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2025 Medicare Changes

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Medicare Eligibility Guide

Understanding Medicare Eligibility

Navigating Medicare eligibility can be complex. This guide will help you determine your eligibility and explore how Medigap plans can enhance your coverage.

Medicare Eligibility Criteria

Age 65 or Older

U.S. citizens or permanent residents aged 65 or older qualify for Medicare.

Under 65 with Certain Disabilities

Individuals under 65 receiving Social Security Disability Insurance (SSDI) for 24 months are eligible.

ESRD or ALS

Those diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis qualify for Medicare without a waiting period.

Enrollment Periods

Initial Enrollment Period

WHO is it for?

The Initial Enrollment Period is for those who are turning 65 and are looking to enroll in Medicare.

WHEN is it?

3 months before your 65th birthday through 3 months after

General Enrollment Period

WHO is it for?

General Enrollment Period is for those who missed their initial enrollment period and are looking to enroll in Medicare Part A or Part B.

WHEN is it?

January 1st through March 31st

Special Enrollment Periods

WHO is it for?

Special Enrollment Periods are available for specific situations, such as losting employer-based coverage.

WHEN is it?

Depends on the circumstance

Annual Enrollment Period

WHO is it for?

Annual Enrollment Period (AEP) is for those looking to enroll in Medicare. It is also a time for those currently on Medicare to reevaluate their coverage and make changes.

WHEN is it?

October 15th through December 7th

Open Enrollment Period

WHO is it for?

Open Enrollment Period is for those looking to enroll in a Medicare Advantage or Prescription Drug Plan.

WHEN is it?

January 1st through March 31st

The Importance of Medicare Supplement Plans

To be eligible for a Medigap plan, you must first be enrolled in Medicare Part A and Part B. Medigap policies help cover costs that Original Medicare does not, such as copayments, coinsurance, and deductibles. Here’s what you need to know about enrolling in a Medigap plan:

  • Medigap Open Enrollment Period: This six-month period begins the month you turn 65 and are enrolled in Medicare Part B. During this time, you have guaranteed issue rights, meaning insurers cannot deny you coverage or charge higher premiums due to pre-existing conditions.
  • Enrolling After Open Enrollment: If you miss your initial enrollment window, you may still apply for a Medigap plan, but insurers may use medical underwriting to determine your eligibility and premium rates.
  • Medigap for Those Under 65: If you’re under 65 and eligible for Medicare due to a disability, your options for Medigap coverage vary by state. 
  • No Coverage Overlap: Medigap policies do not work with Medicare Advantage Plans. If you have a Medicare Advantage Plan and want Medigap, you’ll need to switch back to Original Medicare.

Schedule a Consultation to Find the Right Plan

Every individual’s healthcare needs and financial situations are different. The best way to determine which Medigap plan is right for you is to speak with an expert who can guide you through the options.

At The Benefit Link, our team of Medicare specialists is here to help you navigate your choices and find a plan that fits your unique needs.

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