Medicare is a federal government program that provides health insurance for people at age 65 or older as well as people with certain disabilities. It consists of two main parts: Part A and Part B which are also called Original Medicare. Part A is your hospital insurance whilst Part B is medical insurance coverage. Be aware that medications aren’t covered under any of these parts as well as dental insurance, vision, and hearing aids. Medicare also doesn’t provide full coverage, it covers only 80% of the services so the beneficiaries are responsible for 20% of the remaining costs in form of deductibles, copayments and premiums.
Who is eligible for Medicare?
As already said, all people with age 65 or more and people with certain disabilities are eligible to apply for Medicare coverage. Some might get Part A free premium, but that depends on several factors, which will be explained below. Still, if you are not eligible for Part A free premium you can buy it if you come of age but you need to be a legal U.S. citizen who has lived in the States for a minimum of five years. Every beneficiary who has Part A is automatically eligible for Part B. However, the Part B premium isn’t free for anyone, so you will have to pay for it regardless of whether you have a free Part A premium or not.
Medicare Part A Eligibility
Medicare Part A covers hospital insurance which stands for hospitalization and covers your hospital stays. This includes inpatient hospital stays, skilled nursing facilities, hospice care, surgeries, home health care, etc.
So, if you have a permanent stay in the U.S. and are 65 and older you are eligible for Medicare Part A. Most people who are eligible can get free Part A. Therefore, you can get “Part A free- premium” if any of the following applies to you:
- you receive your Social Security benefits or are eligible to receive them
- you receive railroad retirement benefits or are eligible to receive them
- If your spouse receives social security or railroad retirement benefits or is eligible for them- that also stands for divorced spouses
- If you or your spouse worked long enough in a government job and paid Medicare taxes- if you or your spouse worked for a minimum of 10 years (40 calendar quarters)
Some citizens can be eligible for Medicare before the age of 65 with Part A free premium if they fulfill certain requirements. You are eligible for Part A at no cost in these circumstances:
- You receive Social Security Disability benefits for at least two years (24 months)
- You receive a pension for disability from the railroad retirement board
- You receive Social Security benefits based on Lou Gehrig’s disease (amyotrophic lateral sclerosis) or End-Stage Renal disease
- You have worked in a government job long enough and paid Medicare taxes and also have the right to receive Social Security disability benefits for 2 years
- You are a child or widower age 50 or older of someone who had worked long enough in a government job or received Social Security benefits
- You have permanent kidney failure and receive dialysis or kidney transplant: this is the case for those who are eligible to receive Social Security benefits or railroad retirement benefits, worked long enough in a government job, or are a child or spouse of someone who had worked long enough for Social Security benefits or in a government job
Most people who receive Social Security benefits are automatically enrolled in Parts A and B.
Medicare Part B Eligibility
Medicare Part B covers your medical insurance such as doctor visits, specialist visits, lab tests, outpatient care, durable medical equipment, etc. Anyone who is eligible for Part A or has Part A is eligible for Medicare Part B. But, unlike with Part A, everyone has to pay for Part B monthly premium which is 170.10$ in 2022. Some beneficiaries who have higher incomes may pay higher monthly premiums due to IRMAA (The income-related monthly adjustment amount).
Medicare Eligibility If You Don’t Qualify For Free Part A
If you are not eligible for Part A premium-free you can still purchase both parts A and B but under certain conditions. You can buy Original Medicare in these circumstances:
- If you are a citizen of the States
- If you are a lawfully admitted citizen of the U.S and lived in the States at least for five years
You will need to pay for Part A monthly premium. The cost of the premium depends on how long you or your spouse have worked and paid Medicare taxes. If you paid Medicare taxes for 30 to 39 quarters your cost will be 274$ in 2022, but if you worked less than 30 quarters you will need to pay a monthly premium in full which is 499$ per month. For more detailed information about all Medicare costs and premiums look here.
Also, keep in mind that you will pay a late enrollment penalty for part A if you don’t buy it when you are first eligible. You are first eligible for Parts A and be three months before your 65 birthday and three months after you turn 65. This is a 7-month open enrollment window and it is called the Initial Enrollment Period. If you miss your IEP, you will pay higher rates for life, as long as you have Medicare due to the late enrollment.
Medicare Part C and Part D Eligibility in Missouri
Also, any beneficiary who is eligible for Medicare Parts A and B or Original Medicare is eligible for Medicare Part D or drug prescription coverage. As we already said in the beginning Original Medicare doesn’t cover medications. If you want drug prescriptions you need to purchase them through Medicare Part D stand-alone plan or Medicare Part C or Medicare Advantage plan. Also if you are enrolled in Original Medicare you can purchase Part C, known as Medicare Advantage. Medicare Advantage plans are sold by private insurance companies and become your primary source of coverage instead of Original Medicare. In most Medicare Advantage plans drug prescription benefits are included all in one plan.
If you are eligible for Medicare soon or already are eligible, but Medicare world confuses you you can contact us. We at Medicare Missouri Advisors have licensed Medicare brokers with years of experience in the world of Medicare. We know that the Medicare journey can be tough but you don’t have to do this alone. Call us or text us today and get proper coverage in the state of Missouri!