It is important to understand the Medicare eligibility requirements before submitting an application. Eligibility guidelines for Medicare are drafted by the federal government, and they define who can get Medicare and the costs you will have to pay for the different plans. To learn more about Medicare benefits eligibility requirements and costs, read the sections below.
Find Out Who Can Qualify for Medicare
Medicare eligibility is based on several factors. Medicare benefits eligibility is usually only available for senior citizens who meet the minimum age requirement, although there are a couple of exceptions to this rule. You must understand what qualifications you need to meet to get Medicaid given that some older residents who do not meet Medicaid’s minimum age requirement may still be able to apply. Younger people who have a certifiable qualifying disability and are already getting disability benefits from the Social Security Administration (SSA) may qualify for Medicare coverage after collecting disability benefits for a specific period. Younger people can also be considered eligible for Medicare if they have Lou Gehrig’s Disease or End-Stage Renal Disease, which is permanent kidney failure that needs either dialysis or a kidney transplant.
Download our free guide to learn more about the Medicare requirements and how to apply.
Other Medicare requirements include living in the United States or one of its territories. Even though you can qualify for Medicare coverage and live out of the country, you have to contact a U.S. Consular office to apply. The program will not pay for services if you are not legally present in the country or a U.S. territory, even if you meet the Medicare benefits eligibility to apply. Also, you may not be able to apply for Medicare Part B if you live outside the 50 states.
If you are in prison at the time you reach the minimum age requirement, you will not be eligible to apply or for benefits while you are in prison. However, you may learn about applying for Medicare benefits after being released. If you were enrolled before going to prison, then you will stay eligible for Medicare but you will not get coverage while in prison, as that is the responsibility of the correctional facility.
It is crucial that you understand that Medicare eligibility can change over time. Just because you meet Medicare benefits eligibility for one year does not mean that you will be eligible the next year. For example, younger people have different qualifications and could lose their benefits if they don’t meet the qualifications anymore. However, if you qualify for Medicare based on age, then you will not lose your eligibility as long as you meet all of the other requirements.
Learn Who Qualifies for Medicare Free of Charge
Apart from meeting Medicare eligibility for enrollment, you should see if you may qualify for premium-free coverage. Knowing who is eligible for Medicare for free is beneficial for those on a fixed income and in need of medical coverage. Seniors may qualify for Medicare Part A premium-free if they get or are eligible to get certain benefits from the SSA or Railroad Retirement Board. Former Medicare-covered government employees and their spouses can also be eligible for premium-free coverage. However, most applicants who are eligible for Medicare Part A premium-free are eligible because either they or their spouse have earned enough work credits from paying Medicare taxes while they were employed.
As long as you meet all the other Medicare eligibility criteria, you may be able to get Medicare Part A even if you did not pay enough in taxes, but there will be a fee. If you are not eligible for Medicare Part A premium-free because you did not earn enough work credits, then your premium amount for Medicare coverage will depend on the number of work credits you earned. Download our guide to learn about the coverage given by Medicare and more.
Discover How Income Affects Your Ability to Qualify for Medicare
Another factor that will affect your Medicare benefits eligibility is your income because it will influence the cost of your Medicare premiums. While you may qualify for Medicare Part A premium-free, your income will determine how much you pay for Part B and Part D. Many out-of-pocket costs will be based on a sliding scale, which means that the lower your annual income is, the less you will be expected to pay for your Medicare health insurance.
You may be eligible for both Medicare and Medicaid depending on your income. People who are eligible for Medicare and Medicaid are considered “dually eligible” and will normally pay less for health care services and have additional coverage benefits. This means that Medicare eligibility can also be affected by Medicaid eligibility. If you meet both Medicare and Medicaid qualifications, Medicaid may pay for some of your Medicare costs like deductibles, copayments, premiums, and max out-of-pocket expenses.