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Medicare Eligibility: Breaking Down The Different Parts

Posted by : Premraj | Posted on : Wednesday, March 25, 2020


While Medicare is fairly simple to define — it being the federal health insurance program that gives benefits to a select group of the population including seniors and people with disabilities — it’s comprised of several parts and therefore can be hard to navigate. With this in mind, this article will define who is eligible for Medicare and when, as well as the varying costs associated with enrolling.

Medicare Eligibility Part A and Part B

Eligibility requirements are some of the most common questions insurers get regarding Medicare. So, to start here are some basic conditions of which you have to meet at least one to qualify for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance):

— American citizen or permanent legal resident of at least five continuous years

— 65 years or older and eligible for Social Security

— Are permanently disabled and receive disability benefits for at least 24 months

— Have end-stage renal disease(ESRD), even if you’re under 65 (you will still need to sign up for Medicare, as your enrollment isn’t automatic)

— Have Lou Gehrig’s disease, Amyotrophic Lateral Sclerosis, or ALS, even if you’re under 65 (The month your disability benefits begin, you are automatically enrolled in Part A and Part B)

— You’re under 65, permanently disabled and you’re receiving disability benefits from Social Securityor the Railroad Retirement Board

It’s also important to note that there are no illnesses or underlying conditions that disqualify people for Medicare coverage. And for most who meet eligibility requirements, they won’t be forced to pay a premium for Medicare Part A as long as they or their spouse paid Medicare taxes while working for at least 10 years. Medicare Part B usually requires paying a premium to enroll, but the monthly cost varies depending upon income.

Eligibility For Medicare Part C

Otherwise known as Medicare Advantage, Medicare Part C is an alternate way to gain access to both Medicare Part A and Part B benefits. Medicare Advantage plans are offered through private insurers, and eligibility for Medicare Part C is only available to those already enrolled in Medicare Part A and Part B. Also, if you do sign up for Medicare Advantage, you must continue paying your Part B premium. Other restrictions include parties must reside within the service area of whichever Medicare Advantage Plan they wish to join. And for those with end-stage renal disease, you may not qualify for most Medicare Advantage plans. However, there is one type of Medicare Advantage plan that’s exclusively for people facing ESRD, so check with a trusted insurer for more information.

Eligibility for Medicare Part D

Medicare Part D is another optional benefit offered through private insurers, which provides prescription drug coverage. To partake in this type of coverage, you have to be enrolled in at minimum Medicare Part A, and you must reside within the service area for the prescription drug coverage you wish to join.

If you are enrolled in a Medicare Advantage Plan, you should already have some form of prescription drug coverage included, and the same guidelines for eligibility apply as listed above.

Finding the Right Coverage

Hopefully, this gives you a clearer picture of what is needed to become eligible for Medicare. However, if you need further assistance, consider a trusted resource like Anthem, which can answer any questions you may have and help you enroll as quickly as possible.


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