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Insurance for Seniors: 5 Things to Know About Medicare Eligibility



Insurance for Seniors: 5 Things to Know About Medicare Eligibility

From 2021 to 2022, the number of seniors enrolling in Medicare grew by roughly 2.2 million beneficiaries. But what type of eligibility requirements are needed to provide insurance for seniors?

For starters, age plays a deciding role. Seeing as Medicare can assist with everything from hospital stays to medication, seniors must access this invaluable service. But Medicare isn’t just available to seniors; it’s also available to the disabled.

If you’re looking to learn more about Medicare insurance and who’s eligible for Medicare, this article is for you. Keep reading for five key things you need to know about this federal health insurance.

What Is Medicare?

Are you wondering, “What is Medicare?” It’s a health insurance program regulated by the federal government. Enrollment in Medicare is often determined by age and citizenship.

Medicare is often confused with Medicaid. Medicaid is health insurance available for low-income citizens. Medicare is primarily for anyone over 65 years of age or for the disabled. Check out this link for Medicare eligibility and enrollment to learn more.

It’s also important to understand how Medicare is broken down.

1. Medicare Has Four Parts

The first thing every senior needs to know is that Medicare is divided into four parts. Each part focuses on a specific type of coverage, and the cost varies.

Part A

Part A focuses on nursing care or inpatient stay in a hospital setting. On average, most people pay $0/month for the premium, but it can range as high as $499/month if an individual doesn’t qualify for free coverage. The deductible in 2022 is roughly $1,500.

Part B

Part B isn’t free; premiums start around $170/month. The deductible is roughly $230. Part B covers doctor visits and preventative care treatment.

Part C

Part C encompasses Parts A and B but includes dental, vision, and hearing. Premiums are included in the cost of Part B, plus private insurers billing their premium. However, some plans may only cost $0.

Yearly out-of-pocket can be upwards of $7,500.

Part D

Part D covers prescription drugs. This includes generic and name-brand prescriptions. The monthly premium varies from insurer to insurer, but most people pay $33/per month.

2. Age Restrictions

Qualifying seniors must be at least 65 years of age. However, you can take part in Medicare enrollment three months before you’re 65th birthday.

For anyone suffering from a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig’s disease), Medicare can be provided earlier than your 65th birthday.

3. Income

Does income affect a senior’s Medicare enrollment eligibility? No.

But it does affect the premium, as discussed in Parts B and D. The more you make, the more you’ll pay. This is known as the “income-related monthly adjustment amount”.

While Part B covers doctor’s visits, it also covers extras such as physical and occupational therapy. On average, the government pays about 75% of these services, with you being responsible for the other 25%.

However, if you have a higher income, you may be responsible for more. This percentage is based on what you report to the IRS every year. Your premium may be anywhere from 35 to 85% of the total cost.

4. Citizenship

Citizenship affects your ability to obtain Medicare. All US residents qualify for Medicare if they meet the following qualifications:

  • Worked at least 10 years in jobs where they (or their spouses) contributed to Medicare payroll taxes
  • At least 65 years of age

There are requirements for legal immigrants who apply for Medicare enrollment if they’re ages 65 and older. For starters, work history is taken into consideration. Without proper work history, legal immigrants qualify after residing in the US for five continuous years.

Disabled legal immigrants (non-citizen US residents) under the age of 65 qualify if they meet the same requirements as US citizens. This includes work history, contributions to Social Security taxes from income, and adequate years of Social Security taxes accrued to equal five to ten years of work credit.

Immigrants new to the US are ineligible for Medicare no matter their age. Eligibility is based on residency requirements but still follows the same protocol that US citizens must follow.

5. Work History

You may be wondering how, if, at all, work history affects Medicare enrollment. This question is important for homemakers who may not have contributed to Social Security taxes. However, they still qualify.

For starters, if their spouse is at least 62 years of age and has paid at least 10 years of Medicare taxes, they qualify for Medicare. If a homemaker’s spouse is under 62 years of age, they can still apply for Parts A and B (which is optional).

If you’re unmarried and never worked, you may still qualify for Part A, especially if you’re disabled or have certain medical conditions. You may also pay more for Medicare if you never worked, even if you’re married and your spouse has contributed. If you’re both 65 or older, you won’t be on their Medicare plan- you’ll have your own plan. 

Insurance for Seniors

It’s essential to understand that, although there is insurance for seniors, the cost varies depending on income and work history. On average, Medicare is available for anyone who is at least 65 years of age, but for those with disabilities or certain medical conditions, Medicare may be available sooner.

Medicare provides coverage for doctor’s visits, hospital stays, and various types of therapy, as well as dental, vision, and hearing However, there is still a monthly premium, as with traditional health insurance plans, as this service isn’t free. However, medical bills can quickly add up, and insurance is crucial.

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