Medicare has been offering comprehensive health insurance to Americans 65 years of age and older, as well as individuals with disabilities. It has different parts, namely Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Medicare eligibility criteria may vary slightly for each part. So, understanding Medicare’s eligibility and regulations will help you assess your qualification for the program’s benefits.
To help you better understand if you are eligible for Medicare, this article discusses the age requirement for getting Medicare and other factors that influence your qualification.
Are You Eligible for Medicare?
Medicare coverage is generally available and is eligible to anyone who is 65 years of age or older, has been lawfully resident of the United States for at least five years, and meets certain eligibility requirements.
- Age — You are eligible for Medicare if you are 65 years or older. If you’re under 65, you may still qualify if you have certain disabilities or medical conditions.
- Disabilities — If you are under 65, you may be eligible for Medicare if you have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months. Individuals with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) may also be eligible, regardless of age.
- Citizenship/Residency — You must be a U.S. citizen or a legal resident who has lived in the U.S. for at least five consecutive years.
- Social Security or Railroad Retirement Benefits — You or your spouse must have worked long enough in a job where you paid Social Security taxes or Railroad Retirement taxes.
You may be charged late enrollment fines for Parts A, B, and D if you fail to enroll when you are first eligible. It’s critical to understand your eligibility for each Medicare benefit as it determines when you can apply.
Medicare Eligibility for Parts A, B, C, and D
As long as you are eligible to receive Social Security benefits when you turn 65, Medicare will automatically enroll you in Part A and Part B. Enrollment in such programs is voluntary.
On the other hand, you have to sign up for additional Medicare benefits, such as Medicare Supplement Insurance (Medigap) or Medicare Part D (drug coverage). There are other annual Medicare open enrollment periods if you want to change plans later or miss your initial enrollment time.
• Medicare Part A
Hospitals, assisted living homes, hospices, and certain home health care are all covered by Medicare Part A. Nevertheless, long-term or hospice care is not covered by this plan. Anyone who receives Social Security income is automatically covered. Those who do not get benefits can enroll online at the SSA website.
• Medicare Part B
Generally speaking, Medicare Part B pays for outpatient care expenses like doctor visits. In addition, Part B provides coverage for mental health services, emergency transportation, and specific medical equipment.
Medicare Part B enrollees will pay an average monthly premium of $174.70 in 2024 instead of $164.90 in 2023. The 2024 annual deductible is $240, which is $14 more than the $226.9 yearly deductible from 2023.
• Medicare Part C
Medicare Advantage, or Part C, is available to those who qualify for Medicare Parts A and B. Instead of buying Medicare Advantage plans through Medicare, consumers buy Medicare Advantage plans from private insurers. These plans have to provide coverage that is at least comparable to Parts A and B of Original Medicare.
Out-of-pocket expenses are capped annually in Medicare Advantage plans. This program also offers advantages, including dental, vision, and hearing care.
• Medicare Part D
Medicare Part D provides supplemental prescription drug coverage. Individuals enrolled in Medicare Part A or Part B are eligible to enroll in Part D in order to obtain subsidies for prescription medication expenditures that are not covered by Original Medicare plans.
Prescription medicine coverage is frequently included in Medicare Advantage plans, but you might still need to buy the program separately. The average Part D plan premium in 2024 is $18.50.
Medicare Eligibility Frequently Asked Questions
Do I qualify for Medicare if I’m still working?
Yes, you can be eligible for Medicare even if you’re still working. However, if you have health coverage through your employer, you may choose to delay enrollment in Medicare Part B without penalty. It’s crucial to consider factors like the size of your employer and the type of health insurance you have.
What if I haven’t worked enough to qualify for premium-free Medicare Part A?
While many people qualify for premium-free Medicare Part A based on their own or their spouse’s work history, some may need to pay a premium. If you haven’t worked enough to qualify for premium-free Part A, you may still be eligible to purchase it.
Can I get Medicare if I have a disability?
Yes, individuals under 65 with qualifying disabilities may be eligible for Medicare. To qualify, you typically need to receive Social Security Disability Insurance (SSDI) benefits for at least 24 months or have certain medical conditions like end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Do non-citizens qualify for Medicare?
Non-citizens who are legal residents and have lived in the United States for at least five consecutive years are generally eligible for Medicare. It’s important to have the appropriate immigration status and meet the residency requirements.
Conclusion
Medicare is a federal health insurance program in the United States that subsidizes medical expenses. The plan provides coverage to persons 65 years old and those with certain diseases and supports other Medicare eligibility. If you’re unsure what to do next or confused about which supplemental plan suits your needs, our expert brokers can help you make informed decisions about healthcare needs. Contact us today.