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Does everyone qualify for Medicare?

Does everyone qualify for Medicare?

Just the Essentials...

  • Not every person qualifies for Medicare due to the same reason.

  • People of any age can qualify for Medicare due to disability status or diagnosis with certain debilitating illnesses.

  • Based on your history of paying taxes, you may be eligible for free Medicare Part A.

Medicare is often misunderstood by Americans because of the assumption that every single person qualifies for it. While most qualify later in life at age 65, Americans of any age can qualify due to disability status, or diagnosis with certain debilitating diseases.

The U.S. Department of Health and Human Services details what it takes to qualify for Medicare.

In essence, if you qualify for both Medicare Parts A and B, then you also qualify for a Medicare health plan. However, to enroll in any plan, you generally need to enroll in Parts A and B.

Frequently, these various plans offer benefits left uncovered by Part A or B, like prescription drugs under Part D. Often, plans include dental and vision benefits, or reduce out-of-pocket costs for health services.

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The Two Parts of Original Medicare

Does everyone qualify for Medicare? - Medicare Diagram

Although we often think of Medicare as a single entity of health insurance, the program splits itself into focused areas of coverage.

Medicare Part A covers inpatient health care, like hospital stays.

Medicare Part B provides coverage for medical services that don’t require a hospital stay, like a doctor’s visit.

Together, Parts A and B combine into Original Medicare.

Qualifying for Medicare Part A

Does everyone qualify for Medicare? - Medicare Enrollment Form

Medicare Part A provides hospital insurance. More commonly, qualifying for any part of Medicare requires an American citizen to reach age 65.  However, younger people who have disabilities, as well as those with End Stage Renal Disease or Lou Gehrig’s disease will also qualify for Medicare Part A.

Normally, Medicare Part A requires payment of a premium, which can effectively be paid in advance through taxes. In fact, most working Americans end up getting their Part A at no premium cost.

If you or your spouse worked and paid Medicare taxes for a period about 10-years, then Part A has no monthly cost attached.

Further, if you or your spouse had government employment that was covered by Medicare, then Part A will also be free of any premium.

Medicare with a Premium

Does everyone qualify for Medicare?

In the event that you do not pay income taxes, or simply didn’t work long enough to have fully paid-in, you will pay a premium for Medicare Part A coverage. Nonetheless, almost everyone pays a premium for Part B medical insurance.

When you pay for Medicare Part B, premiums typically deduct from your monthly Social Security, Railroad Retirement Board, or Civil Service retirement checks. Otherwise, if you don’t receive these retirement benefits, Medicare bills you every three months for premiums.

The Prescription Drug Coverage of Part D

Does everyone qualify for Medicare?

In many cases, a hospital stay or a doctor’s visit entails your physician administering medications to you. When that’s the case, Parts A and B cover those medications. However, a separate part of Medicare covers prescription drugs you would pick up at a pharmacy.

Medicare Part D offers prescription drug coverage through separate policies offered by private insurers.

Anyone with at least Medicare Part A can sign up for Part D prescription drug coverage, regardless of whether you have to pay Part A premiums.

In many cases, Medicare Advantage plans build in the drug coverage of Part D. Across the board, all Medicare Advantage plans already build in Part A and B coverage, making Medicare Advantage Prescription Drug (MAPD) plans an all-in-one option.

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