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Who qualifies for the different Medicare benefits?

Have you been curious lately on who exactly qualifies for Medicare benefits? Sometimes Medicare qualification can get confusing – but it doesn’t have to be.

Keep reading to learn important details everyone must know about Medicare.

Who Qualifies for the Different Medicare Benefits?

First, let’s go over who qualifies for Medicare benefits. Typically Medicare is available to those that are 65 years or older, younger people that have disabilities, or those with End-Stage Renal Disease.

There are different parts of Medicare that cover different services and the qualifications for each vary. Part A provides inpatient and hospital coverage. Part B provides outpatient/medical coverage. Part C offers an alternative way to receive Medicare benefits and Part D provides prescription drug coverage.

Medicare Part A and B

To receive Part A and Part B you have to either be a U.S. Citizen or a permanent legal resident for a minimum of five years straight. You also have to fall into one of the following criteria:

  • Permanently Disabled – If you are permanently disabled and receive disability benefits for a minimum of two years from Social Security or from the Railroad Retirement Board you automatically receive Part A and Part B Medicare.
  • End-Stage Renal Disease (ESRD) – this is also known as permanent kidney failure that requires either a transplant or a dialysis treatment. Keep in mind enrollment isn’t automatic, which means you will have to sign up for Medicare.
  • 65+ years old – when you reach the age of 65 you may be automatically enrolled in Medicare Part A plus become eligible for Social Security. If you are not retired yet you have to sign up for Medicare Part B because your enrollment won’t be automatic. If you are receiving benefits from Social Security or the Railroad Retirement Board you will automatically be enrolled in Part A and Part B Medicare on the first day of the month that you turn 65.

You won’t have to worry about paying premiums if you are eligible to receive Social Security or Railroad benefits but you haven’t filed for them, or if you are already receiving benefits from Social Security or the Railroad Retirement Board. If you or your spouse had Medicare-covered government employment then you won’t have to pay premiums either.

If you worked and paid Medicare taxes for at least 10 years then you’re eligible for premium-free Part A as long as you are 65 years old. If you’re not eligible for a free premium at the time of this writing you will have to pay a monthly premium of up to $458 in 2020.

Medicare Part B everyone that wants the coverage has to pay for it. Unlike Part A where you might qualify for a free premium. In 2020 the standard Part B premium is $144.60. Those that have a higher income might have to pay more for their Part B premium.

The monthly premium for Part B is deducted from either your Civil Service Retirement check, your Social Security, or your Railroad Retirement. If you don’t receive any of the payments listed above then Medicare will send you a bill every three months. You don’t want to skip out on signing up for Medicare Part B when you become eligible.

They might charge you a 10% penalty for each 12-month period that you didn’t sign up but you could have signed up for it.

Medicare Part C

This Medicare is also known as Medicare Advantage. This is an alternative way to receive your Medicare Part A and Part B benefits. These plans are available through private insurers.

To be eligible you will have to be enrolled in Medicare Part A and Part B, and you have to live within the service area of the Medicare Advantage plan that you want. To get more information about Medicare Advantage plans you can contact 1-800-MEDICARE 24/7.

The Enrollment period for Medicare C is typically the same as the enrollment period for Part A and Part B. It’s a seven month period that starts three months before the month you turn 65. The enrollment period ends three months after the month you turn 65.

There is also an Annual Election Period from October 15 to December 7th where you can apply for coverage that’s effective January 1st of the following year.

Keep in mind that Medicare Part C is completely optional and if you choose to not sign up, there’s no penalty. If you choose to sign up you will need to have Part A and Part B in order to qualify.

Medicare Part D

Part D covers prescription drugs and is available through private insurers just like Part C. These private insurers have to be approved through Medicare and include companies such as MedicareWire. In order to enroll for Medicare Part D you have to have both Medicare Part A, Part B, and live in the service area for the Medicare Advantage Plan with prescription drug coverage (MAPD).

Do You or Someone You Know Qualify for Medicare?

Now that you know who qualifies for medicare benefits you’re probably feeling like a pro. Hopefully, we cleared up any confusion you might have had previously about you or a loved one qualifying. Don’t forget to pick your coverage carefully and don’t rush the process.

How you end up choosing to get your benefits can affect your out-of-pocket costs and where you can get your care which is why it’s wise to carefully choose your coverage to fit your specific needs.

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