How To Qualify for Medicare - Parentology

How To Qualify for Medicare

by Parentology

Medicare is a health insurance plan that benefits many people as they age, and you don’t have to be 65 to be eligible for Medicare. Here’s some info to see if you qualify at your age.

There are two main parts to Medicare — Part A and Part B. Medicare Part A helps pay for a hospital stay, limited time at a skilled nursing facility, or for hospice care and some home health care. Medicare Part B deals with medical insurance, covering doctor’s visits, outpatient care, durable medical equipment, and some preventive services. There is also supplemental Medicare coverage if you need more than what Parts A and B offer.

Medicare Part A Qualifications

According to the U.S. Department of Health and Human Services, you can qualify for free Medicare Part A if:

How to Qualify for Medicare
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  • You are 65 or older.
  • You or your spouse worked and paid Medicare taxes for at least 10 years.
  • You receive Social Security retirement benefits or benefits from the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but haven’t filed for them yet.
  • You or your spouse had Medicare-covered government employment.

If you’re not 65 yet you may still qualify for free Medicare Part A if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

If you qualify for free Medicare Part A, there are no premiums, but there is still a deductible for hospital stays as well as a yearly benefit cap.

People who don’t qualify for free Medicare Part A coverage on their own can still get Medicare benefits once they turn 65, but they have to pay into them. To be eligible for this benefit you need to be 65 or older and a U.S. citizen or have been a legal resident for at least five years. The amount you would have to pay would depend on how long you have worked. The more you’ve worked, the more credits you receive which help to lower your payment.

Medicare Part B Qualifications

While qualifying for free Medicare Part A is pretty standard, you do have to pay a premium if you decide you want Medicare Part B coverage. This monthly premium gets deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of these benefits, you pay a Medicare Part B premium bill every 3 months.

The premium for Medicare Part B is income-based, with higher earners paying more into their coverage. No one is required to take a Medicare Part B plan because they do have to pay premiums and some people just can’t afford it.

Supplemental Coverage

Medicare Supplement Insurance — often referred to as Medigap Insurance — is health insurance that can help pay some of the health care costs that Medicare doesn’t cover alone. This can include coinsurance, copayments, or deductibles. Some Medigap policies also cover emergency foreign travel expenses.

It’s important to know that neither Medicare Part A nor Part B covers prescription drugs. You can get coverage for medication through a Medicare Part D or Part C plan, but will still have out-of-pocket costs. The costs of prescription drugs are usually lower under these plans.

Medigap policies DON’T cover your costs under other types of health coverage, including Medicare Advantage Plans (like HMOs or PPOs), standalone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, or TRICARE.

Private insurance companies sell Medigap policies. However, insurance companies generally can’t sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan. So when selecting one of these policies it’s important to know exactly what they do and don’t cover, and if you think you will need that assistance.

Signing Up for Medicare

If you receive Social Security benefits, you will be automatically enrolled in Medicare Parts A and B at age 65. You can opt-out of Part B coverage.

The initial enrollment period for Medicare starts three months before you turn 65. You can start signing up then and have three months until after your birthday to do so. If you miss that window, there is an annual general enrollment period that lasts from January 1st to March 31st. You can enroll during this time but your coverage won’t begin until July 1st. 

The easiest way to enroll in Medicare coverage is by going online to the Social Security Administration site. You can also call the Social Security office over the phone or visit your local office in person.