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Age and Medicare Eligibility
If you are 65 or over, you are automatically eligible for Medicare. There are several conditions for those under 65 which will qualify you for Medicare as well. However, it is important to remember that if you or your spouse have worked for over ten years in a Medicare-covered job, are U.S. citizens or have been permanent residents for five continuous years and are 65 or over, you do not need to meet other conditions to be eligible for Medicare. If you are eligible for Social Security or Railroad Retirement Board benefits, then you are generally eligible for Medicare as well. Even if you have not paid enough into Social Security you can pay premiums to get Medicare benefits anyway if you 65 or over.
Other Medicare Eligibility
If you have End-Stage Renal Disease, meaning you need dialysis and/or a kidney transplant to live, you are generally eligible for Medicare even if you are under 65. You may also be eligible for Medicare when under 65 with certain other disabilities. If you have been receiving disability benefits from Social Security or Railroad Retirement for 24 months or more, you are eligible for Medicare Part A even if you are under 65.
How Medicare Eligibility Works
There are two parts to the basic Original Medicare Program, Part A and Part B. Individuals can supplement this if they choose with a Medicare Advantage Plan, Medicare Prescription Drug Plan or Medigap Plan. Part A is generally free to those who are eligible for Medicare, while maintaining Part B requires most people to pay a monthly premium.
Part A is your hospital insurance. This covers inpatient hospital care, skilled nursing facilities, hospice care and certain kinds of home care. If you are Medicare-eligible but for some reason you don’t automatically qualify for Part A, for example you did not pay enough into the program while you worked, you can usually pay a premium to get Part A coverage.
Part B is your medical insurance. This covers doctor’s visits, outpatient care and some other medical services when these services are medically necessary. Since most people are required to pay a premium for Part B even if they meet all Medicare guidelines, this portion of the program is optional. You can decline Part B and purchase it later, but if you do so, the premiums will be higher.
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