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Do I Qualify: Understanding the Criteria for Medicare Eligibility

You already know that Medicare provides a safety net for various medical expenses. But who can take advantage of this valuable program? Are you almost 65 or have a disability? This article explores the different ways people can become eligible for Medicare and helps you determine if you qualify for coverage.



Age and Medicare

The most common route to Medicare eligibility is through age. Specifically, when you turn 65, you’ll be able to apply when you first become eligible during the Initial Enrollment Period. 


This period begins three months before your 65th birthday, includes your birthday month, and the three months after. However, people with certain conditions can get Medicare benefits before 65.  


Disability and Medicare coverage

If you are not yet 65 but have a qualifying disability, you might still be able to get Medicare. Individuals who have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months automatically get enrolled in Medicare Part A and B. 


Medicare for end-stage renal disease (ESRD)

End-stage renal disease (ESRD), a condition where the kidneys no longer work and you need dialysis or a kidney transplant, can qualify you for Medicare no matter how old you are. If you have ESRD, you do not need to wait until you are 65 to get Medicare. 


Medicare for ALS (Amyotrophic Lateral Sclerosis)

If you have been diagnosed with ALS, also known as Lou Gehrig's disease, you can enroll in Medicare before you turn 65. And you don’t have to wait long before you become eligible. You get automatic enrollment the first month you receive Social Security Disability benefits. 


Who’s eligible for free Medicare Part A?

Most people do not have to pay a premium for Medicare Part A. This is called "premium-free Part A." You can get this if you or your spouse worked and paid Medicare taxes for at least 40 quarters, which is usually about 10 years.


If you have worked and paid these taxes for that long, you will not have to pay for Part A when you are eligible for Medicare. 


Who’s eligible for free Medicare Part B?

Medicare Part B usually requires everyone to pay a monthly premium. However, there is help available for some people to pay these costs. If you are in the low-income bracket, you may qualify for help through the state-run Medicaid program.


Medicaid can help cover the monthly premiums and other costs, making it easier to afford the healthcare you need.


How about Medicare Advantage and supplement plans? 

You can qualify for Medicare Advantage and Medicare supplement (Medigap) plans when you qualify for Medicare. 


However, the cost may be higher or lower depending on whether you are under 65 or over. Also, it may be challenging to find an affordable Medigap plan if you are under 65, making Medicare Advantage the better option for many people. 


Get help finding the right Medicare plans for your needs

Understanding Medicare eligibility is important for planning for your healthcare future. Even if you are still far from turning 65, knowing your options can help you make better decisions. Call us today to navigate Medicare and find the best plans for your health and finances.

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