How Do You Know If You Qualify for a Medicare Plan?


We live in a time where health insurance is no longer a luxury, but rather a necessity. The prices of medical care in the USA can be extremely high and if you are not covered by a proper plan, you can lose a lot of money or worse; not get treated because you can’t afford the costs. This is even more important as you grow older since health problems are more frequent and so are the medical bills. This is why Medicare was created over 50 years ago. But how exactly do you know if you qualify for a Medicare plan?

Legal Requirements 

Before we get into the technical aspects, you should know what the basic requirements are to qualify for a Medicare plan. You have to be an American citizen or have permanent legal residency for at least 5 years in a row. So, living in the country for a couple of years is not enough to qualify for Medicare. Assuming that is out of the way, let’s discover more about what it takes to qualify for  Medicare plans A and B.

65 Years or Older 

The great thing about Medicare Part A is the fact that you automatically get enrolled in it once you turn 65. This is basically hospital insurance, which you will need for any recurrent visits, hospice, and other medical bills. This part also includes home health care in case you need some nursing help. Medicare Part B, on the other hand, covers outpatient care like x-rays, tests, doctor visits, preventative care, and others. As you can see, the two parts complement one another, and they are part of a comprehensive healthcare insurance policy that all seniors need to cover their medical expenses in the long run. You can also be eligible for Part A when you turn 65 and not have to worry about paying premiums if the RRB, also known as the Railroad Retirement Board, or Social Security are providing you with retirement benefits. You should know, though, that enrollment in Part B isn’t automatic if you are not getting retirement benefits, so you must sign up for it when you turn 65.


Permanent Disability 

The second way you can qualify for Medicare Parts A and B is if you have a permanent disability. If you have been receiving disability benefits for two years, you automatically get both parts. As you can see on, sometimes people get Medicare supplemental plans if they are disabled and under 65. This means that you don’t have to wait until you turn 65 to get enrolled in a health insurance plan if you are suffering from a disability. This definitely helps for people who need frequent doctor visits because those can be extremely costly if you don’t have a Medicare plan covering you. 

Certain Conditions 

There are some medical conditions that qualify you for Medicare, even if you are not 65 yet. Those include end-stage renal disease –– kidney failure, which requires dialysis or a transplant –– and in this case you have to sign up for the parts as you are not automatically enrolled. If you have Lou Gehrig’s disease, though, you automatically get Medicare parts A and B as soon as your disability benefits start. 

What About the Premiums?

For Medicare Part A, you don’t have to pay premiums if you or your spouse paid the designated Medicare taxes before retirement for at least 10 years. If you don’t qualify for the premium-free Part A, then you will need to pay a monthly premium just like with Part B premiums which you will pay monthly either way. 

Other Parts 

Parts A and B aren’t the only available Medicare options. You also have Part C, which is administered by private insurance companies and covers the same angles as A and B –– and in some cases, it offers additional benefits. You can’t qualify for Part C, though, unless you already have the other ones. Medicare Part D, on the other hand, covers prescription drugs, and you can also get it through private insurers. This makes it much easier for people to buy the necessary drugs they need to treat a certain illness without the obligation to pay a lot of money. Parts C and D are optional and you don’t have to get them. 

Medicare can make a huge difference in your life by helping you cover much of your medical expenses. This makes it much easier for seniors and people with disabilities to enjoy a stress-free life as they can have their medical bills covered without having to worry about securing the necessary money for that. It is important, though, that you learn about your state requirements regarding each of the plans because they might vary from one to the other.

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