Medicare eligibility depends on several factors, such as age, disability status, and more. While signing up for Medicare is pretty easy, there are hurdles to overcome.
It’s in your best interest to understand Medicare before you’re eligible. You need to know when to enroll and what coverage is best.
So, who qualifies for Medicare? Who is eligible for Medicare? How old do you have to be to get Medicare? And what are your options?
Below we discuss everything you need to know about Medicare eligibility. You’ll learn about Medicare age, requirements, guidelines, and more.
Medicare Eligibility Age
You must be a U.S. citizen or a permanent resident living in the U.S. for five years in a row.
Further, you or your spouse must pay at least ten years of Medicare taxes to qualify for Premium-free Part A.
Also, those of ANY age on Social Security disability for at least two years are eligible for Medicare.
Those with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis are eligible upon diagnosis.
But, ALS patients get automatic enrollment, whereas ESRD patients must enroll themselves.
Those with either disease don’t need to meet the ten year Medicare tax requirement for premium-free Part A.
Medicare Part B costs $144.60 each month, high-income earners may pay more. If you’re eligible for Part A, you can get Part B.
Tip: The free Medicare eligibility checker can help you determine eligibility and calculate premiums.
Medicare Eligibility Requirements
There are a few requirements to be eligible for Medicare. For premium-free Part A, you must pay ten years towards Medicare taxes. Also, if a spouse paid Medicare taxes and you otherwise qualify for Medicare.
If you or your spouse didn’t pay Medicare taxes for at least ten years and you’re over the age of 65, you may be able to buy Part A.
Low-income earners may get help paying for Part B. Further, low-income earners could be eligible for Medicare and Medicaid.
High-income earners may pay more for Part B or Part D; this is an Income-Related Monthly Adjustment Amount (IRMAA). Medicare bases the cost on your income from two years ago.
Tip: If your income went down in the last two years, consider filing an IRMAA appeal with Social Security.
Medicare Disability Eligibility Requirements
At the start of the 25th month that you obtain Social Security Disability checks, you’ll automatically have Medicare. Certain circumstances don’t require patients to wait for 24-months.
Those on disability because of Amyotrophic Lateral Sclerosis automatically start Medicare the same month that disability benefits begin.
Medicare isn’t responsible for determining if you qualify for disability; Social Security oversees that decision as they are the ones who administer the checks.
If you have any questions regarding this matter, you should contact your local Social Security Administration office, as they can better assist you.
Medicare Automatic Enrollment
If you get Social Security and Medicare, you could be eligible for automatic enrollment. Automatic enrollment won’t apply to those that buy Part A.
Those that need to buy Part A MUST apply through the Social Security Administration. You may enroll in Part A and Part B for a monthly premium, during an enrollment period.
Your first enrollment period is the Initial Enrollment Period; this is the best time to sign up, especially if you don’t have coverage.
If you have an employer group plan, you may delay enrollment. First, talk to the benefits administrator where you work to be sure Medicare isn’t primary at age 65.
When you miss your enrollment period and don’t qualify for the Special Enrollment Period, you’ll apply for Medicare during the General Enrollment Period.
Those that get Part B during the General Enrollment Period will likely face a late enrollment penalty.
Medicare Eligibility for Nursing Home Care
Although Medicare does cover skilled nursing care, coverage is generally for a short-term stay. Many limitations come with Medicare Eligibility for Nursing Home Care.
However, you may qualify for coverage if you meet the following Medicare eligibility rules:
- You must have Part A – hospital insurance
- You must have stayed inpatient for a minimum of 3 days in a row before nursing home admission
- A nursing home must be Medicare-certified
- Your nursing home start date is within 30 days after spending three days in the hospital
- Your doctor must order nursing home care and services
- Skilled professionals must provide services
Medicare Savings Program Eligibility
The Medicare Savings Program helps with some out-of-pocket expenses, such as Part A and Part B. One of these programs can help you pay for your premiums, deductibles, copayments as well as coinsurances associated with Medicare.
Medicare Savings Programs has 4 Types:
- QMB – Qualified Medicare Beneficiary Program
- SLMB – Specified Low-Income Medicare Beneficiary Program
- QI – Qualifying Individual Program
- QDWI – Qualified Disabled and Working Individuals Program.
Aside from the QDWI Program, all these programs will help pay for your Part B premiums.
Medicare Savings Program eligibility automatically qualifies you for Extra Help. The Extra Help program helps you cover the costs of prescriptions. However, if you are eligible for Extra Help, that does not mean you also qualify for the Medicare Savings Program.
Medicare Eligibility Verification
When you go to the doctor, the billing department will verify your Medicare eligibility. The billing department will need your full name, Medicare number, gender, and date of birth.
So, when you arrive at the doctors and they request identification, be ready!
Medicare Eligibility FAQ’s
How Much is My Medicare Premium?
Not all Medicare premiums are the same; your situation is different than the next persons, and therefore the premium won’t be the same.
If you have any questions or concerns regarding your eligibility, please contact a Medicare expert. You can reach an expert by calling the phone number above or by filling out the online rate form.