrig’s disease or end-stage renal disease (ESRD).


If you do not meet these requirements, you must apply for coverage during your IEP. Applying for coverage early in your IEP will allow your coverage to start as soon as necessary. If you wait until the end of these seven months, you may experience a coverage gap.

Special Enrollment Period (SEP) 

Special Enrollment Periods allow you to sign up for Original Medicare Part A and/or Part B outside the regular enrollment periods if:

  • You permanently move out of your service area.

  • You lose creditable prescription drug coverage.

  • You enter, reside in, or leave a long-term care facility (Ex. Nursing Home)

  • You have Medicaid or are in a Medicare Savings Program 

  • You have other exceptional circumstances​ Medicare coverage options. ​​​​

Annual Election Period (AEP) 

The Annual Election Period runs from October 15 through December 7 and is an excellent time to change your Medicare health or prescription drug coverage.


During annual open enrollment, Medicare beneficiaries who want to change or add coverage to their Medicare insurance have until October 15 and December 7. They may make any change effective January 1st of the coming year.


Medicare beneficiaries may:

  • Switch from Original Medicare to a Medicare Advantage Plan

  • Switch from Medicare Advantage to Original Medicare

  • Switch from an Advantage plan without Prescription Drug Coverage to one with It

  • Switch from a Plan with Prescription Drug coverage to one without

  • Join or Drop a Part D Prescription Drug Plan

Annual Open Enrollment

The Annual Open Enrollment period allows those eligible to apply for Medicare if they missed their initial application window. Annual open enrollment for Original Medicare occurs from January 1–March 31 each year. This means that, during this time, you may apply for Medicare Part A and Part B if you missed your initial enrollment period (IEP) or are not eligible for a special enrollment period (SEP).

Medicare and Medicaid Together

Medicare Eligibility

​Medicare eligibility is primarily based on age, health, and/or work history. To be eligible for Medicare, you must either:

  • Be a U.S. Citizen and Be 65 Years Old or Older

  • Have End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease

  • Be Receiving/can Receive Social Security or Railroad Retirement Benefits

  • Be Under 65 and Have Received Certain Disability Benefits from the RRB for at Least 24 Months

  • Be Under 65 and Have Received Disability Benefits from Social Security for 24 Months or More​

Medicaid Eligibility

​​Medicaid eligibility is based on financial need. Modified Adjusted Gross Income (MAGI) determines your financial eligibility for Medicaid. You are exempt from this consideration based on disability (including blindness) and age (65 or older). If you fall under these categories, your Medicaid eligibility is based on Supplemental Security Income (SSI) rather than MAGI.

Dual Eligibility

These requirements allow people to receive both Medicare and Medicaid at once. Both plans will put money towards your healthcare costs and significantly reduce out-of-pocket costs.

​

Medicare will pay first for costs, and then Medicaid will pay its remaining share. The amount of money Medicaid will pay for services depends on each beneficiary's coverage.  

​

If you are fully eligible for both forms of coverage, all of your costs will be covered. You may still have some out-of-pocket costs if you are partially dually eligible. Different dual-eligibility programs determine this:

​

  • Medicare Savings Programs: You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions.

Need Assistance

TWhite Insurance will help you better understand your Medicare coverage options. ​​​​

bottom of page