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Is my elderly parent eligible for Medicare?

Daughter and elderly mother

Have questions concerning your parent’s Medicare eligibility? Feel free to utilize our online chat feature or give us a call at (800) 950-0608 for more detailed information about your parent’s specific scenario.

Just the Essentials…

  • Medicare is a U.S. federally government funded health insurance program designed to help certain groups of people pay for their healthcare costs.

  • One typically becomes eligible for Medicare upon attaining the age of 65, or upon the diagnosis of certain disabilities or diseases.

  • In some cases, your parent will already need to be eligible to receive Social Security benefits or Railroad Retirement Board benefits before they are eligible for Medicare.

  • Parents who are non-U.S. citizens or U.S. citizens living abroad may also be eligible to receive Medicare under certain circumstances.

  • Depending on your parent’s healthcare situation, they may become eligible for Medicare prior to turning 65.

Medicare Eligibility and Your Parents

Most people are eligible and receive Medicare benefits when they turn 65, but keep in mind that receiving Medicare is not necessarily guaranteed. There are certain eligibility requirements that one must meet in order to receive Medicare. 

Read on to learn more about how your parent can become eligible for Medicare, when benefits take effect, and during which period your parent can apply for Medicare.

Understanding the Basics of Medicare Eligibility

One’s eligibility for Medicare typically relies on how long he or she has worked in the United States or how long their spouse has worked. There are a few exceptions to this rule, but people who have worked for at least 10 years are typically eligible to receive Medicare when they turn 65 or upon the diagnosis of certain disabilities or diseases. This period is known as Initial Enrollment.

Medicare divides those 10 working years into 40 quarters, with one quarter representing a quarter of the calendar year. Please note that it is not required to work all 40 quarters, or 10 years, consecutively to be eligible for Medicare.

Additionally, if your parent has worked in local, state, or federal government after March 31, 1986, they may also be eligible for coverage.

Will my parent automatically become eligible for Medicare at age 65?

It’s common assumption that Medicare benefits are automatically conferred upon attaining the age of 65, but there are certain requirements that must be met before someone receives or can enroll in Medicare at this age. For example, they must first qualify for benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB) or already be receiving benefits from one of these institutions.

If your parent already receives one of these benefits, they will be able to receive their Medicare benefits without issue. However, if your parent doesn’t already receive SSA or RRB benefits, they will need to apply for Medicare formally. U.S. citizens and permanent U.S. residents who have lived in the country for at least five years continuously, are also eligible to apply.

Can my parent defer Medicare benefits?

Some people may choose to defer Medicare enrollment if they are still working for an employer and have health coverage through that employer or through a spouse’s employer. Keep in mind though, that if your parent chooses not enroll in Medicare and does not qualify for an exception that allows them to delay or defer enrollment, they will be required to pay a late enrollment penalty. 

This late enrollment penalty adds an additional 10% onto the monthly Medicare premium cost for each full 12-month period one was eligible to receive Medicare but neglected to enroll.

How does Medicare eligibility work for non-U.S. citizens and U.S. citizens living abroad?

Non-U.S. citizens are not eligible for Medicare unless they have been living in the United States for at least five years. For those who are considered lawfully present immigrants, it’s possible to apply for and receive Medicare Part A without a premium and to pay a premium for Medicare Part B. However, like with U.S. citizens, one must receive SSA benefits, RRB benefits, or Social Security Disability Insurance (SSDI) benefits in order to qualify.

If your parent does not meet these requirements as a non-U.S. Citizen or lawfully present immigrant, they may still be able to get health insurance through an employer or through the healthcare exchanges (subsidies may be available depending on income level).

Under current U.S. federal law, people who are considered to be undocumented immigrants will not be eligible for Medicare or healthcare through the exchanges.

Elderly people who decide to move to another country for retirement from the U.S. are still eligible for Medicare, though this may depend on whether they plan to return to the U.S. to live. Please note that if your parent decides to come back to the U.S. for full-time residence and they did not enroll in Medicare when they first eligible, a 10 percent penalty for Original Medicare (Part A and Part B) will apply, provided they do not qualify for additional exception.

Can my parent become eligible for Medicare before they turn 65 years old?

If your parent is under the age of 65, they may still be eligible to receive Medicare benefits as a result of a disability. Generally speaking, however, they must receive SSDI benefits for 24 months or 2 years before they are considered eligible to receive Medicare. 

In addition, if your parent is diagnosed with End-Stage Renal Disease (ESRD), they can start their coverage as early as three months after a kidney transplant or a course of dialysis begins. Those who have ALS can also receive Medicare benefits as soon as they begin collecting Social Security Disability benefits. 

If your parent meets the requirements for Medicare due to disability, they will generally be enrolled in Medicare Part A and Part B automatically. That said, parents who don’t qualify to receive SSDI coverage must purchase Medicare Part A and Part B coverage and pay the premiums for one or both, depending on certain circumstances. 

Typically, whether your parent qualifies for premium-free Medicare Part A depends on whether they have worked and paid Medicare taxes during their 40 credit quarters.

Need assistance determining if your parent qualifies to receive Medicare? Don’t hesitate to reach out to MedicareInsurance.com via our online chat feature or by phone at (800) 950-0608 today. Our team of experts will be happy to help you research and compare potentially available insurance plans in their area.

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