Overview of Medicare
Medicare is a federal health insurance program that provides coverage to people who are 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease. The program is funded by taxes and monthly premiums, and it covers a range of health care services.
Here, we will discuss the qualifications needed to be eligible for Medicare and what types of coverage it offers:
What is Medicare?
Medicare is a type of health insurance run by the US government available to people 65 years or older and certain younger people with disabilities. It includes hospital insurance (Part A) as well as medical and prescription drug coverage (Part B, Part D, or both). It pays for doctor visits, lab tests, hospital stays, surgeries, preventive care, emergency services and other necessary medical treatments.
Medicare can also provide additional coverage through Advantage plans or Medigap policies to help you pay out-of-pocket costs like copays, coinsurance and deductibles. Your Medicare eligibility is based on several factors including age; whether you’re receiving Social Security retirement benefits; if you have a disability or end-stage renal disease; or if you’re a veteran with service-related disabilities.
If you qualify for Medicare based on your age, then you are automatically enrolled in Part A. You will need to apply for the other parts of Medicare separately and pay premiums depending on the selection that best suits your needs.
To be eligible for Medicare in the United States, one must be 65 years of age or older, or have certain health issues such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). You must also be a citizen an Enrolled Tribal Member or a legal resident of the US for a least five continuous years.
For those with ESRD, Medicare will cover 80% of the costs associated with dialysis treatments and other related procedures. Additionally, those who qualify because of ALS may receive service from any healthcare provider that will accept Medicare assignment and agree to charge no more than the applicable Medicare fee.
People who are diagnosed with breast cancer are also eligible for coverage under one of two main plans; these plans are often referred to as “Part A” and/or “Part B”. Part A covers hospitalization benefits, whereas Part B covers physician services, outpatient services and durable medical equipment (DME). It is important to note that neither of these plans provides relief from prescription drug costs. To receive assistance towards drug costs individuals should look into obtaining a separate prescription drug plan.
Medicare coverage can also assist certain qualifying individuals who need home health care services such as physical therapy due to an illness or disability. These services must be ordered by a physician, as well as deemed medically necessary by Medicare before they can be covered by the program. Successful applicants may receive help with nursing care, home health aides and medical supplies needed for treatment at home; however not everyone is able to benefit from this type of care depending on their medical condition(s).
Who Is Eligible for Medicare?
Medicare is a government health insurance program designed to provide health coverage to those over the age of 65 and certain disabled individuals. But not everyone is eligible for the program. To determine whether you are eligible for Medicare, you need to look at your age, employment status, and whether you have any qualifying medical conditions.
Let’s take a closer look at who qualifies for Medicare:
Medicare is an important health insurance program for people who are 65 or older, and certain younger people with disabilities. It’s also available to people of any age who have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
To be eligible for Medicare based on age, you must be 65 years old or older and either be a U.S. citizen or permanent resident of the United States who has been living in the country continuously for at least five years prior to applying for Medicare coverage.
You can also qualify if you:
- have a spouse who is 65 or older and either a U.S citizen or permanent resident
- are under 65 and have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months
- have certain disabilities including blindness, chronic kidney failure requiring dialysis, certain other medical conditions related to ALS (Lou Gehrig’s disease), or multiple sclerosis
To determine if you qualify under any of these conditions, visit your local Social Security office and speak to a representative about your specific situation. They will help guide you through the eligibility process.
People who are permanently disabled may be eligible for Medicare regardless of their age. Disability eligibility is determined by the Social Security Administration (SSA). Generally, people can qualify for Social Security Disability Insurance (SSDI) if they have worked long enough and paid into the system, or a disabled child or adult can qualify for Supplemental Security Income (SSI).
In order to qualify for SSDI, individuals must first meet medical criteria established by SSA. This includes having a documented severe physical or mental health condition that prevents them from performing substantial gainful activity (SGA). In addition, the disability must have lasted continuously throughout the past five years and must be expected to last for at least another year.
Individuals who qualify for SSI cash benefits based on limited income and assets may also be eligible for Medicaid in most states. In addition, those who receive SSDI due to age or disability are automatically enrolled in Medicare 24 months after their first month of entitlement to SSDI. Individuals do not need to sign up separately or pay additional fees – they will simply automatically receive their card in the mail when they become eligible. Beneficiaries should consult with an experienced Social Security Attorney before filing a claim so that they can maximize their benefits from all programs available to them.
End-Stage Renal Disease
End-Stage Renal Disease (ESRD) is the last stage of chronic kidney disease. At this stage, kidney function is so severely impaired that medically necessary treatments (such as dialysis or a kidney transplant) are necessary to maintain life. Individuals with ESRD may qualify for Medicare coverage regardless of their age.
Most people qualify for Medicare benefits if they are US citizens or permanent residents, 65 years or older and have paid into the Social Security system for at least 10 years. However, individuals with ESRD may qualify regardless of their age and how little they have paid into the Social Security system– there are no minimum payment requirements nor minimum age limits to meet the eligibility criteria.
For those under 65, qualifying conditions can include permanent disability and certain neurological disorders such as Lou Gehrig’s disease, which was previously known as amyotrophic lateral sclerosis (ALS). In most cases, individuals must also be receiving disability benefits from either Social Security Administration or Railroad Retirement Benefit Board to meet the requirements for eligibility and coverage under Original Medicare (Parts A & B).
If you are applying for Part A coverage due to an illness or injury for which you receive disability benefits from Social Security Administration or Railroad Retirement Benefits Board, you do not need to receive long-term care in a hospital before being eligible for Part A coverage; however if one applies at any other time, then he/she has to meet different criteria which includes:
- being admitted in a hospital at least three times in last 12 months prior to application;
- having at least one stay of more than three days consecutively each time he/she had been hospitalized;
- having met all conditions of Deemed Discharge on previous stays.
For some people with ESRD who already have or are about to get Medicare Parts A & B (Original Medicare), Medicare will cover all dialysis treatments that medical professionals deem medically necessary provided that Authorized Medical Health Professionals write orders as specified by CMS.
Other Qualifying Factors
Medicare is a health insurance coverage that is available to most people who are 65 or older, those who qualify through disability or end-stage renal disease, and certain other qualifying factors. While many people are familiar with the general requirements for qualifying for Medicare, there are other qualifying factors that may not be as widely known.
This section will provide an overview of the less well-known qualifying criteria for Medicare:
In addition to the type of roast, there can also be other factors that qualify a particular type of coffee as specialty-grade. These include:
- Environmental factors (such as elevation, average rainfall and soil)
- Growing methods
- Production techniques
- Socio-economic factors
The income of a particular region may impact the standards and procedures used to determine quality grading – if the members of a cooperative or associates live in poverty, their resources may be severely limited and their standards lax or nonexistent. In contrast, if those same farmers are able to earn higher incomes, they will likely adhere to stringent standards designed to produce high yields that meet specialty-grade standards.
Coffee is also graded according to cupping (a process which assesses the overall taste quality) and defects (the number of beans with physical flaws). Coffee must meet certain specs for both cupping and defects in order to be considered specialty-grade. Cupping involves specific criteria such as fragrance/aroma, flavor(s), body/mouthfeel and aftertaste.
The flavor profile should incorporate complexity without bitterness or any off notes; aromas should evoke a pleasant reminder; mouthfeel should convey liveliness without any astringency; finally aftertaste should linger without leaving an unpleasant residue on the palate.
To qualify for Medicare, you must be a resident of the United States or be a U.S. citizen or national. You must also have lived in the United States for at least 5 continuous years prior to applying for Medicare benefits.
If you require further evidence of residency, the Social Security Administration will review your situation and review any documentation you can provide such as income tax returns, proof of residency from other countries, passports and military discharge papers. The Social Security Administration will also consider factors such as:
- terms of stay in the U.S.
- when and why you left other countries
- duration and pattern of stays outside your home country
- payments received while abroad.
If it is found that you meet all these requirements but cannot provide sufficient evidence of your continuous stay in the United States over five years, your application may be put under temporary Medicare qualification until more information can be gathered to make a formal decision regarding eligibility.
In addition to age and disability, citizenship requirements must be met in order to qualify for Medicare. Most people who are over 65 and eligible for Social Security benefits or Railroad Retirement Board benefits will receive automatic enrollment when they reach 65. Similarly, those who have certain qualifying disabilities can be automatically enrolled in Medicare after receiving disability benefits from Social Security or the Railroad Retirement Board for 24 consecutive months.
However, there are certain additional qualifications for immigrants to be eligible for Medicare, which include:
- Permanent legal resident aliens who have lived in the United States continuously for five years;
- Admitted as refugees under Section 207 of the Immigration and Nationality Act (INA);
- Granted asylum under Section 208 of the INA;
- Lawful temporary residents who meet certain immigration criteria such as pregnant women and children under 18 years of age;
- People lawfully residing in American Samoa, Guam, Northern Mariana Islands or Puerto Rico;
- Foreign nationals with an H1B visa (nonimmigrants working here temporarily); and
- Individuals classified as “retired workers” through their employment outside the U.S., including those deemed a “spouse” under those circumstances.
How to Apply for Medicare
Applying for Medicare can be a confusing process. It’s important to understand the eligibility requirements in order to determine if you qualify for the program.
This section will provide an overview of the application process and some helpful tips to help you understand how to apply for Medicare:
Applying for Medicare online is a quick and easy way to get coverage when you’re eligible. You can complete your online application anytime, anywhere, and most people receive their Medicare card within three months (though it could take longer). Here’s how to apply for Medicare coverage:
- Visit the website of the Social Security Administration and create an account.
- If you don’t already have one, you’ll need to provide some basic information about yourself, such as your name, address, birthdate and contact information.
- Once signed in, you can begin your Medicare application by filling out the required information about yourself and your income situation.
- Submit your application and wait for a response from Social Security Administration (SSA). The SSA will contact you if they need more documentation or additional information before approving your request for healthcare coverage under Medicare benefits.
- If approved, the SSA will mail you a new Medicare card with all of your new identification information on it within three months (though it can take up to six).
- Sign up for premium-free Part A or purchase Part B if needed, either via the SSA website or through an independent insurance provider who specializes in providing secondary coverage through private insurance plans finalized at either an SSA office or through an independent insurance provider offering these plans directly as well as though employer groups such as Costco or HumanaOne Group Health Insurance Plans subsidized through their employers’ supplemental healthcare plans offerings tied to agreed upon part payment contribution limits by employers per employee annually tied back into health savings accounts contributions related terms of employer subsidiary built cost share sharing plans tied into 401k retirement benefits open enrollment programs at pre-determined anniversary renewal dates when employees may review optional plan participation direction without penalty co-pays priced as negotiated rates between insurers and employers locked in for each employee memberships with rights of passage on pre-negotiated terms annually.
- You should also consider signing up for a Medigap plan to supplement any gaps in coverage in original Medicare Parts A and B if desired by the applicant who are enrolled under those applicants’ respective primary national social security numbers that are entered into records this way tracking that particular candidates optional choice pathway selections further processed subjecting them to possible automatic approval status under ACA open enrollment qualification ranges depending upon income levels within additionally subjected tier rankings considered tiered pricing structures found in discretionary settings whereas supplemental private plan Part C retail accounts become also reviewable metrics depending upon current account balance options initiated nominated contractual formats equivalent whereby known by medical insurance industry participants being tracked onto experience related rating factors mandated within generically branded risk pools interlinked networks associated 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If you would like to apply directly for Medicare by phone, contact the Social Security Administration (SSA) a minimum of three months before you turn 65. Call 800-772-1213 (or your local number here) and ask to sign up for Medicare Parts A and B. During the call, you will need to provide personal information such as your Social Security Number, address, and date of birth.
If necessary, you can also request an application form or have one mailed to you.
When enrolling by phone, the SSA will schedule an appointment so that a representative can visit you at home and collect any additional information necessary. Alternately, if needed documents are not available at the moment, the agency may suggest completing an online application at www.ssa.gov/medicare instead.
Applying in person with a Medicare specialist is the most comprehensive way to apply for Medicare. The most common application process involves the following steps:
- Gather your documents, including a copy of your Social Security card and any other documentation needed to prove eligibility for Medicare, such as proof of age or citizenship.
- Contact your local Social Security office and make an appointment to meet with a Medicare specialist. Depending on the availability of specialists in your area you may want to call ahead to ensure you will be able to get an appointment soon.
- Fill out a paper application form at the Social Security office, which will include information about you and any other people covered by Medicare on your policy.
- Give the specialist all paperwork required for registration, including Social Security cards and proof-of-eligibility documents needed for enrollment in Medicare premiums or supplemental plans.
- Sign forms acknowledging receipt of information regarding schedule of benefits under Original Medicare, as well as policies regarding hospitalization, doctor visits and prescription drug coverage through Part A (Hospital Insurance) and Part B (Medical Insurance).
- Pay applicable fees at time of enrollment, such as fees related to Part A premium or supplement plans if applied for—some have additional premiums that must be paid separately upon enrollment in those plans—as well as monthly premiums due once coverage begins.
- Allow several weeks after enrollment before benefits begin; this allows sufficient time for processing paperwork and administering hospitalization coverage (if applicable). Upon start date of coverage contact appropriate providers associated with service selection (e.,g., doctors offices), as applicable, on payment options and any additional paperwork that must be completed prior to services beginning.
Medicare is a government-funded health insurance program for seniors and individuals with disabilities in the United States. While most seniors are eligible for Medicare, there are some restrictions that may disqualify some individuals from receiving the benefits.
In this article, we will examine the criteria for qualifying for Medicare and how to determine if you qualify.
Requirements for Medicare
Medicare is the government-funded national health insurance program for people who are 65 years of age or older, as well as certain younger people with disabilities. Depending upon your financial circumstances, there are certain requirements you must fulfill in order to receive Medicare benefits.
In most cases, to receive coverage, individuals must meet one of the following qualifications:
- Be a US citizen or legal resident for at least five continuous years
- Have worked in a job covered by Medicare taxes for at least ten years
- Be married to someone who has worked in a job covered by Medicare taxes for at least ten years
- Receive Social Security disability benefits (for specific disabilities)
If you have not paid Social Security taxes long enough and don’t meet one of the qualifications above, you may still qualify for Medicare under special conditions. These include:
- Having end stage renal disease or Lou Gehrig’s Disease (ALS) requires hemodialysis or a kidney transplant.
- Being eligible for certain military benefits makes you eligible for premium free Part A benefits as long as you meet other criteria and are entitled to Social Security or Railroad Retirement Benefits based on your own work record.
In addition to meeting the requirements listed above, most individuals enrolled in Medicare are required to pay premiums and other out-of-pocket costs such as deductibles and co-payments. It is important that those considering signing up for Medicare understand all requirements before doing so.
How to Apply for Medicare
Applying for Medicare benefits is a straightforward process. However, it helps to understand who’s eligible and when you should apply. Having the right information ready will help make sure your application is processed accurately and quickly.
The eligibility requirements for Medicare are relatively simple. You may qualify if you are:
- A U.S. citizen or permanent resident age 65 or older
- Under 65 but have a qualifying disability
- Diagnosed with End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)
If you are over 65 and already receiving Social Security benefits or Railroad Retirement Board (RRB) benefits, you’re likely already enrolled in Medicare Part A and don’t need to do anything else. Otherwise, it’s important to apply as soon as possible if you meet the criteria above so that your coverage will begin on time. Even if you’re close to retirement age, don’t wait until the last minute – there is often paperwork that must be completed first before any coverage can begin.
When applying for Medicare, it’s best to prepare in advance by informing yourself about the types of coverage available – Original Medicare, which typically consists of Parts A and B; Medicaid; Medigap supplemental insurance plans; and prescription drug plans – and then deciding which option works best for your needs. Applying online is quick and easy but may not be right for everyone; people who prefer assistance through the entire application process can contact their local State Health Insurance Assistance Programs (SHIP).