Eligibility and Medicare

By Amanda Mattox

Eligibility for Medicare usually occurs at age 65. Some people who are younger (ages 18 to 65) and have certain disabilities that prevent substantial gainful employment can also get Medicare. However, the focus of this article will be on Medicare Parts A & B, also referred to as “Original Medicare” or “Traditional Medicare”.

Medicare is individual, not group/family, insurance. Anyone who qualifies to receive Medicare can get it – regardless of work history. However, Medicare is not free. Everyone pays premiums for Part B and for Part C (Medicare Advantage), Part D (drug coverage) and for Medigap (supplemental insurance) if you choose that coverage.

Most people can enroll in Part A premium-free, based on work history, since Part A is paid for through payroll taxes. Under certain conditions, a spouse, divorced spouse, widow or widower or a dependent parent may be eligible for Medicare Part A premium-free, when they turn 65, based on their spouse’s work record.

Criteria for Original Medicare is the following:
Citizenship
You must be:
      A United States citizen OR
     Have been living in the United States legally for at least 5 years nonstop.

Age
You must be:
     Age 65 or older, OR
     Over 18 and under age 65 AND meet one of these conditions:
     Received Social Security disability benefits (SSDI), for at least 2 years, OR
     Diagnosed with Amyotrophic Lateral  Sclerosis (ALS)/"Lou Gehrig’s Disease", AND
     Awarded SSDI: Usually get Medicare 6 months after established onset date of disability, OR
     Have been diagnosed with End Stage Renal Disease, sometimes called ESRD, AND
     Have been on dialysis for 3 months OR
     Have had a kidney transplant.

 

As you can see, Medicare eligibility goes beyond just turning 65 and being a United States citizen. In preparation for the Medicare Open Enrollment Period (October 15 through December 7)  be sure to familiarize yourself with the specifics. For details that may apply more to your personal situation, please be sure to visit  Medicare to learn how you can download the Medicare & You Handbook.
If you are a Florida Resident, you may also contact  the Elder Helpline at 1-800-96 ELDER; TTY: 1-800-955-8770 or visit Florida Shine.

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