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Medicare ELIGIBILITY
Medicare Eligibility
Life is uncertain, and you never know when you might fall sick or get an injury. The cost of healthcare could put a serious dent in your income.
Fortunately, with Medicare, you don’t have to carry the financial burden of healthcare alone. Medicare is a government-run program that helps you pay for various health expenses. The Medicare program has four Parts: Original Medicare, which comprises Part A and B, Medicare Advantage (Part C) and Medicare Part D.
Navigating between all these parts can be quite confusing, but don’t worry, we’re here for you. In this article, we’ll explain the basics of what you need to know about Medicare eligibility, and if you need more clarification on any aspect of Medicare, don’t hesitate to contact us.
Medicare Part A Eligibility
Medicare Part A is also known as hospital insurance, and it covers inpatient care in a hospital, a time-limited stay in a skilled nursing facility, time-limited health care services in the home, and care in a hospice.
Most people don’t pay premiums for Part A. This is called premium-free part A and it applies if:
- You are 65 years of age or older.
- You or your spouse worked for at least ten years (forty quarters) and have been paying Medicare taxes throughout that time.
- You receive retirement benefits from the Railroad Retirement Board (RRB) or from Social Security.
- You are eligible for the above retirement benefits but you haven’t filed for them yet.
You can qualify for premium-free Medicare Part A before you clock 65 years if:
- You live with a disability and collect disability benefits from the Railroad Retirement Board or Social Security. You will automatically be enrolled in both Part A and B twenty-four months after you start receiving the benefits.
- You have End-Stage Renal Disease (ESRD) and require frequent dialysis.
- You have Amyotrophic Lateral Sclerosis (ALS).
People who don’t meet the qualifications for premium-free Part A can still enroll in it and pay premiums. If you qualify for Part A but delay signing up for it, you may have to pay a late enrollment penalty once you sign up.
Medicare Part B Eligibility
Medicare Part B is the other component of Original Medicare and is also called medical insurance. It covers medical services and necessary medical supplies for your health condition.
Part B eligibility rules depend on whether you qualify for premium-free Part A or not. If you qualify for premium-free Part A, you automatically qualify for part B. You can sign up immediately and begin paying premiums. You also automatically qualify for Part B under 65 years of age if you:
- Live with a disability
- Have end-stage renal disease.
- Have Amyotrophic Lateral Sclerosis
If you pay premiums for Part A, to be eligible for part B, you must:
- Be 65 years of age or above.
- Be a United States citizen
- Be a permanent resident and lawfully resided in the U.S for the last 5 consecutive years.
Keep in mind that, unlike Part A which does not require payment of premiums in some cases, Part B is optional and requires beneficiaries to pay monthly premiums for all months they get coverage. The premium is taken out of the check you get from Social Security, Civil Service Retirement or Railroad Retirement. If you don’t receive any of these, you’ll get billed for premiums every three months.
Medicare Part C Eligibility
Medicare Part C is also called Medicare Advantage and is an alternative to Original Medicare. It offers similar coverage to Parts A and B, but with more benefits such as vision care, and dental care and physical fitness programs. You can get Medicare Part C plans from private health insurance firms contracted by Medicare.
To be eligible for Medicare Part C, you must:
- Already have signed up for Medicare Part A and B.
- Live in the area where the Part C coverage is offered. The Plan must also be taking on new users for the period you are enrolling.
Different insurance companies offer different extents of cover and monthly premiums, and you can contact us to find out more about them. Some companies also include coverage for prescription drugs (Part D). Medicare Part C is optional, and you don’t need it if you already have Original Medicare. However, some people prefer it as it offers more benefits and is considered to be cheaper. You should also remember that you still have to pay your Part B premiums as well as those of Part C.
Medicare Part D Eligibility
This is an optional Medicare program that covers some costs of prescription drugs. It is also known as Prescription Drug Plan (PDP) coverage, and is available from private insurance companies contracted by Medicare. Through this program, the government caters for 75% of the costs for medication, while you pay deductibles, premiums, and copays. Different companies offer different rates and coverage depending on which plan you select, and you can contact us for more information on how to choose a plan that best works for you.
To qualify for Medicare Part D, you must:
- Be signed up for either Part A or B.
- Enroll between October 15th and December 7th. Note that if you sign up late you’ll have to pay penalties.
If you already have Medicare Part A and B, you can sign up for a stand-alone cover for Medicare Part D to cover your prescription drug costs. Alternatively, you can get a Medicare Part C plan that also includes Medicare Part D.
This is an optional Medicare program that covers some costs of prescription drugs. It is also known as Prescription Drug Plan (PDP) coverage, and is available from private insurance companies contracted by Medicare. Through this program, the government caters for 75% of the costs for medication, while you pay deductibles, premiums, and copays. Different companies offer different rates and coverage depending on which plan you select, and you can contact us for more information on how to choose a plan that best works for you.
To qualify for Medicare Part D, you must:
- Be signed up for either Part A or B.
- Enroll between October 15th and December 7th. Note that if you sign up late you’ll have to pay penalties.
If you already have Medicare Part A and B, you can sign up for a stand-alone cover for Medicare Part D to cover your prescription drug costs. Alternatively, you can get a Medicare Part C plan that also includes Medicare Part D.
Conclusion
In summary, sifting through the amount of information available on Medicare can be quite daunting, but you don’t have to do it alone. What we’ve provided you with here is just the tip of the iceberg. If you’d like more information on the different parts of Medicare and which ones you qualify for, we’re more than happy to share what we know with you and help you navigate the complexities of health insurance. Contact us for more information or any questions you might have.
Our Promise To You
At the California Health Agency, every person matters. Your specific needs and situation will be met with care and respect, and we will listen attentively to work with you to ensure you get the care and coverage you need, at the best rate. Health insurance and medicare should be simple. We make sure it is. That is our promise to you.
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