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Medicare Eligibility Requirements

Who is Eligible for Medicare?

The price of medical bills and maintaining your health can be quite overwhelming to anyone. As people approach the age of 65 and start retiring they need to consider how they will pay for these constant medical expenses. The US Government has established Medicare, a health insurance system to aid US citizens in meeting the costs of their healthcare. However, being a US citizen age 65 or older is not the sole requirement for receiving Medicare. You may also qualify to receive for the Medicare benefits if you are under the age of 65 and have certain disabilities or if you have permanent kidney failure. Find more information on Medicare eligibility for those collecting Social Security here. Since all Americans have different medical and financial needs, it is important to pick the health insurance plan that works best for you.

Which Medicare Plan Are You Eligible For?

The Medicare Health Insurance Program consists of four parts, Part A, B, C, and D.  While Part A, B, and D are all grouped similarly as a part of the Original Medicare Plan, Part C is known separately as Medicare Advantage Plan.

Part A:
When you register to receive Medicare Part A, you will be covered for hospital insurance.  While Part A covers most necessary medical hospital services, it does not cover all expenses. The medical expenses covered by Medicare Part A include inpatient care in hospitals (over-night hospital care and treatment for a minimum of three days, 72 hours), blood transfusions (units of blood received at the hospital), skilled nursing facility care (brief period care at a facility or at a nursing home after medical treatment in the hospital), hospice (at home support services for terminally ill patients), and home health care services (part time nursing care service and equipment for ill at home). The payment of a premium is not common for Medicare Part A, since most payments are taken from a paycheck for those who work.  You are eligible for Part A if you meet any of the listed qualifications for Medicare.

Part B:
Most Medicare providers require that you also get Medicare Part B coverage when you apply for Part A. Medicare Part B is medical insurance.  These are all the other expenses that your medical needs may require that are not covered in Part A. This can include necessary doctor services’ (doctor visits or medical advice), and outpatient care (medical service that does not require overnight stay in the hospital or may not even include a hospital visit). Medicare Part B is important for those with diabetes or at risk for diabetes because it covers many costs associated with diabetes. Also, Part B covers many necessary preventative shots (such as the flu shot or hepatitis B). However, unlike Part A, Medicare Part B requires a monthly premium around $96.40 a month.  If you qualify for Part A, you will likely qualify for Part B.

Part D:
Medicare Part D may also be added to your Medicare Plan coverage. Part D covers prescription drug costs, which is done through private companies approved by Medicare.  This, too, requires a premium monthly payment. To receive coverage from these private companies, you must either join a Medicare prescription drug plan or choose the Medicare Advantage Plan, Part C (which already covers Part D). Medicare Part D will cover your necessary prescription drugs. Depending on the costs of your prescription drugs, you may have co-pay fees. If you are eligible to receive Part A or Part B Medicare, then you are eligible to receive Part D.

Are You Eligible For The Medicare Advantage Plan (Part C)?

Part C:
Medicare Part C is the Medical Advantage Plan whose services are performed by private companies also approved by Medicare. Part C combines Part A and B as well as any other necessary medical services a person may require (drug prescription, hearing, and vision services). Many people will opt for this plan because it offers the ability to add a wide range of service coverage to their medical insurance plan, but Plan C is not offered in every state. However, most Medicare Advantage Plans consist of particular doctors and hospitals in an area that a person must use in order to receive coverage for the medical treatment they receive. In addition to the premium paid for Part B Medicare coverage, a person receiving Part C coverage will have to pay a monthly premium.  There are several Medicare Advantage Plans available to you. These plans include Medicare Health Maintenance Organizations (HMO), Medicare Preferred Provider Organization plans (PPO), Medicare Private Fee-for-Service plans (PPFS), Medicare Special Needs, and Medicare Medical Savings Account (MSA).

Today, there are over 40 million Americans who experience the benefits of Medicare health insurance coverage.