Medicare includes many parts such as Medicare Part A, which covers skilled nursing facilities, hospice care, Hospital Insurance and some home health care. Medicare Part B covers necessary doctor’s visits, outpatient hospital care, and some physical and occupational therapies. Medicare also includes some other health benefits as well. However, most of these benefits have some eligibility requirements. Mentioned below is a brief overview to answer the question – what does Medicare cover require as prerequisites?
What does Medicare cover require as prerequisites?
Medicare Age Requirement: Everyone is eligible for Medicare once they turn 65 years of age. You need to have worked in Medicare covered employment for a minimum of ten years. You should be a U.S. citizen or a permanent resident. Individuals can also be eligible for Medicare under age 65 if they have a disability or if they have end-stage renal disease requiring a dialysis or kidney transplant.
Medicare Enrollment Choices: Shortly before turning 65, you will be notified by the Social Security Administration regarding your Medicare eligibility. Since most people don’t pay a premium for Medicare Part A, they often enroll in Medicare Part A as soon as they are eligible. There is a premium for Medicare Part B which is deducted from the Social Security, civil service retirement or railroad retirement check. In case either you or your spouse is still working and have health insurance provided by the employer, you can decline Part B coverage until retirement.
Medicare Enrollment Periods: Individuals can enroll in Medicare three months before they turn 65 and for four months after their birthday. In case someone does not enroll in Medicare Part B when they turn 65, they can get themselves enrolled during the general enrollment period which is from January 1st to March 31st every year. Individuals can enroll by visiting the local Social Security office or calling the Social Security Administration. When you enroll during this period, the benefits would begin from July 1st. In case you retire and the health coverage provided by your employer ends, you have eight months starting from the end of coverage in order to enroll in the Medicare Part B without paying a penalty.
Medicare Advantage and Supplements: Whenever you enroll in Medicare, you have the option of enrolling in the Medicare Advantage plan or Medicare Supplement plan as well. A Medicare Advantage plan provides all the benefits of Medicare Part A and B, and generally includes Medicare Part D benefit for prescription drugs as well. The Medicare Supplement plan offers additional benefits to Medicare Part A and Part B. Medicare advantage as well as supplement plans are managed by private insurance companies, and you might need to pay a premium to the insurance companies in addition to paying a premium for your Part B plan. Individuals can enroll in these plans when they enroll in Medicare and can make changes only during the Annual Election Period.
Exceptions for Medicare eligibility: There are 2 medical circumstances in which an applicant can qualify for Medicare even before they turn 65 years of age. If someone has Amyotrophic Lateral Sclerosis, the Medicare benefits start the first month after they receive SSDI monthly income benefits. In case someone is suffering from renal disease or permanent kidney failure, undergoing dialysis or awaiting a kidney transplant, then they are also eligible for Medicare. People who are suffering from end stage renal disease or ESRD receive Medicare coverage within 3 months of their first dialysis treatment, irrespective of whether they have applied or qualify for SSDI.
You can also contact the local health insurance Counseling and Advocacy Program to know more about what Medicare cover requires as prerequisites.