Medicare is a federal insurance program that can be free for individuals who meet specific criteria. To determine if you’re eligible or not, you should understand its parts first and how each differs from the others.
Before diving into the eligibility qualifications with Medicare, you should know that Medicare isn’t the same with Medicaid. Although they’re both federal programs for healthcare, Medicare versus Medicaid eligibility criteria are different.
Parts Of Medicare And Their Eligibility Requirements
Medicare has four different parts; The original Medicare (Part A and Part B), Part C, and Part D. Each piece works differently, and eligibility criteria might also vary. Here are the parts:
Medicare Part A and B
When you turn 65 years old, you or your partner who served for, at least, 10 years for the US and paid Medicare taxes are already eligible for Medicare Part A and B. Some of the basic information for each part is as follows.
Part A
This is the part of Medicare that covers inpatient services, including but not limited to, hospital stays and skilled nursing facilities. Although it usually covers inpatient and skilled nursing services, Medicare doesn’t cover assisted living expenses. Part A is premium-free for specific individuals who will meet its criteria.
Medicare Part B
Part B of Medicare covers outpatient services like doctor’s office visits, wellness services, outpatient laboratory services, and others. You’ll be charged a monthly premium for Medicare Part B, and you may also opt-out, depending on your preference.
Remember that you don’t need to pay a premium to get Medicare Part A. You’ll be automatically enrolled if;
- Social Security or the Railroad Retirement Board provides you with retirement benefits.
- You or your partner worked for the government and were covered by Medicare.
- You’re eligible for Social Security or Railroad Retirement payments, but you haven’t yet applied.
If any of the criteria above doesn’t apply to you, you may buy Medicare Part A and B during open enrollment. Part B may be enrolled to without purchasing Part A. However, if you’re buying Part A, buying Part B is necessary.
Medicare Part C (Medicare Advantage)
To be eligible for Medicare Advantage, you must have Parts A and B of Medicare.
Part C is another option for getting Medicare Part A and Part B coverage from a private insurance provider. Getting Part C isn’t mandatory, but many choose to enroll to it for the additional coverage that Medicare Part A and B don’t cover. Some Medicare Advantage plans already include prescription coverage as well.
Medicare Part D
To get Medicare Part D, you must have Medicare Part A or Part B.
Part D is also known as the Medicare Prescription Drug Benefit, a voluntary United States federal government initiative. It assists Medicare beneficiaries in paying for self-administered prescription drugs via premiums on prescription drug insurance.
If You’re Younger Than 65 Years Old
If you’re younger than 65 years old, you might still be eligible for Medicare under the circumstances below:
- If you’re diagnosed with Lou Gehrig’s disease or Amyotrophic Lateral Sclerosis (ALS)
You’ll be eligible for Medicare from the first day of the month you start collecting disability payments. Also, you’ll be automatically enrolled to Medicare Parts A and B, unlike most conditions that require two years of waiting.
- If you’re permanently disabled and collecting medical coverage for, at least, two years
If you’ve been receiving disability payments from the Railroad Retirement Board or Social Security Disability Insurance for, at least, two years, you’re eligible for Medicare. You’re automatically enrolled to Medicare Part A and Part B on the first day of your 25th month of disability coverage.
- If you have end-stage renal failure and need dialysis or a kidney transplant
To be eligible for Medicare, you must either be eligible for or currently receiving Social Security or Railroad Retirement Board benefits or have worked long enough for Social Security, the Railroad Retirement Board, or the government.
Enroll When You’re Eligible
If you don’t get Part B when you first become entitled, your monthly premium will go up for each month when you should have received Part B but didn’t.
You’ll also have to pay this tax any time you pay your premiums. As you go without Part B coverage for a more extended period, the penalty increases.
Your monthly premium will rise if you’re allowed to buy Part A but chose not to do so when you first became eligible for Medicare. As you didn’t sign up, you’ll be paying the higher price for twice as many years.
This consequence only suggests that when you turn 65, getting Medicare can also be a great way of saving money after retirement. So, why wait to pay higher premiums if you can have it at a lower price the first time you become eligible?
Final Thoughts
Medicare isn’t mandatory, and some eligible people can choose not to enroll. However, it’s highly recommended not to wait and immediately consider getting Medicare upon reaching your 65th birthday. Not only would you feel secured, you can avoid late enrollment penalties too.
