Medicare Eligibility

Are you eligible for Medicare Insurance, Medicare Benefits, and Medicare Supplements?

Medicare is a Federal run health insurance program which helps eligible recipients with healthcare related expenses. Medicare is structured by four parts: Part A, B, C, and D. Each part covers a separate and specific area in the Medicare health care system. There are four different important requirements you need to meet in order to be eligible for Medicare benefits. The following requirements include:

You must have paid taxes into the Medicare system for at least 10 years (usually automatically deducted from your paycheck)
You must be 65 years or older
You are under 65 years old with certain disabilities
You have End-Stage Renal Disease (ESRD)

Medicare Part A helps to cover care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term), hospice care, and some home health care. Most Medicare participants get Part A automatically when they turn age 65. Most eligible individuals do not have to pay a premium for Part A due to the following circumstances:

You receive or are eligible to receive Social Security benefits
You receive or are eligible to receive railroad retirement benefits
You contributed Medicare taxes when you were employed in a government job
You are the dependent parent of someone who worked long enough in a government job where Medicare taxes were paid.

If you don’t automatically get premium-free Part A, you may be able to buy it if:

You (or your spouse) aren’t entitled to Social Security because you didn’t work or didn’t pay enough Medicare taxes while you worked and you are age 65 or older.
You are disabled but no longer get premium-free Part A because you returned to work.

Medicare Part B helps to cover doctors’ services, outpatient hospital care, and some other medical services that Part doesn’t cover, such as the services of physical and occupational therapists, and some home health care. It also helps pay for these covered services and supplies when they are medically necessary. Enrolling in Part B is your choice; however, if you don’t take it when first eligible, penalties may occur. Any eligible recipient for Part A can enroll in Part B by paying a monthly premium.

Medicare Part C is also known as a Medicare Advantage Plan which is another Medicare health plan option you may have as part of Medicare. These plans are offered by private companies approved by Medicare that offer a variety of benefits to fit any individuals needs or budget. You are eligible to join when you are enrolled in Medicare Part A and B. A Medicare Advantage Plan will provide all of your Part A and B coverage and can include extra help such as vision, hearing, dental, and/or health and wellness programs. For these extra benefits, most people have to pay a monthly premium. There are different types of Medicare Advantage Plans available for purchase:

Medicare Preferred Provider Organization plans (PPO)
Medicare Health Maintenance Organizations (HMO)
Medicare Private Fee-for-Service Plans (PFFS)
Medicare Special Needs
Medicare Medical Savings Account (MSA)

Medicare Part D is prescription drug coverage. It helps to assist people with the high cost of prescription medication. There are two ways to get Medicare prescription drug coverage: Medicare Prescription Drug Plans and Medicare Advantage Plans. If you are enrolled in a Medicare Part A, B, or C, you are eligible, but since the program is voluntary there is a monthly premium that is to be paid to the insurance provider. Although, prescription coverage is voluntary you may be penalized if you do not join a plan when first eligible.

For more information on your Medicare eligibility and health insurance, contact ABC Healthcare Plans at (800) 707-5795 or request a quote by clicking the button above!