More than 28 million Americans don’t have health insurance coverage.
So, if they’re diagnosed with a serious illness or they need to get surgery, they’ll have to worry about thousands of dollars in medical bills on top of the stress from being in the hospital.
Fortunately, Medicare can help alleviate that concern, though only for those who qualify. It can sometimes be difficult to understand who qualifies for Medicare, so you may be missing out on the opportunity for coverage without realizing it.
So, what are the Medicare eligibility requirements, and do you meet them?
We’re here to help. Read this guide to learn more about Medicare, who qualifies for it, average costs for coverage, and how to apply.
What Is Medicare?
In short, Medicare is a health insurance program created by the federal government. It’s made up of the following parts, to help cover specific things.
Medicare Part A
This is a form of hospital insurance that helps cover the cost of hospital stays. It’s also used to cover the time spent in a nursing facility or under the care of hospice. In some cases, it can also cover the costs of home health care.
Medicare Part B
Medicare Part B is used most often. It covers the cost of doctor’s visits and medical supplies you may need. It also covers preventative care and outpatient services as needed.
Medicare Part C (Medicare Advantage)
This is available through private insurers and you must already be enrolled in Medicare Part A and Medicare Part B to qualify. You need to work with a licensed insurance agent to see if Medicare Advantage is available to you.
Medicare Part D
If you require longterm use of medication, you understand the importance of having access to lower prescription costs. Medicare Part D helps with that. It helps covers the cost of many prescription drugs, vaccines, and shots to keep you healthy.
Medicare Eligibility Requirements
Now that you know about the primary parts of Medicare, you can see how helpful it is for those who qualify. So, are you eligible? Here’s a breakdown of the eligibility requirements.
Those Over 65
U.S. citizens and permanent residents over the age of 65 are eligible for Medicare coverage. If you meet the following qualifications, you don’t have to pay premiums for Medicare Part A coverage:
- You receive benefits from Social Security or the Railroad Retirement Board
- You are eligible for Social Security or the Railroad Retirement benefits but are not yet collecting them
- You or your spouse works or worked for the government and has paid into Medicare payroll taxes
If you don’t meet those qualifications but you’re over 65, you may be able to buy Medicare Part A coverage.
Even if you’re over the age of 65, you’ll have to pay for Medicare Part B coverage if you want to use it. However, everyone that qualifies for Medicare has access to the Medicare Part D prescription drug coverage.
Those Under 65
If you’re under the age of 65, you may also qualify for Medicare coverage. Here are the qualifications you must meet:
- You’ve been eligible for Social Security for at least 24 months (consecutive or non-consecutive)
- You’ve received a disability pension from the Railroad Retirement Board
- You have amyotrophic lateral sclerosis (ALS or Lou Gherig’s disease)
- You have End-Stage Renal Disease and require a kidney transplant or regular dialysis
- You are permanently disabled and have received disability benefits for a minimum of two years
If you meet any of these requirements, then you can take advantage of the Medicare options that are available to you.
Average Medicare Costs
As with any health insurance, the costs you can expect to pay for Medicare vary based on a number of conditions. However, there are some average figures you can use as a guideline when seeing if you qualify for Medicare coverage.
Medicare Part A Costs
As we mentioned above, many people don’t have to pay any premiums for Part A coverage. If you do have to pay, the max amount is $458 per month. The total amount you pay is based on how long you’ve paid Medicare taxes.
Medicare Part B Costs
Part B costs are based on your income level. The standard premium is $144.60, but it can be higher if you have a higher income level. After meeting your deductible of $198, you’ll have to pay 20% on services covered by Part B.
Medicare Part C Costs
As a private insurance plan, Part C costs vary depending on the plan. You can compare costs for specific plans before you buy to get the best possible premium.
Medicare Part D Costs
Part D prescription drug coverage also varies by plan. And, as with Part B, your monthly premium is dictated by your income. If you have a higher income level, you can expect to pay a higher premium.
How to Apply for Medicare Coverage
Now that you know more about the different Medicare plans, you can start the application process if you meet the qualifications.
You can apply for Medicare online, and see all the plans for which you qualify. There are also helpful checklists on the Medicare.gov website as you navigate your new health coverage.
Depending on your circumstances, you may be able to enroll right away, if you qualify for a Special Enrollment Period.
Once you’re enrolled in Medicare, you can also manage your benefits online and make adjustments as needed.
Medicare Can Help You Prepare for the Worst
Not having health insurance coverage, especially as you get older, is stressful. By reviewing the Medicare eligibility requirements, you now have the knowledge you need to know if you qualify for this coverage.
Not taking advantage of what’s available to you could quite literally be a matter of life and death.
Looking for more ways to take control of your health? Browse through our other helpful articles before you go.