Medicare Health Insurance: Is Everyone Eligible?

Fran Majidi
August 21, 2019

Citizens and legal residents of the United States, who are 65 years old or older, are eligible for Medicare Part A, B, and C. Medicare Part D is for prescription drugs. Keep reading to learn about all four parts and options to Medicare.

Legal residents must have been legal residents for at least 5 years to be eligible. Younger people with disabilities and people with End Stage Renal Disease, permanent kidney failure requiring dialysis or transplant, are eligible and so are people with SSI or Railroad Retirement Board disability benefits for 24 months. Medicare comes with two parts, Part A (which covers hospitalization) and Part B (Medicare Insurance). You may have to pay a premium for Part A if you don’t fulfill these requirements: you are 65 or older and you or your spouse worked and paid Medicare taxes for 10 or more years; you are receiving retirement benefits from Social Security or the Railroad Retirement Board; you are eligible for Social Security or Railroad Retirement benefits; you or your spouse had Medicare-covered government employment.

If you didn’t pay Medicare taxes while employed, you may be able to buy Medicare Part A. If you’re not eligible for premium-free Part A, you will have to pay a monthly premium up to $437. You must also pay for Part B, which is about $135 on average. You may have to pay more for Part B if you have a substantial income.

People with Lou Gehrig’s disease qualify for benefits the first month they get disability benefits.

With Medicare Part B, the premium is deducted from your Social Security benefits or Railroad Retirement or Civil Service Retirement check. If you do not get these sorts of payments, Medicare will send you a bill for Part B every three months.

There is a 10% penalty for each full year if you don’t sign up for Medicare Part B when you first become eligible. Some exceptions apply.

Medicare Part C is also called Medicare Advantage. It is an alternative way to get the benefits of Medicare Part A and B but through private insurers. To be eligible for Medicare Part C, you must already be enrolled in Medicare Part A and Part B. You should also live in the area covered by the Medicare Advantage plan you want. A licensed health insurance agent can help you find the right plan you need if you begin.

Medicare Part D covers prescription drugs and is also available through private insurers. In order to qualify for Medicare Part D, you must have Medicare Part A and/or Part B and live in the service area of the drug plan you choose.

Medicare Advantage plan with prescription drug coverage (MAPD) also requires that you first have Medicare Part A and Part B.

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