Who Qualifies For Medicare?

Who qualifies for Medicare? Read on to find out.

Medicare is America’s health insurance program for individuals who are either 65 years old or more. Some individuals who are younger than 65 can also meet all requirements for Medicare, such as those with permanent kidney failure and/or disabilities  The program assists with the expense of health care. However, it doesn’t cover every medical cost or the expense of most long-term care. Furthermore, you have options for how you get Medicare coverage. In the event that you decide to have Original Medicare (Part A and Part B) coverage, you can purchase a Medicare Supplement Insurance (Medigap) strategy from a private insurance organization. Read this article to learn more about who qualifies for Medicare.

The parts of Medicare

Social Security enrolls you in Medicare Part A and Part B.

  • Medicare Part A helps pay for the care of a patient who is admitted to the hospital or at a skilled nursing facility for a certain time period. Part A likewise pays for some home health care and hospice care.
  • Medicare Part B helps pay for administrations from specialists and other health care suppliers, outpatient care, home health care, strong medical gear, and some preventive services.

Private insurance companies that follow rules set by Medicare are in charge of other Medicare parts.

  • Medigap strategies assist with paying Medicare copayments, coinsurance, and deductible costs from your own pocket.
  • Medicare Advantage Plan (also known as Part C) incorporates all advantages and services covered under Part A and Part B — prescription drugs and extra advantages like vision, hearing, and dental — packaged together in one arrangement.
  • Medicare Part D (Medicare physician endorsed drug coverage) helps cover the expense of doctor-prescribed medications.

Who qualifies for Medicare?

To be qualified for Medicare Part A and Part B, you should be a U.S. resident or a permanent legal citizen for a span of almost five years. You should likewise meet some of the accompanying requirements to be eligible for Medicare:

  • You are 65 years old or more and you or your life partner has worked for a minimum of 10 years in Medicare-covered employment.
  • You are 65 years old or more and you or your life partner has worked 30-39 quarters in Medicare-covered employment.
  • You are 65 years old or more and you or your life partner has worked 0-29 quarters in Medicare-covered employment. In addition to this, you should enroll as an independent enrollee and pay the entire Part A monthly premium.
  • You are younger than 65 years old with a disability and have received Social Security Disability Insurance (SSDI) or Railroad Retirement disability payments for 24 months.
  • You have amyotrophic lateral sclerosis (ALS) — also known as Lou Gehrig’s disease — and have received your first month of SSDI payments.
  • You have an end-stage renal disease (ESRD) — permanent kidney failure — and need dialysis or transplant.

Medicare eligibility for people 65 or older

When can I start receiving Medicare Part A benefits?

You can begin getting Medicare Part A benefits with no charge once you are 65 years old or more in the event that you or your life partner worked and paid Medicare charges for a minimum of 10 years. You can figure out if you are qualified for premium-free Medicare A or not, on the off chance that one of the accompanying concerns you:

  • You or your life partner served in a Medicare-covered government job.
  • You are presently qualified for Social Security or are already getting it.
  • You are qualified for Railroad Retirement Board (RRB) benefits or are already getting those payments.

On the off chance that you get Social Security or RRB benefits at least four months before turning 65, you will automatically get Medicare Part A. If not, you need to record an application with the Social Security Administration.

When can I start receiving Medicare Part B benefits?

You can decide to buy Medicare Part B benefits in case you are qualified for Medicare Part A. It is a deliberate program that expects you to pay month-to-month charges. For 2020, the standard premium is $144.60 (or higher relying upon your salary). On the off chance that you don’t take on Part B when you are first qualified, you might need to suffer a late enrollment penalty for as long as you have Part B coverage.

If you got Social Security or RRB benefits for a minimum of at least four months prior to turning 65, you will get Part B consequently (except if you live in Puerto Rico). You will have a decision assuming you need to keep or reject enrollment. On the off chance that you reject, you can re-enlist during a legitimate enrollment period. However, you will suffer a late enrollment punishment as long as you have the coverage.

Medicare eligibility for people under 65

When you are less than 65 years old, you are qualified for Medicare if you:

  • Have received Social Security Disability Insurance (SSDI) for 24 months.
  • Have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
  • Have end-stage renal disease (ESRD).

How to get Medicare Part A and Part B coverage?

  • Getting SSDI for 24 months means that you will automatically be enrolled in Medicare Parts A and B when the 25th month starts.
  • In case you suffer from ALS, you will unquestionably be enrolled in Medicare Parts A and B as soon as you receive the first month of SSDI benefits.
  • You must apply for Medicare benefits if you have ESRD. Qualifying for Medicare depends on a number of factors, such as whether you are receiving dialysis or not, have had a kidney transplant, and/or have effectively paid Medicare taxes.

Eligibility for Medicare due to a disability

You might fit the bill for Medicare because of a disability on the off chance that you have been getting SSDI checks for over two years, otherwise called the two-year waiting period. The two-year waiting period starts the main month you get an SSDI check. You will be consequently enrolled in Medicare toward the start of the 25th month that you get an SSDI check.

If you get SSDI due to the fact that you have Amyotrophic Lateral Sclerosis, or ALS, Medicare consequently starts the primary month that your SSDI benefits start. You don’t have a two-year waiting period. Government-backed retirement — not Medicare — causes the assurance of whether you fit the bill for SSDI checks and controls the program that gives the checks. For more data on the Social Security Disability Insurance program, it is suggested that you contact your local Social Security Administration (SSA) office.

Eligibility for ESRD Medicare

You may qualify for ESRD Medicare in case you have been diagnosed with permanent kidney failure and you:

  • Are getting dialysis treatments or have had a kidney transplant
  • You are eligible to receive SSDI
  • You are eligible to receive Railroad Retirement benefits
  • You, a spouse, or a parent have paid Medicare taxes for a sufficient amount of time as specified by the Social Security Administration

If you are less than 65 years old and have ESRD, your Medicare benefits depend on your specific circumstances, such as when you apply for Medicare, whether you receive dialysis at home or a facility, and whether you have had a kidney transplant or not. If you are qualified for ESRD Medicare, you can enroll in Parts A and B simultaneously at any time. Part A will be retroactive for up to 12 months, but it cannot start earlier than the first month you were eligible for ESRD Medicare.

Am I eligible for Medicare Part C?

Medicare Part C (also called Medicare Advantage ) is an alternative way to get your Medicare Part A and Part B benefits. Medicare Advantage plans are available through private guarantors. To be qualified for Medicare Part C, you should already be enrolled in Medicare Part A and Part B, and you should live within the service area of the Medicare Advantage plan you want. Moreover, you can get more information about and enroll in a Medicare Advantage plan by contacting an authorized insurance agent or representative, like eHealth.

The Medicare Advantage plan (Part C) Initial Coverage Election Period is generally the same as the Initial Enrollment Period for Medicare Part A and Part B (the seven-month time frame that starts 3 months before you turn 65, incorporates the month you turn 65, and finishes 3 months after the month you turn 65). Or then again, you can join during the Annual Election Period (AEP) from October 15 to December 7 for coverage starting from January 1 of the next year. You can also enroll during a Special Election Period (SEP) on the off chance that you qualify. In 2021 (starting January 1), you may qualify for a Medicare Advantage plan on the off chance that you have an end-stage renal disease (ESRD) and meet certain necessities.

Medicare Part C is optional, and there is no penalty for not having it. However, you should have Medicare Part A and Part B to get Part C and must be residing in the service area of a Medicare Advantage plan. On the off chance that you have Medicare Part C, you should keep paying your Part B expense regardless of whether you enroll in a Medicare Advantage plan or not. Month-to-month rates and plan coverage for Medicare Advantage plans vary on the basis of the insurance company you pick and your particular plan details.

Am I eligible for Medicare Part D?

Medicare Part D provides coverage for prescribed medications and, similar to Medicare Part C, is available through private backup plans that are approved by Medicare. To be qualified to enroll in a Medicare prescription drug plan (PDP), you should have Medicare Part A and/or Part B and you should be residing in the service area for the prescription drug plan in which you want to enroll. To be qualified to enroll in a Medicare Advantage plan with prescription drug coverage (MAPD), you should have Medicare Part A and Part B, and you should live in the service area for the MAPD plan you’re thinking about.

What is the maximum income to qualify for Medicare?

There are no income limits to get Medicare benefits. You may pay more for your expenses based on your degree of pay. On the off chance that you have restricted pay, you may qualify for assistance in paying Medicare expenses.

Numerous people will not even pay a single charge for Medicare Part A. Your Part A coverage is free insofar as you’re qualified for Social Security or Railroad Retirement Board benefits. You can also get premium-free Part A coverage regardless of whether you’re ready to get Social Security retirement benefits yet or not. Thus, in case you do not want to resign even if you’re 65 years old, you can in any case take advantage of Medicare coverage. Part A has a yearly deductible. In 2021, the deductible is $1,484. You’ll have to spend this amount before your Part A coverage takes over.

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For Part B coverage, you’ll pay a premium each year. Several people will pay the standard premium amount. In 2021, the standard premium is $148.50. Notwithstanding, on the off chance that you earn more than the already set pay limits, you’ll pay more for your premium. The added premium amount is known as an income-related monthly adjustment amount (IRMAA). The Social Security Administration (SSA) decides your IRMAA based on the gross pay on your tax return. In addition to this, Medicare utilizes your tax return from 2 years ago.

Medicare Part D is prescription drug coverage. Part D plans have their own separate expenses. The national base beneficiary expense amount for Medicare Part D in 2021 is $33.06. However, costs may vary. Your Part D premium will rely upon the plan you pick. Similar to your Part B coverage, you’ll pay an increased expense on the off chance that you earn more than the current pay level.

Furthermore, several people will pay the standard amount for their Medicare Part B expense. Nonetheless, you’ll owe an IRMAA in the event that you make more than $88,000 in a given year. For Part D, you’ll pay the premium for the plan you select. Moreover, contingent upon your pay, you’ll also pay an additional amount to Medicare.

There are various segments for married couples who file taxes independently. If this is similar to your filing circumstances, you’ll pay the following amounts for Part B:

  • $148.50 per month if you make $88,000 or less
  • $475.20 per month if you make more than $88,000 and less than $412,000
  • $504.90 per month if you make $412,000 or more

The charges for your Part B premium will be subtracted directly from your Social Security or Railroad Retirement Board benefits. In case you don’t get any of the benefits, you’ll get a bill from Medicare every 3 months. Similar to Part B, there are different segments for married couples who file independently. In this case, you’ll pay the following premiums for Part D:

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  • only the plan premium if you make $88,000 or less
  • your plan premium plus $70.70 if you make more than $88,000 and less than $412,000
  • your plan premium plus $77.10 if you make $412,000 or more

Medicare will bill you monthly for the additional Part D amount.

Medicare savings programs

There are four types of Medicare savings programs. Let us look at them in more delta below.

Qualified Medicare Beneficiary (QMB) program: You can qualify for the QMB program in the event that you have a month-to-month salary of under $1,084 and total assets of under $7,860. For married couples, the limit is below $1,457 monthly and below $11,800 altogether. You will not be answerable for the expenses of charges, deductibles, copayments, or coinsurance amounts under a QMB plan.

Specified Low-Income Medicare Beneficiary (SLMB) program: In the event that you earn under $1,296 a month and have under $7,860 in assets, you can qualify for SLMB. Married couples need to earn below $1,744 and have under $11,800 in assets to qualify. This program covers your Part B charges.

Qualifying Individual (QI) program: The QI program also takes care of Part B costs and is controlled by each state. Remember that you’ll have to reapply yearly, and applications are approved on a first-come, first-served basis. Moreover, you can’t qualify for the QI program in the event that you have Medicaid. On the off chance that you have a month-to-month salary of less than $1,456 or a joint monthly income of under $1,960, you are qualified to apply for the QI program. You’ll have to have under $7,860 in assets. Married couples need to have under $11,800 in assets.

Furthermore, salary limits are higher in Alaska and Hawaii for all programs. Additionally, if your salary is from work and advantages, you could qualify for these programs regardless of whether you earn a little above the limit. You can contact your state Medicaid office on the off chance that you believe you may qualify.

Qualifying Individual (QDWI) program: The QDWI program helps pay the Medicare Part A charge for certain individuals under the age of 65 who don’t qualify for premium-free Part A. You should meet the accompanying salary necessities to enroll in your state’s QDWI program:

  • an individual monthly income of $4,339 or less
  • an individual resources limit of $4,000
  • a married couple monthly income of $5,833 or less
  • a married couple resources limit of $6,000

Can you get Medicare if you’ve never worked?

Indeed, you can get Medicare if you never worked. However, you’ll have to pay a charge for Medicare Part A. In case you are a U.S. resident who is older than 65 and you or your life partner didn’t pay Medicare taxes for at least 10 years, you may be qualified to purchase Medicare Part A health insurance. In 2020, seniors who didn’t get premium-free Part A coverage paid $458 each month on the off chance that they paid Medicare taxes for under 30 quarters (7 ½ years); the individuals who paid Medicare taxes for 30 to 39 quarters pay $252 each month.

Moreover, you won’t be enrolled automatically, so you need to document an application with the Social Security Administration. You can then enroll in Medicare Part A and Part B for a month-to-month expense during a valid Medicare enrollment period. Remember that you can not purchase Part A alone.

Why are you forced into Medicare?

In the event that you or your life partner worked for at least 10 years in a task where Medicare taxes were retained (counting independent work where you paid your own independent work taxes), you’ll become unquestionably qualified for Medicare once you turn 65.

Late immigrants are not qualified for Medicare. However, whenever they’ve been legal permanent inhabitants for five years and are at least 65, they have the choice to purchase Medicare coverage — rather than getting Medicare Part A free of charge — which is the same alternative available to long-term U.S. citizens who, for some reason, don’t have a work record that allows them to have premium-free Medicare Part A (although the vast majority get Medicare Part A with no charges, it costs up to $458 each month in 2022 for individuals who have to get this is because they have zero to no years of work history). Furthermore, you must note that immigrants who proceed to work for at least 10 years in the US do then become qualified for premium-free Part A Medicare in case they’re 65 years old or more, actually like anyone else who has paid into the Medicare framework for at least a decade.

When you become qualified for premium-free Medicare Part A, you have to enroll in Medicare Part A or you relinquish your Social Security benefits. Most individuals are reluctant to relinquish their Social Security advantages, and accordingly, accept the enrollment into Medicare. Note that you’re simply needed to accept Medicare Part A — which is premium-free in case you’re getting Social Security benefits — to retain your Social Security benefits. Although you could be dependent upon a late enrollment penalty on the off chance that you decide to enroll in Part B at a later date, you are allowed to dismiss Medicare Part B — which has an expense — on the off chance that you decide to do as such.

There is a great deal of speculation about why the system is set up in this manner. Perhaps this approach was initially organized to make it easier for seniors to enroll in Medicare once they reached the age of 65, yet was never suspended when private coverage became more popular. Private coverage wasn’t as popular in the past as it is now, such countless older individuals were without health coverage before the presentation of Medicare. This introduced an issue when they inevitably required health care. Regardless of why the framework is set up in the manner that it is, these are the set rules, and they are not about to change in the near future.

Other ways to get Medicare coverage

In the event that you don’t qualify all alone or through your partner’s work record yet are a U.S. resident or have been a legal inhabitant for at least five years, you can get full Medicare benefits at age 65 or more. You simply have to get tied up with them by:

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  • Paying charges for Part A, the hospital insurance. The amount you would have to pay for Part A relies upon how long you’ve functioned. The more you work, the more work credits you will earn. Work credits are earned based on your salary; the amount of salary it takes to earn credit changes each year. In 2021 you earn one work credit for each $1,470 in earnings, up to a maximum of four credits each year. On the off chance that you have accrued less than 30 work credits, you pay the maximum premium — $471 in 2021. Moreover, on the off chance that you have 30 to 39 credits, you pay less — $259 a month in 2021. If you keep working until you gain 40 credits, you will at this point don’t pay these charges.
  • Paying the same month-to-month expenses for Part B covers specialist visits and other outpatient administrations, as different enrollees pay. In 2021 the amount is $148.50 for individuals with a yearly pay of $88,000 or less or those documenting a joint tax get back with $176,000 in pay or less. Rates are higher for individuals with higher livelihoods.
  • Paying the same month-to-month premium for Part D physician recommended drug coverage as others enrolled in the medication plan you pick.

You can enroll in Part B without purchasing Part A. In any case, on the off chance that you purchase Part A, you also should enroll in Part B. You can get Part D in case you’re enrolled in one or the other A or B. You cannot enroll in a Medicare Advantage plan, which is a private insurance alternative to Original Medicare, or purchase a Medigap supplemental insurance strategy except if you’re enrolled in both A and B.

Conclusion

Now that you have read this article, you know all about who qualifies for Medicare? Remember that you can only qualify for Medicare if you are a citizen of the United States or have been a legal resident for a minimum of 5 years.

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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