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Who Is Eligible for Medicare Coverage?

Who Is Eligible for Medicare Coverage?

Medicare was created in 1965 as part of some Social Security amerndments. The system provides valuable medical coverage for seniors once they turn 65 years of age. The eligibility requirements for Medicare are relatively simple. However, there are a few rules and exceptions to be aware of before applying for or receiving medicare.

Determining Eligibility

Once you turn 65, you are eligible for Medicare, provided that you meet certain criteria:

  • You or your spouse has worked a certain number of accumulated hours
  • Taxes were taken out of your paychecks for Medicare

If you become disabled before reaching the age of 65 and can no longer work you may also be eligible for Medicare. There is a two year waiting period from the time you are determined to be eligible for disability until the time you receive your benefits.

If you have certain medical conditions such as kidney failure you may qualify for Medicare benefits before the age of 65. Dependent adult children may also be eligible if they become severely or permanently disabled before age 22.

Applying for Medicare

Medicare enrollment is automatic in the United States. If you are eligible to receive Medicare, you will receive a Medicare card in the mail approximately three months prior to turning 65. Enrollment starts on your birthday with the option to decline Part B coverage. If you do not

have enough accumulated work hours, you may still apply for Medicare coverage. You would need to pay premiums though. Medicare is divided into four basic components.

  • Part A - Covers home heath care, inpatient hospital care and hospice care.
  • Part B - Covers outpatient hospital services, prescription drugs provided directly in the doctor's office and basic physician care.
  • Part C - Provides "managed care options" referred to as Medicare Advantage. Coverage includes all benefits in Part A and Part B along with outpatient prescription drug coverage.
  • Part D - Provides outpatient prescription drug coverage.

Generally, most seniors are eligible for Part A coverage upon reaching the age of 65 as long as the following criteria is met:

  • You are eligible to receive Social Security or railroad benefits.
  • You are not getting Social Security/railroad benefits, but have enough accumulated work hours to be eligible for such benefits.
  • You are entitled to Social Security benefits based on the work record of your spouse once they have reached the minimum required age of 62.
  • You have worked long enough in a local, state or federal job to eligible for Medicare coverage.

For additional information contact the Centers for Medicare & Medicaid Services at 7500 Security Boulevard in Baltimore MD 21244-1850 or call the Medicare information phone number at 1-800-MEDICARE for questions about eligibility and available benefits.

Category: Insurance

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