Who is eligible?

Generally, if your are age 65, you are eligible for Medicare if:

• You or your spouse worked for at least 10 years in Medicare-covered employment and
• you are a citizen or permanent resident of the United States.

Prior to age 65, you are eligible for free Medicare if:

• You have been entitled to Social Security disability benefits for 24 months; or
• You receive a disability pension from the railroad retirement board and meet certain conditions; or
• You have Lou Gehrig’s disease (amyotrophic lateral sclerosis); or
• You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program; or
• You are the child or widow(er) age 50 or older, including a divorced widow(er) of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program.
• You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and:
• You are eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
• You have worked long enough in a Medicare-covered government job; or
• You are the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.

If you are 65 or older you can get Part A without having to pay premiums if:

• You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to receive Social Security or Railroad benefits but have not 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.
• You are a kidney dialysis or kidney transplant patient.

Types of Medicare Coverage

There are a number of different types of Medicare coverage:

• Part A: Hospital Insurance
• Part B: Medical Insurance
• Part C: Medicare choice/managed care
• Part D: Prescription Insurance

Part A

There usually is no monthly premium for this program if an individual has paid Social Security taxes for at least 40 qualifying quarters. Under certain conditions, a spouse, divorced spouse, widow or widower, or a dependent parent may be eligible for hospital insurance when he or she turns 65, based on a wage earner’s work record. Certain aged people who do not qualify for Medicare hospital insurance under these rules may be able to get it by paying a monthly premium. They must also always enroll in medical insurance (Part B) to get this coverage. Certain disabled people who lost premium-free hospital insurance due to work can get Medicare hospital insurance again by paying a premium.

Part B

Enrollment in Part B is voluntary. A premium is charged for enrollment in Medicare Part B. This program helps to pay for doctor bills, lab tests and other diagnostic testing.

When you are enrolled in Part A you will be automatically enrolled in Part B, unless you complete the "opt out" paperwork and return it to Social Security.However, if a person waits to sign up for Part B, the premium could go up by 10 percent for each year not enrolled after 65. Some individuals choose to delay enrollment as they do not plan to retire at 65 and they are covered by group health insurance. There is no penalty for waiting if a person signs up for Medicare Part B within eight months after the end of coverage by group health insurance.

Part C

Medicare Part C, formerly known as "Medicare+Choice," is now known as "Medicare Advantage". If you are able to enroll in Medicare Part A and enroll in Part B, you can switch to a Medicare Advantage plan, provided you reside in an area where a plan is available. Medicare Advantage provides numerous options and coverage varies based on the plan. If you choose this plan, it will replace your Part A and B coverage and sometimes the D coverage.

Part D

This program provides prescription coverage to Medicare beneficiaries. Medicare contracts with private companies to offer drug coverage. The companies can offer a variety of options with varying monthly costs for the plans they offer. The companies also can create “formularies” -lists of drugs a plan chooses to cover.

Medicare D, like Medicare B, is voluntary (if you choose not to enroll, then a higher premium is charged if you decide to sign up later). The penalty for late enrollment is about 1% of the national average monthly drug premium for every month you could enroll but chose not to (e.g. if you delay enrollment for 12 months, and if the average premium at enrollment is $37, an extra 12 percent—about $4.50—is added to each monthly premium. Like many rules there are exceptions, so you will need to explain to Social Security why you did not enroll when you could.) There is no penalty charged if you enroll in Medicare D up to 63 days after involuntary termination of drug benefits from another entity (employer, military, and retiree) and the coverage was at least as good as the Medicare coverage or after discontinuing employer sponsored health coverage.

Eligible persons must currently be enrolled in Medicare in order to enroll in Medicare D.

Help to Pay Medicare Premiums

You may be able to obtain help to pay some or all of your Medicare premiums. Your household income and assets can be a factor. There are a number of different names for the programs that help to pay your premiums.

Medicare Savings Program (also known as the Medicare Buy-In): If your income is below 135% of the Federal Poverty Level and you have assets less than $4000 (1 person) and $6000 (husband and wife), you may be able to have your Medicare Part B premium paid. Contact your local IDHS FCRC (Family Community Resource Center) to apply. Since the IDHS office also does Medicaid applications, you can choose to apply for Medicaid. If you want to apply only for the Medicare Savings Program let the state worker know that all you want to apply for is help paying your Medicare Part B premium. If you are enrolled in this program, you will also be enrolled in the Extra Help to pay your Part D premium.

You can obtain the application here, complete it and mail into the local FCRC.  Make sure you attach a copy of your Medicare card (the Red, White and Blue card).

Extra Help/Low Income Subsidy: This helps to pay your Part D premium. There are a number of ways you can be eligible for this extra help:

• You are approved for the Medicare Savings Program
• You receive both Medicaid and Medicare,
• You are approved for state Medicaid coverage and have a spenddown you met between July and December of the prior year
• You are eligible for Illinois Cares Rx Plus and enroll in a coordinating Medicare prescription drug plan
• You apply directly through Social Security for the Extra help or on-line at https://s044a90.ssa.gov/apps6z/i1020/main.html

Where do you apply?

Enrollment in Medicare is done through the local Social Security office or you can call 1-800-772-1213. You have a 7 month window to enroll in Medicare:

• the three months before the 65th birthday
• the month of the 65th birthday, and
• the three months after the 65th birthday
• If you decide to enroll after the initial 7 month period, there is a limited time frame each year when enrollment can occur.  You may also have to pay higher premiums.  Call 1-800-772-1213, if you are not enrolled in a Medicare program for which you believe you qualify.  You will be informed as to when you will be able to enrol.

Individuals can enroll in Medicare in two ways:

• Automatically sign up for Medicare when a person turns 65 and is applying for Social Security or Railroad Retirement payments,
• Or contact the Social Security to apply for the benefit if s/he does not get Social Security or Railroad Retirement payments. This also applies to individuals who are End Stage Renal Disease, or have Amyotrophic Lateral Sclerosis (ALS/Lou Gehrigs Disease