It is important to understand the Medicare eligibility requirements prior to submitting an application. Guidelines on eligibility for Medicare enrollment are federally mandated and clearly stated for any potential applicants. Not only do these set Medicare qualifications determine whether you can obtain Medicare coverage, but they also outline the costs you will be expected to pay for your Medicare plans. For your convenience, you can learn more about Medicare benefits eligibility and cost estimates in the sections provided below.
WHO QUALIFIES FOR MEDICARE?
Medicare eligibility is based upon a number of deciding factors. Medicare benefits eligibility is reserved for senior citizens who meet the minimum age requirement. However, there are a couple of exceptions to this rule. It is crucial to understand what qualifications need to meet to obtain Medicaid, as some older residents who do not meet Medicaid’s minimum age requirement may still be able to enroll. Younger people who have a qualifying certified disability and are already receiving disability benefits from the Social Security Administration (SSA) may qualify for Medicare coverage after collecting disability benefits for a certain period of time. Younger individuals may also be considered eligible for Medicare if they have Lou Gehrig’s Disease or End Stage Renal Disease, which is permanent kidney failure that requires either dialysis or a kidney transplant.
Download our free guide to learn more about Medicare requirements.
Other Medicare qualifications for enrollment include living in the United States or one of its territories. While you may qualify for Medicare coverage and live outside of the country, you must contact a U.S. Consular office to enroll. 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 for enrollment. Furthermore, you may not be able to enroll in Medicare Part B if living outside of the 50 states.
You do not qualify for Medicare if you are incarcerated when you reach the minimum age requirement. However, you may learn about applying for Medicare benefits after being released. If you were enrolled prior to incarceration, then you will remain eligible for Medicare but the coverage will not pay for your medical care while detained, 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 one year does not necessarily mean that you will be eligible the next year. For example, those who are younger than the minimum age requirement have different qualifications and could lose Medicare benefits if those qualifications are no longer met, such as after a recovery from an illness or disability. However, if you qualify for Medicare based on age, then you likely will not lose your eligibility.
QUALIFYING FOR PREMIUM-FREE MEDICARE
In addition to meeting Medicare eligibility for enrollment, applicants should determine if they 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 collect or are eligible to collect certain benefits from the SSA or Railroad Retirement Board. Former Medicare-covered government employees and their spouses may also be eligible for premium-free coverage. However, most petitioners who are eligible for Medicare Part A premium-free coverage are eligible because they or their spouse have earned enough work credits from paying Medicare taxes while employed.
As long as you meet all other Medicare eligibility criteria, you may be able to obtain Medicare Part A even if you did not pay enough in taxes, but there will probably 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 did earn. Download our guide to find out more about coverage.
HOW INCOME AFFECTS YOUR ABILITY TO QUALIFY FOR MEDICARE
Another element that will affect your Medicare benefits eligibility is your income, as 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 upon a sliding scale. This means that the lower your annual income, the less you will be expected to pay for your Medicare health insurance.
Additionally, you may also be eligible for both Medicare and Medicaid depending on your level of income. Individuals who are eligible for both Medicare and Medicaid are considered “dually eligible” and can generally expect lower costs for health care services as well as additional coverage benefits. Therefore, Medicare eligibility can also be affected by Medicaid eligibility. If you meet both Medicare qualifications and Medicaid eligibility, then it is also possible that Medicaid may pay for some of your Medicare costs such as deductibles, copayments, premiums and max out-of-pocket expenses.