Want to find out if you are eligible for Medicare? If your answer is yes then you have come to the right place where you can make sure about the right age to qualify for Medicare. Now, when you think of Medicare, the very thing that comes to your mind is that this is meant for retired people. But Medicare is basically a federally funded health insurance program which aims at financing basic health care needs. This health insurance is meant for people who have 65 or above age. Not just that! This health care program also covers some specific qualified individuals. You must note that there is more than one way to be eligible for Medicare. Basic conditions for eligibility would differ for different parts of enrolling. Based on how you qualify, the coverage that you will get and the premium that you have to pay will be decided. Nobody is directly entitled to Medicare. There are certain conditions which should be fulfilled to become eligible. This health insurance program has been in existence since many years. But there are many people who are unaware of its existence. This insurance policy has been designed to benefit those who are eligible as per the given criteria. At the beginning, Medicare consists of two primary parts which are Medicare Part A and Medicare Part B. Now, at present day it has further been divided into Medicare Part C and Medicare Part B. None can stop you from getting full coverage even at the age of 65 if you have sufficient credits. Getting a private health insurance is also an option but you must consider getting Medicare as the primary option. Don’t hesitate if you are stay at home parents with no work history as you can qualify to get Medicare benefits based on your spouse’s work record. Your situation and credentials will be evaluated carefully before making sure about your eligibility.
Eligibility conditions for Medicare part A and part B
Hospital services, skilled nursing facility care and other home health care come under Medicare Part A. While, medical services that include doctor visits, preventive screenings, certain vaccinations, lab tests and durable medical equipment are covered under Medicare Part B. In order to be eligible for Medicare Part A and Part B you must fulfill the residency requirements and your age must be 65 years or above. At the same time you should be eligible for retirement benefits. Your enrollment will be automatic if you fit the criteria. If you are receiving retirement benefits then you will be eligible to get Part A and Part B from the very first day of the month you turn 65. It may happen that your birthday is on the first day of the month, then coverage for Part A and Part B will start from first day of the previous month. In case if the age requirement is met but you are not receiving retirement benefits as you are still working then you need to sign up for Medicare Part A and Medicare Part B as automatic enrollment is not possible. Premium free Medicare Part A is obtainable if your age is 65 or above and if you or your spouse paid Medicare taxes while working for at least 10 years. You can earn 40 credits while working for 10 years and can enjoy benefits of Part A which mainly covers inpatient hospital care. You don’t have to pay any premium for this. While for Part B there is no need of work credits and Part B mainly covers doctors’ service and outpatient care. You are entitled to get Part A at the age of 65 without paying any premium if you are receiving retirement benefits or are eligible for retirement benefits but have not applied for anyone or you or your spouse were a government employee or a retiree who paid for Medicare taxes while working. However, if you or your spouse has not paid for Medicare taxes while working then in that case you will have to buy Part A and Part B. Premium free Part A benefits can also be obtained based on work record of your spouse provided that your age is at least 65 years and your spouse is at least 62 years. It is also possible for you to enroll for Part A based on work history of divorced or deceased spouse. You must know that you can qualify to get full benefits of Medicare even if you are under 65. For that you need to show that you are getting Social Security disability benefits for at least 24 months. It is not necessary that benefits are provided in consecutive manner. Medicare benefits can be obtained under 65 if you are receiving disability pension. So, you are eligible to get full benefits of Medicare even if your age is not 65 provided that you have qualifying disability. When you qualify for Medicare on the basis of your disability your initial period of enrollment starts from 22nd month of receiving such benefits. If you are suffering from end stage renal disease then also Medicare facilities are accessible for you. In this case, either you should be under regular dialysis treatment or might need a kidney transplant. You should sign up for Medicare as automatic enrollment is not possible. Soon you start taking the dialysis treatment, you will start receiving benefits. It should be noted here that if you have undergone a transplant and don’t need dialysis further then you will stop receiving benefits of Medicare. If you are diagnosed with Amyotrophic lateral sclerosis which is also termed as Lou Gehrig’s disease at the terminal stage then you will gain Medicare eligibility immediately. While it is possible to get Medicare Part A without paying any premium, it is necessary to pay for Part B. Generally, the premium is deducted from retirement benefits that you might be getting. But, if you are not receiving such benefits then a bill for Part B premium will be sent to you every three months. You must be aware of the fact that if your income is high then you might have to pay more premiums for Part B. Also, if you forgot to sign in for Part B the moment you become eligible then you may end up paying a penalty for not signing up on time. If you want you can enroll for Medicare Part B without buying Part A. But if you already enrolled for Medicare Part A then it is compulsory that you enroll for Part B. It is important that you are enrolled for Medicare Part A and Part B if you want to get benefits of Medicare Advantage plan or even to buy Medigap supplement insurance policy. These Medicare supplement plans aim at accompanying the original Medicare. These plans also help to cover additional parts of Part A and Part B.
Eligibility conditions for Medicare part C
Medicare Part C which is also known as Medicare Advantage plan is an alternative of Original Medicare that is Part A and Part B. Benefits that you will receive under this plan is a combination of Part A and Part B. It is not just that. Medicare Part C also gives coverage for additional things like dental, vision, hearing etc. This plan is provided through private insurers. It should be noted here that only if you have enrolled for Medicare Part A and Part B then only you can qualify to get benefits of Medicare Part C. It is also required that you must live within the service area of the Medicare Advantage plan that you want to opt for. Moreover, in order to be considered eligible you must not have a last stage renal disease unless you are enrolled in a plan that is specially meant for covering ESRD patients. But you can find a special type of Medicare Advantage plan tailored for these types of patients. You are eligible for this type of plans if you pay the premiums of Part A, Part B and Part C in case if it is applicable. Getting Medicare Part C is optional. Plus, if you don’t sign up then no penalty will be charged. It is necessary for you to continue paying for Part B premium even if you have enrolled for Medicare Advantage plan that is Medicare Part C. Based on specific plan details and insurance company that you choose monthly rates and plan coverage for Medicare Part C would vary. There could be additional requirements which you must fulfill in order to be eligible for Medicare Advantage plan. Initial coverage election period for Medicare Part C is generally the same as the initial enrollment period for Medicare Part A and Part B.
Eligibility conditions for Medicare part D
Medicare Part D is meant for covering prescription drugs. In order to enroll in Medicare Part D, you must be enrolled in Medicare Part A and Part B. Please note that Medicare drug coverage has been made available through private plans only. So, you need to reach out for a private insurer to get approval for Medicare Part D. In most of the cases, you will be considered eligible for Part D from 3 months before your 65th birthday to 3 months after your birthday. Eligibility requirements of Medicare Part D are same as Part A and Part B. Also, you must reside in the service area for prescription drug where you want it to be. Pay for the premiums of Medicare Part A, Part B and Part D if applicable. In other words, anyone who has access to Medicare can get prescription drug coverage regardless of his or her income, health status and prescription drug usage. You must keep in mind that premiums could be high and you might need to go in network doctors and pharmacies. You could have prescription drug coverage through an employer or union. This plan is also good and is almost like the basic coverage option. You can keep it and finally go with the one which offers you the best coverage at best rates. If you don’t sign in for a drug plan when you are eligible then a permanent penalty will be added to your premium once you enroll in. Thus, it is advisable to buy Part D at comparatively low cost the moment you become eligible. Plans can be changed based on your need for coverage.
Other Medicare requirements-
Now you are well aware of ways you can become eligible for Medicare and how you can qualify for various parts of Medicare. But do you know that there are additional requirements to meet also? These conditions include that you must be a legal resident of that specific place for at least five years, you cannot be someone who went to a correction home or have been imprisoned, you must have a stable permanent address, and you must not have access to a Health Savings Account although you can use existing funds in your account.
Summary:
If you need help in finding out your chances of getting of Medicare then go through the eligibility conditions that must be fulfilled. There are websites where you can find an eligibility and premium calculator to check your eligibility for benefits and to figure out the monthly premium. It may happen that your individual condition is not covered in the calculator. In that case, contacting an expert is the right thing to do. The expert can guide you through the next steps. It does not matter if you have other insurances like VA benefits, Medicaid etc. Medicare can be used with other insurances also. In some cases, having other insurances can enhance your chances of getting a Medicare. This health insurance program is meant to provide various preventive services and screenings in cashless manner. Although one may find all good things about this medical policy but there are certain things which need to be understood. A good number of people are facing frauds under the current Medicare system almost every day. It is easy to scam senior people. The Medicare communication system is an ineffective one as it fails on regular basis.
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