Who can get Medicare?

Who can get Medicare?

Original Medicare

Most U.S. citizens earn the right to enroll in Medicare by working and paying their taxes for a minimum required period. Even if you didn’t work long enough to be entitled to Medicare benefits, you may still be eligible to enroll, but you might have to pay more. Medicare beneficiaries include:

  • People age 65 or older
  • People under age 65 with certain disabilities who have been receiving Social Security Disability Insurance (SSDI) for 24 months, and
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

In addition, those with ALS, or Lou Gehrig’s disease, are covered by Medicare in the first month they start receiving SSDI benefits.

In order to qualify for full Medicare benefits at 65, you must be a U.S. citizen or must have been a legal resident for at least 5 years.

In order to qualify for premium-free Part A (hospital insurance) at age 65, you or your spouse must have worked long enough (usually 10 years) to be eligible for Social Security benefits. You can get premium-free Part A at age 65 if:

  • You receive retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you haven’t yet filed for them.
  • You or your spouse had Medicare-covered government employment.

 

Note:While most Medicare beneficiaries don’t pay a premium for Part A, every Medicare beneficiary pays a premium for Part B, whether it is taken out of your Social Security, Railroad Retirement or Civil Service Retirement check, or you are billed directly by Medicare.

If you are uncertain whether you qualify or how much you owe in premiums, try Medicare’s eligibility and premium calculator. Also, take our brief quiz to make sure you qualify for Medicare.

Medigap

Medigap is supplemental insurance for Original Medicare that helps pay for certain out-of-pocket expenses associated with Medicare. To be eligible for Medigap, you must:

  • Have Medicare Part A and Part B.
  • Be enrolled in Original Medicare. (You can’t have Medigap with Medicare Advantage plans).
  • Live in the service area of the plan you wish to join.

Medicare Part C

Medicare Advantage is an alternative to Original Medicare offered through a private insurer. Medicare Advantage, or Part C, has its own set of rules for eligibility. To be eligible for Part C, you must:

  • Be enrolled in Part A and Part B.
  • Reside within the service area of the Medicare Advantage plan.
  • Not have ESRD (End Stage Renal Disease), with some exceptions.

Medicare Part D

Medicare Part D is prescription drug coverage which is offered through private insurance companies that contract with Medicare.

You can either get Part D as a stand-alone plan (PDP), or Part D that is part of a Medicare Advantage plan (MAPD).

To be eligible for a Medicare prescription drug plan (PDP), you must:

  • Have Medicare Part A and/or Medicare Part B.
  • Live in the service area of the prescription drug plan you choose.

To be eligible for a Medicare Advantage plan with prescription drug coverage (MAPD), you must:

  • Have Medicare Part A and Part B.
  • Live in the service area of the prescription drug plan you are choosing.
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