Medicare Eligibility

Who Is Eligible for Medicare?

Medicare is typically made available for everyone on their 65th birthday, as long as they meet certain criteria. While some of the requirements are standard, such as being born in the United States or living as a permanent resident in the country, other factors must be met to obtain certain parts of the plan. To help you understand what qualifies you for coverage under each part, each section is broken out below.

Qualifying for Original Medicare – Part A and Part B

Anyone who decides to enroll in Medicare will automatically receive coverage under Original Medicare as long as they meet the minimum guidelines. For Part A and Part B benefits, you must be a U.S. citizen or have been a permanent legal resident of the country for at least five consecutive years. You must also be eligible for Social Security and receiving benefits from either Social Security or the Railroad Retirement Board to be automatically enrolled in Original Medicare. For those who are still working and not receiving benefits from either institution, you will need to enroll in Medicare Part B during your Initial Enrollment Period when you turn 65.

There are special cases when a beneficiary doesn’t need to meet the requirements above to qualify for Original Medicare benefits. A person can receive coverage under Parts A and B if they are:

  • Diagnosed with Lou Gehrig’s disease. (Benefits will start the same month disability benefits are received.)
  • Permanently disabled and have received disability benefits for 24 months or more from Social Security.
  • Diagnosed with end-stage renal disease and require a kidney transplant or dialysis treatment. (Benefits aren’t automatic under this scenario, and it is important to remember you must enroll to receive coverage.)

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Qualifying for Medicare Part C

Medicare Part C provides an alternative option for anyone who is seeking healthcare coverage under Medicare. Also known as Medicare Advantage, this part of the plan is conducted through private insurance companies, as opposed to the government. To enroll in Medicare Part C, you will need to have coverage under Original Medicare already and be located within the geographical area stated in your insurance plan. Most enrollment periods will align with the Medicare Part A and Part B Initial Enrollment Period. This allows beneficiaries to easily sign up for all three parts at once if they wish to do so.

There is no requirement to sign-up for it when you enter your first enrollment period with Medicare Advantage. If you decide that later in life you would like coverage under this section, you can call a local private insurance provider, and they will walk you through the next steps of the plan. Unlike Original Medicare, individuals who have End-Stage Renal Disease may not be eligible for coverage.

Qualifying for Medicare Part D

One of the costliest expenses for anyone with health issues is buying prescription drugs. Even the generic version of pills can be enough to cause financial distress. By enrolling in Medicare Part D, the burden of cost will be significantly less. Like Medicare Part C, this part of the Medicare plan is offered through private insurance companies and is optional when you first enroll. Qualifications for Part D are also minimal. You only need to have Original Medicare and be located within the drug plan’s service area.

John Kyle Insurance – An Agency You Can Rely On

If you have questions on whether you are eligible to receive any of the benefits under Medicare, give us a call today at (440) 230-1223. Our experienced agents will sit down with you and help you pick the plan to provide you with the best coverage.