Medicare is a US federal health insurance program for people over 65 years of age or younger individuals with End-Stage Renal Disease. There is no dollar limit on this plan as long as the services requested are medically necessary, except for a few individual Medicare benefits. In this article, you will learn about Medicare’s eligibility, requirements, and enrollment.
Medicare Eligibility on Age and Diseases
You are eligible to enroll for Medicare if you are 65 years old, or about to turn 65 in three months. If you are under or older than 65 years old, there are different requirements.
Medicare Eligibility If You Are Under 65
You can qualify for Medicare under 65 years old if:
- You have been receiving Social Security disability benefits for at least 24 months, and/or
- You have End-Stage Renal Disease with permanent kidney failure requiring dialysis or a kidney transplant.
The Social Security Disability Insurance (SSDI) benefits do not have to be consecutive months. The Social Security Administration (SSA) counts each month of disability benefit received as one month.
Previous disability benefits are also counted in the 24-month Medicare qualifying period if they are:
- Within 60 months after the termination month of the worker, or
- Within 84 months after the termination of disabled widows, disabled widowers, or childhood disability benefits.
If your previous disability benefits include the same or are directly related to your current disabling impairment, then they will automatically be counted in the 24 months at any given time.
Medicare Eligibility at 65 and Older
As for people who are 65 years of age and older, you must fall under the following categories to be qualified for full Medicare benefits:
- If you are either a citizen of the United States or have been a permanent resident for five years.
- You receive Social Security or railroad retirement benefits, or you have worked for at least 10 full years and haven’t collected the benefits, or
- You and your spouse are either government employees or retirees who didn’t pay Social Security taxes but did pay Medicare payroll taxes while employed.
Medicare Part A, which covers hospital services, will be free if you pay Medicare payroll taxes for ten years. You will also be able to qualify for Medicare Part B, which covers outpatient care, and Medicare Part D, which covers prescription drugs, without needing to earn work credits.
Special Rule for People with Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease
Medicare Part A is offered to individuals with the disability of Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease. The coverage of Part A is given on the first month they are credited with Social Security or Railroad Retirement Board disability cash benefits. No waiting period is applied.
Special Rule for Child Disability Benefits
The Social Security Administration (SSA) will only allow child disability benefits to begin at 18 years of age if the individual’s disability is ALS. Without ALS, Medicare Part A is only entitled to people with child disability benefits upon the age of 20.
Medicare Supplement Plan Eligibility
Before you can claim Medicare Part A and Part B benefits, you will have to pay copayments, coinsurance, and deductibles. The Medicare Supplement Plan — often called Medigap — is an option that can help you pay for these out-of-pocket coverage gaps.
Just like Medicare Advantage, Medicare Supplemental Insurance or Medigap is also purchased from private insurers.
Who Is Eligible for Medicare Advantage Plans?
While regular Medicare Advantage does not cover ESRD, you may qualify for a Medicare Special Needs Plan (SNP). SNPs are special types of Advantage plans specifically designed for a particular condition or financial situation. You can keep your Medicare Advantage plan if you purchased it before developing ESRD.
To know more about Medicare Supplement Plans, click here.
How to Enroll in Medicare
To enroll in Medicare, the agency has a Social Security office locator on its website. SSA will enroll you for Medicare Part A and Part B.
Enrollment takes less than 10 minutes online, according to the Social Security Administration (SSA). You will need to create your mySocial Security account. To create an account, you must prepare identity questions for verification, your mobile phone number, credit card, W-2, and tax forms.
Review Medicare’s checklist here.
You can receive your Medicare card in two to three months through the mail before your 65th birthday as long as you are automatically eligible for Medicare. Other than that, you’ll usually receive your card in three weeks to one month after applying for Medicare.
There is also an option to apply for Medicare if you are not planning to retire right away. Although, the enrollment will only be available at certain times of the year.
Initial Enrollment Periods for Medicare
You may open your initial enrollment three months before your 65th birthday or three months after. If you enroll three months before your 65th birthday, your coverage starts as soon as you turn 65. The same rule applies if you enroll three months after.
Special Enrollment Periods for Medicare
In case you miss the Initial Enrollment Period, you can still go through the Special Enrollment Period. Some examples of Medicare Special Enrollment Qualifying Events are the following:
- Moving somewhere outside of the coverage area of your current Medicare Advantage plan,
- If you’re leaving your employer’s health plan,
- Your current Medicare Advantage provider will no longer provide services to Medicare
Medicare is open for US citizens 65 and older and for younger people with End-Stage Renal Disease (ESRD) and Lou Gehrig’s disease or ALS. Enrollment is easy and may take around 10 minutes to do online with minimal requirements. To aid payments on copayments, coinsurance, and deductibles, there is also an option to apply for Medicare Supplement Plan.