Medicare Eligibility Requirements

May 31st, 2017     Medicare

Medicare is the health insurance program for people who are 65 and above. This coverage includes four parts namely Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D. Each part has different eligibility criteria. Lets have a look at each of them.

Medicare Part A Eligibility Requirement

Medicare Part A covers mainly inpatient and hospital services. Each person can avail Part A services for free of cost  who are 65 or above, if they meet any one of the following requirements-

  • Have eligibility to Social Security benefits.
  • Have eligibility to Railroad Retirement benefits.
  • Spouse (living or deceased, including divorced spouses) is eligible to receive Social Security or railroad retirement benefits.
  • If the person or his/her spouse has worked in a government job for a long time and through which he/she paid Medicare taxes.
  • If the person is dependent parent of a fully insured deceased child.

If the person does not meet the above requirements, he/she can avail Medicare Part A by paying a monthly premium.

Each Person is eligible for Medicare Part A before the age of 65, if they meet any one of the following requirements.

  • Have eligibility to Social Security disability benefits for 24 months.
  • Have received a disability pension from the railroad retirement board and met certain conditions.
  • Have received Social Security disability benefits because the person has Lou Gehrig’s disease.
  • Have worked for a government job for a long time through which the person paid Medicare taxes and entitled to Social Security disability benefits for 24 months.
  • If the person is child or widow(er) age 50 or older, including a divorced widow(er), of someone who has worked for a long time in a government job through which he/she paid Medicare taxes and met Social Security disability program requirements.
  • If the person has permanent kidney failure and undergoes maintenance dialysis or a kidney transplant and
    • is eligible to Social Security benefits or railroad retirement benefits; or
    • worked for a Medicare-covered government job for a long time; or
    • is child or spouse (including divorced spouse) of a worker under Social Security or in a Medicare-covered government job.

Medicare Part B Eligibility Requirement

Medicare Part B covers outpatient services and preventive services. People who are eligible for Part A at no cost can avail Medicare Part B services by paying a monthly premium. People who are not eligible for Part A at no cost, can buy Part B without paying for Part A, if the person is 65 or above and he/she is:

  • A U.S. citizen; or
  • A lawfully admitted non-citizen who has lived in the United States for five years or above.

The late enrollment penalty is applicable, if the person did not sign up during designated enrollment period.

Medicare Part C Eligibility Requirement

Medicare Part C is also known as Medicare Advantage Plan which is managed by private companies that are approved by the Medicare. If the person has Medicare Part A and Part B, then he/she can join a Medicare Advantage Plan. Person with Medicare Advantage Plan is not eligible for Medigap policy.

Medicare Part D Eligibility Requirement

Part D is a prescription drug coverage of Medicare. Each person has to pay an extra premium on monthly basis for the coverage. Each person can join Medicare Part D if he/she meets the following requirements.

  • If the person is enrolled for Medicare Part A and/or Part B.
  • If the person permanently resides in the service area of the plan.
  • If the person is a U.S. citizen or lawfully present in the United States.

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.