Who is Eligible for Medicare?
Medicare is a health insurance program that is funded by the federal government. It was established in 1965 as a way to ensure that Americans aged 65 and over had access to medical coverage. In 1972, Medicare was expanded to offer coverage to individuals who are younger than 65 and are afflicted with life-long disabilities, including amyotrophic lateral sclerosis (ALS) and end-stage renal disease (ESRD).
It is estimated that more than 59 million Americans who are 65 years of age or older or who have been diagnosed with permanent disabilities are covered by Medicare. If you are 65 or above or you have been diagnosed with a life-long disability, you may be wondering if you are eligible for Medicare coverage.
Parts of Medicare
When determining if you are eligible for Medicare, it’s important to understand that the Medicare program consists of four different parts. Eligibility requirements for coverage under this program vary for each part. Below, we’ve outlined the different parts of the Medicare program and what each part covers:
- Medicare Part A – Also known as hospital insurance, Medicare Part A is dedicated to covering the cost of inpatient care, such as hospital visits that require a minimum one night stay, assisted or skilled nursing facility care, and hospice or in-home health care.
- Medicare Part B – Also referred to as medical insurance, Medicare Part B covers the cost of outpatient care, such as the services of doctors and other health care professionals, as well as diagnostic testing, such as MRIs, CT scans, X-rays, and dialysis, as well as some types of equipment that may be required to administer care for specific conditions.
- Medicare Part C – This part of the federally funded healthcare program is also referred to as Medicare Advantage, and it makes it possible for those who are eligible for Medicare to receive benefits that are covered by Medicare via private health insurance plans. These plans may also offer extra benefits, on top of the benefits provided by Medicare, such as coverage for prescription medications. Coverage is usually limited to a specific network of providers and facilities.
- Medicare Part D – This part of Medicare offers prescription drug coverage and offers reduced prices on prescription medications.
- Medigap – Medigap is supplemental coverage that Medicare beneficiaries can purchase in order to fill in any “gaps” in their original Medicare coverage. There are a total of 10 different Medigap plans (A through N) and they offer varying amounts of savings benefits.
Eligibility Requirements for Medicare
The eligibility requirements for Medicare are as follows:
- Parts A and B – In order to qualify for Medicare Part A and Part B, you are required to be a citizen of the United States or a permanent legal resident who has lived in the country for a minimum of five consecutive years. Additionally, one of the following must also apply to you:
- Aged 65 or older and have Social Security eligibility – When you turn 65 and are eligible for Social Security, you may automatically be enrolled in Medicare Part A. If you are already receiving Social Security benefits or benefits from the Railroad Retirement Board (RRB), you will instantly receive Part A and Part B benefits the first day of the month that you will turn 65 years old (for example, if you will turn 65 on May 18, you will automatically be enrolled in Part A and Part B on May 1). However, if you aren’t receiving Social Security (SS) or RRB benefits, because you’re still working, for example, you can sign up for Medicare Part B when you turn 65; enrollment isn’t automatic if you aren’t receiving these SS or RRB benefits.
- Permanently Disabled – If you are permanently disabled and have been receiving Social Security disability benefits for a minimum of two years, you automatically receive Medicare Part A and Part B.
- Part C – To qualify for Medicare Advantage, you have to already be enrolled in Part A and Part B; plus, you have to live in an area where the Part C plan you would like is offered.
- Part D – In order to be eligible for Medicare’s prescription drug plan, you have to already be receiving Medicare Part A, Part B, or both. Additionally, you have to live in the service where the prescription drug plan that you are interested in is offered.
Millions of Americans receive healthcare benefits through Medicare. If you meet the eligibility requirements or you believe that you meet them and are interested in receiving federally funded benefits, you can contact the Centers for Medicare and Medicaid Services; or, for faster results, speak with an agent that specializes in health insurance and is knowledgeable about Medicare. By receiving benefits through this federal health insurance program, you can receive the affordable healthcare that you need to improve and/or maintain your health.