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Medicare Eligibility

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Medicare Eligibility – Who Qualifies for Medicare?

- Who Qualifies for Medicare? - Medicare Part A and Part B.

- Who qualifies for premium-free Medicare Part A?

Who Qualifies for Medicare? – Medicare Part A and Part B

To be eligible for Medicare Part A and Part B, you must be a U.S. citizen or a permanent legal resident for at least five continuous years. You must also meet at least one of the following criteria for Medicare eligibility:

  • Be age 65 or older and eligible for Social Security: You may be automatically enrolled in Medicare Part A (hospital insurance) when you reach age 65 and become eligible for Social Security. But, if you’re not receiving retirement benefits from Social Security or the Railroad Retirement Board (for instance, because you’re still working), you must sign up for Medicare Part B when you meet the age requirement, as your enrollment isn’t automatic.
  • Be permanently disabled and receive disability benefits for at least two years: You automatically get Part A and Part B after you get disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board (RRB) for 24 months.
  • Have end-stage renal disease (ESRD) (permanent kidney failure that requires dialysis treatment or a kidney transplant): You need to sign up for Medicare, as your enrollment isn’t automatic.
  • Have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis, or ALS): You automatically get Part A and Part B the month your disability benefits begin.

Who qualifies for premium-free Medicare Part A?

Most people don’t have to pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working for at least 10 years (or 40 quarters). If you’re not eligible for premium-free Part A, you will have to pay a monthly premium of up to $499 in 2022.

In addition, you must also pay the Part B premium each month. The standard premium is $170.10 in 2022.

Also, keep in mind that individuals with a higher income may have to pay more for their Part B premium. Be aware that if you don’t sign up for Medicare Part B when you first become eligible, you may have to pay a 10% penalty (added to your monthly premium) for each full 12-month period you could have had it but didn’t sign up (some exceptions apply).

Who Qualifies for Medicare Part C?

Medicare Part C (also called Medicare Advantage ) is an alternative way to get your Medicare Part A and Part B benefits. Medicare Advantage plans are available through private insurers. To be eligible for Medicare Part C, you must already be enrolled in Medicare Part A and Part B, and you must reside within the service area of the Medicare Advantage plan you want. You can get more information about and enroll in a Medicare Advantage plan by contacting a licensed insurance agent or broker, such as eHealth.

The Medicare Advantage plan (Part C) Initial Coverage Election Period is generally the same as the Initial Enrollment Period for Medicare Part A and Part B (the seven-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65). Or, you can sign up during the Annual Election Period (AEP) from October 15 to December 7 for coverage effective January 1 of the following year. You can also enroll during a Special Election Period (SEP), if you qualify.

Please note: If you have end-stage renal disease (ESRD), here’s a change you may want to know about. Starting in 2021, you may qualify for a Medicare Advantage plan if you have end-stage renal disease (ESRD) and meet the usual requirements listed below.

Medicare Part C is optional, and there is no penalty for not signing up. But you must have Medicare Part A and Part B to get Part C, and live in the service area of a Medicare Advantage plan.

If you have Medicare Part C, you must continue paying your Part B premium even if you enroll in a Medicare Advantage plan. Monthly rates and plan coverage for Medicare Advantage plans vary by the insurance company you choose and your specific plan details.

Who Qualifies for Medicare Part D?

Medicare Part D covers prescription drugs and, like Medicare Part C, is available through private insurers that are approved by Medicare. To be eligible to enroll in a Medicare prescription drug plan (PDP), you must have Medicare Part A and/or Part B and you must live in the service area for the prescription drug plan in which you want to enroll. To be eligible to enroll in a Medicare Advantage plan with prescription drug coverage (MAPD), you must have Medicare Part A and Part B, and you must live in the service area for the MAPD plan you’re considering.

Medicare information is everywhere. What is hard is knowing which information to trust. Because Medicareprofessionaladvisors are following the CMS regulations, you can rest assured you’re getting accurate information so you can make the right decisions for your coverage.

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Medicare Parts

A

Medicare Part A

Part A of Medicare covers hospitalisation. Inpatient treatment, limited time in a licenced nursing facility, limited home health care services, and hospital care are all covered under Part A.

B

Medicare Part B

Non-hospital medical costs such as doctor's appointments, blood tests, x-rays, diabetes testing and supplies, and outpatient hospital treatment are covered by Part B benefits. For this component of the original health insurance, you pay a monthly fee.

C

Medicare Part C

In a health insurance plan, Medicare Advantage or Medicare Part C normally covers all forms of health insurance coverage. Private insurance businesses that have been contracted by the CMS to provide a medicare plan as an alternative to the original health insurance plan provide it.

D

Medicare Part D

Medicare Part D is a prescription medication coverage option. Part D health insurance is available as a stand-alone plan from private insurance firms, with monthly rates varying from one to the next. Depending on the plan you're registered in, you'll split the cost of your prescription medicines.

we’re here to all your questions

We’ve helped over 9 million senior people compare their best Medicare coverage options.

You get the same coverage as Original Medicare plus additional benefits from the Medicare Advantage insurance provider when you enroll in a Medicare Advantage plan.

There are many of savings to be had, but here are a handful you might not be taking advantage of right now:

  • Your Social Security benefit will be reduced by $144 each month.
    $2,500 to spend on dental procedures such as crowns, implants, and dentures.
  • $1,000 to spend on vitamins and aspirin at your neighbourhood drugstore
  • Hearing aids and batteries cost $2,000
  • $300 will be used on eyeglasses and tests.

It’s not simple to learn the ins and outs of Medicare. While Medicare.gov has a wealth of information, there is no real how-to when it comes to determining what is best for you and your lifestyle.

This is where we can help! We put our 20+ years of industry experience to work for you, giving you the peace of mind that you’re getting what you’re entitled to without the hassle.

  • Initial Enrollment Period – Most persons can enrol in Medicare Part A, Part B, Part C, and/or Part D for the first time within a seven-month period: three months before, three months during, and three months after they reach 65.
  • Special Enrollment Period (SEP) – Certain life circumstances, including as moving or losing current coverage, may qualify you for coverage. You usually have two months to enrol, depending on your circumstances.
  • Medicare Part C & D Annual Enrollment Period (AEP) – Every year, from October 15 to December 7, Existing Medicare beneficiaries can take advantage of this time to review and adjust their Medicare Advantage (Part C) and Medicare prescription medication plans (Part D). You cannot utilise AEP to enrol for the first time in Part A and/or Part B. The following year’s coverage begins on January 1st.
  • Medicare General Enrollment Period – Every year, from January 1 to March 31, While the majority of individuals will receive Part B coverage when they join in Medicare, this period is allocated for those who did not enrol in Part B when they initially became eligible. Coverage begins on July 1st of the following year.
  • Medicare Advantage Open Enrollment Period (OEP) – Every year, from January 1 to March 31, You can change to a different Medicare Advantage plan with or without medication coverage during this period, or move to Original Medicare and join a separate Medicare Prescription Drug plan. You cannot, however, go from Original Medicare to a Medicare Advantage plan, join a prescription drug plan while on Original Medicare, or change from one prescription drug plan to another prescription drug plan while on Original Medicare.

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