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Who is Eligible for Medicare?

Are you unsure of who qualifies for Medicare eligibility and whether you or your loved ones are eligible? In this comprehensive guide, we will help you understand precisely who is eligible for Medicare and how to ensure that you receive the health care benefits you deserve.

Who Can Have Medicare Part A and B: The Basic Medicare Eligibility Requirements

First of all, to receive Medicare Part A and Medicare Part B, you must be a U.S. citizen or a permanent legal resident of America who has lived in the country for at least five continuous years. Then, your specific eligibility requirements for medical insurance through the Medicare program are determined by your current age.

Medicare Eligibility If You Are Over Age 65

You must meet one of these requirements to sign up during the Initial Enrollment Period around your 65th birthday. If you don’t sign up for Medicare Part B health coverage as soon as you’re eligible, you could face a Late Enrollment Penalty later.

  • You or your spouse paid Medicare taxes for ten or more years while working.
  • You are currently receiving retirement benefits from the Railroad Retirement Board or Social Security.
  • You are currently eligible to receive Railroad or Social Security benefits but haven’t yet filed for them.
  • You or your spouse worked for the government and paid Medicare payroll taxes.

Medicare Eligibility If You Are Under Age 65

You must meet one of these disability-based requirements. In most cases, you have to wait until the 25th month that you are eligible for Social Security Disability benefits (SSDI) before you can enroll.

  • You are a kidney transplant or kidney dialysis treatment patient, such as if you have end-stage renal disease.
  • You have been eligible for Social Security or Railroad Retirement Board disability benefits for two years.
  • You have Lou Gehrig’s disease (also known as ALS) and have received your first month of Social Security disability insurance payment.
  • You have amyotrophic lateral sclerosis.

What If I Don’t Meet These Requirements?

If you are above the age of 65 and do not meet the above requirements, then you have the opportunity to enroll for Medicare coverage as a voluntary Medicare participant and pay the full premium for Part A, which covers inpatient hospital care. You will not be able to enroll in premium-free Part A, even though most people who sign up for Original Medicare benefits do not have to pay the Part A premium. You can also choose to purchase Part B, which covers doctors’ services and outpatient care, individually or in addition to Part A. There is a Medicare Part B premium required for Part B coverage; however, everyone has to pay this premium after their Medicare Enrollment.

Who is Eligible for Medicare Part C?

Part C, or Medicare Advantage, serves as an alternative to traditional Medicare that is provided by private insurers that have been approved by Medicare. Part C policies offer coverage beyond that provided by Parts A and B, such as vision or dental care. To enroll in Part C, you must already be enrolled in Part A and B, and you must continue paying any premiums for that coverage.

Who is Eligible for Medicare Part D?

If you are currently enrolled in Part A or B, then you can enroll in Medicare Part D. This prescription drug coverage plan is offered by private insurers, much like Part C. You will pay a monthly premium for your Medicare Part D prescription drug plan.

Who Is Eligible for Medicare Supplement Plans?

You must be enrolled in Part A and Part B to receive a Medicare Supplement plan, and many states require that participants be above the age of 65. You will receive special protections during your Medicare Supplement Open Enrollment Period, which extends six months beyond your enrollment in Part B, but you can also apply for Medicare Supplement insurance at any time after that period ends.

Which Medicare Plan Should I Choose?

Some people only enroll in Part A and Part B, but many prefer the added security of a Medigap plan. If you think that Medicare Supplemental coverage might be the right choice for you, then please call us today to find out which Medigap plan and which insurance provider will best fit your needs. We also help Americans just like you to find Medicare Advantage plans if this is the type of health insurance that they think is right for them, and we can tell you more about Medicare Part D plans, too!

Resources

For many people, Medicare is a complicated and confusing system. You can get more information about Part A hospital insurance, Part B medical insurance and more by checking out these United States government websites:

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