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 Medicare is an important health insurance program run by the federal government that provides for both hospital care (Medicare Part A), medical care (Medicare Part B) and starting in 2006 Medicare Part D - prescription insurance. In this article, we are going to discuss Medicare eligibility rules and some of the more common terminology you'll find in the Medicare program.
Medicare Eligibility Rules
In general, U.S. citizens or permanent residents are eligible for Medicare benefits if they have worked for at least ten years in a job that has paid money into the Medicare system. That's pretty easy to figure out just by looking at your paycheck. Most companies show Medicare tax as a separate line item or they combine it with Social Security taxes.
This eligibility rule also applies to your spouse, meaning that if either you or your spouse worked for ten or more years and paid money into the Medicare system, then you are both covered. You must also be 65 years or older to receive Medicare unless you have been diagnosed with permanent disability or permanent kidney failure that requires dialysis or a kidney transplant.
So to summarize, there are really only two conditions you need to meet to qualify for Medicare benefits:
- You must have paid money (taxes) into the Medicare system for at least ten years.
- You must be age 65 or older, unless you have a disability or permanent kidney failure.
Medicare Part A Eligibility
Medicare Part A is the terminology used for hospital insurance. This insurance helps to pay for hospital care, skilled nursing facilities, home health care and hospice care. Most people are eligible to receive Medicare Part A at age 65, and will receive this benefit without having to pay any monthly premiums.
The Medicare eligibility guidelines for Part A (hospital insurance) for individuals age 65 and older include:
- You are receiving Social Security or retirement benefits from the Railroad Retirement Board.
- You are eligible to receive Social Security or retirement benefits from the Railroad Retirement Board, but have not yet applied for these benefits.
- You or your spouse worked for the government in a Medicare covered job.
The eligibility guidelines for individuals under age 65 include:
- You are receiving Social Security or benefits from the Railroad Retirement Board due to a disability for 24 months or more.
- You are going for dialysis treatments or need a kidney transplant.
Medicare Part B Eligibility
If you pass the eligibility rules for Medicare Part A, then you are also eligible for Medicare Part B (medical insurance). This coverage under the Medicare program is for doctor services, outpatient care, and some of the other medical services that are not covered under Part A.
Unlike Medicare Part A (hospital care), Medicare Part B coverage requires payment of a monthly insurance premium. In 2007, the monthly premiums for Medicare Part B (medical insurance) are $93.50 and in 2008 they rise to $96.40. If you did not choose Part B insurance when you first became eligible, then the cost of this insurance may be higher.
As a rule, the cost of Medicare Part B can go up 10% for each year that you could have enrolled in Part B, but chose not to enroll. The 10% increase to the monthly premium is paid as long as you are enrolled in Medicare Part B - which may be for life.
Medicare Part D Eligibility
Everyone that qualifies for Medicare benefits are also eligible for Medicare Part D, which is a plan that provides for prescription drug coverage. The intention of this program is to protect individuals from today's high cost of prescription drugs as well as future costs.
Medicare Part D is provided by private insurance companies. Beneficiaries will need to choose / enroll in a drug plan and pay a monthly premium to the insurance provider they select. And like other insurance, if a participant decides to delay enrollment in a drug plan when they first become eligible, they may wind up paying more for coverage later on.
Alternatives to Medicare
Keep in mind that you do have options beyond Medicare Part A and Part B coverage. We've talked about these options in our article - Medicare Supplemental Insurance. For more information on Medicare enrollment, eligibility and monthly premiums, you can also visit the Medicare website.
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