- Before one can discover if they are eligible, they must first understand what Medicare is and how it functions. To learn more about Medicare, read this section.
- Medicare eligibility depends on a variety of factors. To uncover more about Medicare eligibility and find out if you are qualified, read this section.
- Understanding how to apply for Medicare or knowing what steps come after initial enrollment is crucial. To learn more about these steps, read this section.
- Social Security and Medicare are often considered to have the same eligibility ages; however, they often differ. Read this section to learn more about Social Security and how it interacts with Medicare eligibility or payments.
Medicare can be tricky to comprehend, especially regarding who is eligible, why they are eligible, and how they can sign up. However, eligibility and enrollment can be easy once all the facts are known.
What is Medicare?
Medicare is a federally funded health insurance program for those who are 65 or older that have worked and paid Medicare taxes for at least ten years. This health insurance program provided by the United States government is also extended to younger persons with disabilities and those with End-Stage Renal Disease (ESRD).
Standard Medicare is broken down into three parts known as Part A, Part B, and Part D. Part A is considered ‘hospital insurance’ and often is premium-free. Part B is regarded as “medical insurance” and usually requires a monthly premium. Lastly, Part D is prescription drug coverage and must be added to a Medicare plan. Part D coverage is optional, however, if patients chooses not to register when they’re eligible, there will be a penalty fee later on. Medicare also has what is called “Part C” coverage, otherwise known as Medicare Advantage plans. MA plans typically cover Part A, Part B, and Part D costs in addition to benefits such as dental or vision care.
Medicare Eligibility Age: Who is Eligible for Medicare?
Those 65 & Older
Adults 65 and older are eligible for Medicare; however, their eligibility can be further broken down into two categories: premium-free coverage and paid coverage. Those who are 65 and older, worked for at least ten years, and paid Medicare taxes, are eligible for premium-free Part A coverage. Those who are 65 and older, are citizens of the United States, but did not pay for Medicare taxes while working are still able to enroll in Medicare but they must purchase Part A coverage.
Medicare recipients are eligible for Part B coverage, but it requires a premium. This premium for Part B is often taken as a deduction from a recipient’s Social Security, Railroad Retirement, or Civil Service Retirement check. If a recipient receives none of these payments, Medicare will send a Part B premium bill every three months.
Those Under 65
In particular circumstances, those under the age of 65 are eligible for and able to get Medicare insurance. These circumstances include those already receiving a disability pension from the Railroad Retirement Board, those with Lou Gehrig’s disease (ALS), and those with permanent kidney failure (ESRD) who regularly receive dialysis treatments.
In cases where a patient has been entitled to Social Security or Railroad Retirement Board disability for 24 months, they are eligible to receive premium-free Part A coverage. For those with ALS, Medicare benefits begin in tandem with their first month’s disability benefits.
Non-working individuals are also eligible for Medicare if their spouse (of at least one continuous year) has worked for ten years and paid Medicare taxes. In addition, divorcees that were married for at least ten years and are currently single may also qualify for Medicare under their ex-spouse’s work record.
If a patient continues to work past the age of 65, they are able to enroll in Medicare. However, if their employer provides private health insurance, more options are available to them, and the process may become complicated. If a patient finds themself in this scenario, it’s essential to speak with an insurance agent for guidance.
How to Apply
The majority of patients may automatically be enrolled in Medicare three months prior to the month they turn 65. However, other patients in select circumstances (those who haven’t worked and paid Medicare taxes for ten years, those under the age of 65, etc.) may have to apply for Medicare coverage.
To learn more about enrollment periods, visit this source.
To apply for Medicare or to learn about the application process, visit this source.
Once patients have been enrolled, either automatically or through an application, they should receive a “Welcome to Medicare” package along with their Medicare insurance card. This package will take the patient through all there is to know about Medicare and explain the various coverage options available to them.
To learn more about the Medicare insurance card and see a sample of what one looks like, visit this source.
After a patient has carefully reviewed the details in their welcome packet, it’s time for them to decide which coverage they desire. As stated prior, most patients are eligible for premium-free Part A coverage. However, patients must apply for part B and Part D, and both require a premium.
Medicare Advantage plans, the Medicaid dual eligibles program, and MedSupp (Medigap) programs are also options that provide additional coverage for patients. To learn more about these programs, visit this source.
How Social Security Impacts Medicare
It’s essential to recognize that one may be eligible to collect Social Security benefits at a different time from when their Medicare eligibility begins. This means to emphasize that just because a patient retires early or begins collecting Social Security does not mean they are eligible for Medicare benefits. The only case where collecting Social Security incites Medicare eligibility is for those younger than 65 that are receiving a disability pension, have ALS, or those with ESRD.
For those who aren’t eligible to collect Social Security until after age 65, their Medicare Part B premium will be affected. Medicare Part B is usually deducted from a patient’s Social Security, Railroad Retirement, or Civil Service Retirement check. However, if they aren’t due to collect their check until after the age of 65, Medicare will send a Part B premium bill every three months. To learn more about your Social Security eligibility age, visit this source.
Good health does not come cheap. In fact, national health spending in the United States was around $3.8 trillion in 2019, and it's estimated to grow up to $6.2 trillion by 2028.
Although it’s not extremely common, occasionally healthcare providers may charge patients with Medicare Part B excess charges after their visits.