Who qualifies for Medicare?

By: Lupe Brunenan

Para leer en Español

Medicare is a federally funded health insurance program in the United States. It was established in 1965 and primarily provides health coverage for people who are 65 years old or older. Additionally, certain younger individuals with disabilities or end-stage renal disease may also be eligible for Medicare.

The Medicare program is administered by CMS, or “Centers for Medicaid and Medicare Services” and is divided into four parts:

1. Medicare Part A: This covers inpatient hospital care, skilled nursing facilities, hospice care, and some home health services (short-term).
2. Medicare Part B: This covers outpatient medical services, such as doctor’s visits, preventive services, diagnostic testing, outpatient surgeries, physical therapy, and much more. 
3. Medicare Part C (Medicare Advantage): Private insurance companies who have contracts with CMS cover 100% of Part A, and Part B and add prescription drug coverage (Part D) as well as additional services such as Flexible Spending Cards for the use of paying utility bills and buying Healthy Food, among other benefits. PLEASE NOTE: NOT ALL MEDICARE ADVANTAGE COMPANIES OFFER THE SAME BENEFITS, AND THE BENEFITS CAN DIFFER GREATLY DEPENDING ON THE COUNTY YOU LIVE, YOUR FINANCIAL SITUATION, AND THE MEDICATIONS YOU TAKE.
4. Medicare Part D: This is a standalone prescription drug coverage plan offered by private insurance companies to help with the costs of prescription medications.

Here are a few of the ways one might qualify for Medicare:

1. If you are 65 years old, you worked as a W2 employee for 10 years and accrued the 40 credits required so Part A will be “premium-free.” In this scenario, Part B has a minimum premium of $164.90 per month or greater.  This premium is based on your declared income tax returns as of 2 YEARS AGO. 
2. If you are 65 years old, and you have been or were married for MORE THAN 10 YEARS to a spouse who is older than 62 years old and worked as a W2 employee for 10 +years and accrued the 40 credits so Part A will be “premium-free”.
3. If you are 65 years old, have been a legal resident of your State for 5 years or greater AND you qualify for your State’s Medicaid program, meaning your income is less than $1,100 per month gross. This program is called the MEDICARE SAVINGS PROGRAM
4. If you are collecting Social Security Disability benefits for 24 months or greater (don’t need to be age 65), AND PRIOR to you being approved for Disability, you worked as a W2 employee for 10 years and accrued the 40 credits required so Part A will be “premium-free”.
5. Are Age 65, have not accrued the 40 credits for Part A, but can pay the premium based on the amount of credits you HAVE accrued. In this way, you will need to pay for BOTH Part A and Part B premiums. 

Please note, if you have any questions related to your Medicare qualification, either call Lupe Bruneman at (305) 726-4749 or call Social Security Administration at 1-800-772-1213.