If you’re nearing retirement age, you may be wondering about Medicare eligibility. The good news is that most people qualify for Medicare at 65, regardless of their income or employment status. However, there are a few exceptions to this rule.
In this article, we’ll take a closer look at the requirements for Medicare eligibility and what to expect when you sign up for coverage. Plus, we’ll provide some tips on how to get the most out of your Medicare benefits using Nesso Senior Benefits.
Medicare: The Government’s Health Insurance Program
Before going through the requirements for Medicare eligibility, let’s look at what Medicare is and how it works.
What is Medicare?
Medicare is a health insurance program run by the federal government. It provides coverage for various medical services, including hospital stays, doctor’s visits, and prescription drugs.
How Does Medicare Work?
Medicare is a national health insurance program funded by the U.S. government for people aged 65 and older without health insurance that was created in 1965 through an amendment to the Social Security Act.
The program has extended coverage to people younger than 65 with certain disabilities or end-stage renal disease/amyotrophic lateral sclerosis (ALS). Also known as Lou Gehrig’s disease, ALS is a disease that involves the deterioration of motor neurons in the brain and spinal cord. Medicare consists of four components, each covering a different part of healthcare.
The Medicare program can be divided 4 parts according to what it covers:
Medicare Part A:
If you are enrolled in Medicare Part A, then costs for hospitals, hospices, skilled nursing facilities, and some home-based healthcare will be covered. Unfortunately, long-term or custodial care is not included in this plan. When you receive Social Security benefits, you will be automatically enrolled; however, if you don’t receive these benefits, enrollment can be done easily on the SSA website.
Medicare Part B:
Medicare Part B covers costs for outpatient care, such as doctor visits. It also covers preventive services, ambulance transport, medical equipment, and mental health.
In 2023, the monthly premium for Medicare Part B enrollees will be $164.90, down from $170.10 in 2022. The annual deductible is projected to be $226 in 2023, a decline from last year’s rate of $233.
Medicare Part C:
Consumers eligible for Medicare Parts A and B can also purchase Part C, known as Medicare Advantage, from private insurers. These plans cover individuals at least as well as Original Medicare (Parts A and B) does.
Original Medicare does not limit out-of-pocket costs annually. Patients would need to buy supplemental insurance, such as a Medigap plan, for benefits like copayments, deductibles, and coverage for travel outside the U.S. Some advantage plans might also cover dental, vision, and hearing needs. Hearing aids are not typically covered under basic Medicare. Still, some Medicare Advantage plans do offer hearing services as supplemental benefits.
Medicare Part D:
Medicare Part D fills prescription drug coverage gaps for Medicare Part A or B enrollees. Part D offers subsidies to help with the costs of prescriptions not covered under Original Medicare.
What Doesn’t Medicare Cover?
Medicare doesn’t cover the cost of some vital health care services, the most important being long-term custodial care. Medicaid pays for these costs, but not Medicare.
Some expenses that Medicare does not cover include:
- Eye exams and glasses
- Most dental care
- Medical care overseas
- Cosmetic surgery
- Massage therapy
Are Medicare & Medicaid the Same?
The government offers two separate health insurance programs: Medicare and Medicaid. Even though both services are government-sponsored, there are different rules on who is eligible for each program.
- Medicare typically assists those 65 years or older and younger individuals with specific health conditions. On the other hand, Medicaid is a fusion of state and federal help specifically designed to give low-income earners access to quality healthcare coverage. Qualifying for this type of assistance means that potential recipients can only have a limited number of liquid assets.
- Medicaid provides many services that people often need, like doctor and nursing care, hospitalization, home health care, and lab and X-ray services. Depending on your state, expanded coverage might be available for things like prescriptions, physical therapy, dental services, and more.
Qualifying & Enrolling in Medicare: Do You Have To Wait Until Retirement?
Who Qualifies For Medicare?
Here are the requirements and conditions to qualify for a Medicare plan:
- If you are 65 or older and have resided in the US legally for at least five years, then you are likely eligible for Medicare coverage.
- If you currently receive Social Security benefits, Parts A and B of Medicare will be automatic. Part D is optional, so if you want this type of coverage, you need to enroll in it separately.
- If you are under age 65 and receive Social Security Disability Insurance (SSDI), you may be eligible for Medicare. Generally, those who receive SSDI need to wait 24 months after receiving their first check before becoming eligible for Medicare; however, the program waives this requirement if you have ALS or permanent kidney failure.
How To Enroll in Medicare?
- If you are eligible for Social Security benefits at 65, you will automatically be enrolled in Medicare Part A (hospital costs) and Medicare Part B (doctor visits).
- To get Medicare Part D prescription drug coverage, you will need to sign up for it.
- The Social Security Administration benefits those who sign up for it on its website. You should do this within seven months of your 65th birthday.
Nesso Senior Benefits is Here to Aid You!
At The Nesso Group, we understand that navigating Medicare can be overwhelming. There is a lot of information to process, and the rules are always changing. We are honest and transparent, and we believe that every person’s needs are different. That’s why we’ll help you through all the moving parts to figure out a plan for you.
To be eligible for Medicare, you must be a USA citizen or a permanent resident and have lived in the country continuously for at least five years. We know that figuring out Medicare can be daunting, but we’re here to help. Call us today, and let us help you find a plan that works for you.