There are certain eligibility requirements for Medicare coverage. Use this page as a guide to understanding if you qualify for Medicare benefits.
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65 and over - Most people qualify for Medicare beginning at age 65.
You should be eligible for Medicare at the age of 65 if:
- You are a U.S. citizen or legal resident, and
- You have resided in the United States for a minimum of five years
- Worked at least 10 years in Medicare-covered employment
If the above applies to you and you have had Social Security deductions taken from your payroll, chances are that you will automatically receive a Medicare card in the mail just prior to becoming eligible, showing benefits for both Part A (hospital care) and Part B (medical care). Part B is optional, can be declined, and requires most people to pay a monthly premium for participation.
You may have to apply for Medicare benefits if:
- You have not applied for Social Security or Railroad Retirement benefits, or
- You were employed by the government, or
- You have kidney disease.
U.S. citizens who are 65 and older but do not have enough Medicare-covered employment, as well as permanent resident aliens aged 65 and older who have lived in the United States for five years prior to applying for Medicare, are eligible for Medicare benefits. This is known as "voluntary enrollment." These individuals must pay monthly premiums for both Medicare Part A and Part B benefits.
Under 65 - Generally speaking, if you are under age 65, you will qualify for Medicare if:
- You have End Stage Renal Disease (ESRD), or
- You have received Social Security Disability Income (SSDI) payments for 24 months (or in the first month of disability for ALS ("Lou Gehrig's Disease"))
Medicare Part A and Part B will not cover all of your medical costs. Specific items, such as prescription drugs, premiums, copayments and many more, are considered out-of-pocket costs, unless you have additional insurance. You have the option to buy additional coverage from private insurance companies that fill in these "gaps". There are three different types of plans: Medigap, Medicare Part D prescription drug coverage, and Medicare Advantage plans.
Here is a more comprehensive list of services and expenses that Medicare Part A and Part B generally do not cover:
- Acupuncture and homeopathic care.
- Deductibles, coinsurance, or copayments when you get health care services.
- Routine dental care and dentures (in most cases).
- Cosmetic surgery.
- Custodial care (help with bathing, dressing, using the bathroom and eating) at home or in a nursing home.
- Health care you get while traveling outside of the United States (except in limited cases).
- Hearing aids and hearing exams for the purpose of fitting a hearing aid.
- Orthopedic shoes.
- Routine foot care (with only a few exceptions).
- Routine eye care and most eyeglasses (see exception above for one pair of standard frames after cataract surgery with an intraocular lens).
- Routine or yearly physical exams (beginning in 2011, beneficiaries will be able to get a routine "Annual Wellness Visit" free of charge).
- Some diabetic supplies (such as syringes or insulin, unless the insulin is used with an insulin pump). These supplies are covered by Medicare Prescription Drug Plans.