How to Be Eligible for Medicare

Becoming eligible for Medicare benefits can often seem like a time consuming, obfuscated process fraught with red tape. And that’s probably because it is. However, knowing the requirements of Medicare eligibility before beginning this process can help a lot in knowing what to expect from the whole ordeal. Here is an outline of the basic requirements necessary to be eligible for Medicare part A and Part B benefits:

Residency Requirement

In order to be eligible for Medicare coverage, the applicant must be an American citizen or permanent residence who has lived within the United States for at least 5 years in total.

Age Requirement

The applicant must also be aged 65 or older and eligible for receiving social security benefits. The applicant may have been automatically enrolled in Medicare Part A, which covers hospitalization, upon turning 65, but if they also want to obtain Medicare Part B coverage, which covers medical expenses, they will have to enroll in it specifically. That is, unless the applicant is already receiving social security benefits or benefits from the railroad retirement board, in which case they will automatically receive Medicare Part A and B coverage on the first day of the month in which they turn 65.

Disability

If the applicant is not aged 65 or older and eligible for social security benefits, they may still be eligible for Medicare Parts A and B coverage if they are permanently disabled and have been receiving disability benefits for two years (24 months) prior to the time of application.

Special Cases

Individuals may also obtain eligibility if they have End Stage Renal Disease or Amyotrophic Lateral Sclerosis.

Premiums

Most people will not need to pay a monthly premium for their Medicare Part A coverage if they or their spouse has been working and paying Medicare tax on that income for at least 10 years or 40 quarters. However, in the case that the applicant is not eligible for this premium-free membership, they may need to pay a monthly premium of up to $407 in 2015. They must also pay a premium for Medicare Part B coverage as well. For most people, that is the standard monthly amount of $104.90, although some people with higher incomes may need to pay more in the coming years. If there is a delay between when the person applies for part B coverage and when they first became eligible for that coverage, a fee of 10% for each 12 month period waited could be charged at the time of enrollment.

Parts C and D

Medicare coverage Parts C and D are also available from private insurers. Part C, also called Medicare Advantage is an alternative to Parts A and B. To get it, the applicant must already be enrolled in Parts A and B and live within the designated coverage area of the plan that they want. Part D is designed to cover the costs of prescription drugs and medications and has similar eligibility requirements to Part C.