Are You Eligible for Medicare?

Who is Eligible for Medicare?

Generally, Medicare is usually available for people aged 65 years old or older, younger people who have some kind of disability, and people who need long-term care due to end-stage renal disease (ESRD) (kidney failure requiring dialysis or a transplant).

Medicare has two parts - Part A (hospital insurance) and Part B (Medicare insurance). If you're aged 65 or older and you've been paying into Social Security for over the course of 40 quarters (10 years of work history), then you may be able to get free hospital coverage through Medicare Part A.

You become eligible for Medicare Part A with no premiums when you turn 65 and you meet the following criteria:

• You are a social security beneficiary
• You will become eligible to receive social security
• You receive medicare through your spouse and/or government employment

If you're not certain whether you qualify for Medicare coverage, visit medicare.gov/eligibility to check your status.

You can still be eligible for Medicare if you didn't pay Social Security tax during most of your working life; however, there are exceptions. You don't need to be covered by Medicare until you turn 65 years old; however, if you're younger than 65, you may qualify for part A coverage at no cost.

• You've received Social Security or retirement and disability benefits for approximately 24 months.
• You have a permanent disability like Lou Gehrig's or undergo kidney dialysis or have had a kidney transplant.

A majority of medicare recipients will not need to pay a premium for part A but everyone needs to pay for part B if they want it (also if they do not want to incur a penalty for late payment). Your monthly premiums for Medicare Part B and/or Medicare Part D (Prescription Drug Benefits), if any, may be taken out of your disability, retirement, or SSA checks.

You may be eligible for quarterly premiums if you don't receive any benefits from Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Prescription Drug Coverage For All

Everyone who was eligible for Medicare since January 1, 2006, regardless of their income, health status, and/or prescription drug use, is eligible to apply for Part D - Prescription Drug coverage by Medicare. To learn more, please visit the Prescription Drug Coverage page at Medicare.gov.

What is a Medigap Policy?

A medigap policy is an additional supplemental insurance policy that covers certain medical expenses not included with Medicare Part A and Part B. 

Medigap plans are sold directly by private insurers as separate policies. Medigap Policies can help cover the difference between what Medicare pays and what your health insurer pays for your medical bills. They also provide protection against catastrophic events such as major illness or injury, which can cause large medical bills.

Medigap Plans are designed to supplement Medicare Parts A & B, not replace them. However, some plans offer both Medicare Part A and Part D coverage.

How much does a Medigap Plan Cost?

The price of a Medigap Plan depends on several factors, including your age, gender, location, and how long you’ve had Medicare. In addition, each plan offers varying levels of coverage, so prices vary widely.

On average, the annual cost of a Medigap plan is approximately $1,500; that is about $125 monthly and it is taken from your social security, retirement, or disability (SSI) funds. That means that after you pay your monthly premium, you should expect to have most of your medical services rendered without any excessive costs. 

To find out how much a Medigap plan will cost, call your current health plan carrier and ask for a quote.

What do Medigap Plans not Cover? 

Medigap policies usually do not include vision or dental care, but may cover hearing aids, eyeglass, and private duty nursing, make sure to check what the plan does cover before enrolling.

Depending on your health circumstances, such as if you have the need for eyeglasses; you may want a completely different Medigap policy that does meet this requirement in your health plan. To sort your health insurance needs out, make a list of all the areas of concern in your health plan, and double-check with the current Medigap plans to see if there will be any insurance gaps to plan for. 

What if my current employer offers group medical insurance?

If the company you are currently employed under offers group medical insurance, chances are good that you can continue to receive such coverage after retirement. 

If you leave employment without having secured alternative coverage, you will qualify for a special enrollment period (SEP), where you can commence your enrollment for medicare immediately with options to select your Medigap coverage. 

Make sure to check with your human resources point of contact or department about any special arrangements made for retirees.