As people age or experience certain types of disabilities due to genetic, environmental, or accidental factors, healthcare becomes a crucial aspect of their lives. Medicare has steadily risen over the past two decades after policy changes encouraging private plan options.
According to the Congressional Budget Office, in 2023, 51% or more than 30.8 million of the eligible medicare population enrolled. Anyone considering enrolling in or already in the program should understand how Medicare operates, who qualifies for it, and its eligibility requirements.
What is Medicare?
Medicare is a federal health insurance program that mainly serves people aged 65 and older. It also covers specific youths with disabilities and those suffering from end-stage renal disease (permanent kidney failure needing dialysis or a transplant, sometimes referred to as ESRD).
There are four parts to Medicare, and they include the following;
- Medicare Part A – Hospital Insurance
- Medicare Part B – Medical Insurance
- Medicare Part C – Medicare Advantage Plans (like HMOs and PPOs)
- Medicare Part D – Prescription Drug Coverage
Understanding the details of each part of the Medicare insurance program is essential to make better decisions about your healthcare coverage.
Who Qualifies for Medicare?
The most common way to qualify for Medicare is by age. Most people become eligible when they turn 65. Those who are automatically enrolled in Medicare are those who are already receiving Social Security or Railroad Retirement Board benefits and those who are under 65 but have been getting Social Security disability benefits for at least 24 months.
Also, people of any age who are diagnosed with Amyotrophic Lateral Sclerosis (ALS), Lou Gehrig’s Disease, or end-stage renal disease are automatically eligible for Medicare.
Medicare may be the secondary payer if you or a loved one with ESRD can access group health coverage (either through their employer or a spouse’s employer). The group health plan covers primary expenses.
What are the Eligibility Requirements?
Medicare eligibility requirements are determined by several factors, including;
- Age – Most individuals qualify for Medicare when they turn 65. Known as the “initial enrollment period,” it starts three months before the month a person turns 65 and lasts for seven months. Also, younger people with disabilities can qualify if they’ve received Social Security disability benefits for at least 24 months.
- Citizenship or legal residency – Generally, only U.S. citizens or permanent legal residents who’ve lived in the U.S. for five continuous years are eligible for Medicare. However, If you are a legal resident but have not lived in the U.S. for five continuous years, you may still qualify under certain circumstances.
- Work history – Many people qualify for premium-free Part A based on their or their spouse’s work history. Specifically, if you or your spouse have worked and paid Medicare taxes for almost ten years (40 quarters), you’re eligible for premium-free Part A.
- Disability or medical condition – Those under 65 can qualify for Medicare if they have a qualifying disability and have been receiving Social Security disability benefits or Railroad Retirement Board disability benefits for at least 24 months. Also, people with amyotrophic lateral sclerosis (ALS) and end-stage renal disease (ESRD) are eligible for Medicare regardless of age.
- Income and assets – Some low-income individuals may qualify for help paying Medicare premiums, deductibles, and coinsurance through Medicare Savings Programs (MSPs). They may also qualify for Extra Help with Medicare prescription drug plan costs.
The above are only guidelines. There may be nuances and exceptions based on a person’s specific circumstances. The advisable thing to do is to consult official Medicare resources or a qualified insurance advisor for personalized guidance.
Conclusion
Medicare, a federal insurance healthcare plan, has played a big part in providing millions of Americans access to healthcare. Whether it’s for yourself or your loved one, it’s paramount to understand how this insurance plan works to enjoy its maximum benefits.
So, after understanding how Medicare works and yet unsure of the way forward, work with a qualified insurance advisor. They will provide extensive help, allowing you to make the best choice.
