Who Qualifies for Medicare?
Most Americans have probably heard of Medicare. For decades, the federal government has funded this program and helped older Americans have access to health insurance coverage.
Medicare is a popular option for many older Americans. Nonetheless, Medicare is a complex program. It often includes different options for coverage based on each individual’s needs. In some cases, it may cover more people than just older Americans.
What is Medicare?
One of the ideas behind Medicare is essentially to provide health insurance for Americans who may not have access to it because they no longer work. Many older Americans, even though they often need more care, don’t qualify for insurance after they retire.
Medicare provides insurance with most of the same coverage as a private health plan. Generally, Medicare comes in four different parts:
- Part A: Covers inpatient medical care and hospitalizations. It may also cover hospice care, nursing home care or other long-term needs.
- Part B: Pays for certain medical and physician services. It also usually includes medical supplies or other outpatient care.
- Part C: Part C is a Medicare Advantage Plan. Private insurance companies offer these varied plans as alternatives to traditional Part A and Part B. Most Advantage plans contain similar or identical coverage to traditional Medicare.
- Part D: Provides prescription drug coverage for traditional and Medicare Advantage plans.
Every American will likely have unique needs when it comes to getting Medicare. Therefore, they may need one or more of these types of coverage. After selecting their coverage, Americans pay premiums for their plans like with traditional insurance. Some states provide assistance to help Medicare recipients afford their premiums.
Who Qualifies for Medicare?
Most Americans qualify for Medicare when they turn 65. However, there are exceptions to this rule. Certain Americans may qualify for Medicare even before that age. This includes:
- Certain disabled people qualify for coverage.
- Individuals who receive Social Security Disability Income (SSDI) in place of a normal income can often qualify for coverage.
- Those suffering from End Stage Renal Disease—kidney failure—qualify for coverage.
Nonetheless, even the exceptions have exceptions.
- Railroad workers have pensions and health care managed by the Railroad Retirement Board. These individuals may face different qualifications than other Medicare enrollees.
- Individuals who still work after age 65 often can receive Medicare regardless of employment. However, they may have to follow special enrollment rules from their employer. This helps enrollees and employers make sure Medicare functions appropriately.
Enrolling in Medicare often requires consideration based on an individual’s unique circumstances. Therefore, prospective Medicare recipients should talk to their insurer and do their research before enrolling.
