It’s important to know when you become eligible for Medicare and what to do once you qualify. Below you’ll learn everything you need to know about Medicare eligibility, requirement, guidelines, and more.
Who Qualifies for Medicare?
There are three basic criteria that an individual must meet before they can become eligible for Medicare. First, you must be at least 65 or older. Second, you need to be a U.S. citizen or have been a legal resident for five years. Last, you or your spouse must pay at least ten years (40 quarters) of Medicare taxes. This also makes you eligible for Premium-free Part A. However, not everyone needs to be 65 to get Medicare. Medicare is available for people younger than 65 who have certain health conditions and disabilities.
People living with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS) are eligible upon diagnosis. 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.
Additionally, individuals on Social Security disability, regardless of age, for at least two years are also able to enroll. Premium-free Part A is different for people who receive monthly Social Security or Railroad Retirement Board benefits. They’re not required to file a separate application as long as they get the benefits at least four months before their 65th birthday. Instead, they will automatically get premium-free Part A at 65.
Medicare Eligibility Requirements
There are a few requirements to be eligible for Medicare. As we mentioned above, must pay ten years towards Medicare taxes in order to get premium-free Part A.
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.
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.
Do I Automatically Get Medicare When I Turn 65?
Generally, the answer is yes. If you’re receiving Social Security benefits, you’re automatically signed up for Medicare Part A and Part B. Social Security will notify you when it’s time for you to enroll at the beginning of your Initial Enrollment Period.
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!
How to Learn About Medicare Eligibility
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.