Medicare policy eligibility

What is Medicare? Types, Eligibility & Late Enrollment Penalties

Health Insurance Insurance
Medicare comes with many advantages. But, with its number of components, a Medicare policy can become more confusing for some.

There are even individuals who aren’t aware that if they reach a certain age or disability criteria, their eligibility for Medicare automatically applies to some of its parts. This is an ongoing issue for many holders, and this article will try to cover it, together with some other things you need to know about Medicare eligibility.

What is Medicare?

Medicare is a voluntary health insurance policy for older adults, as well as those with certain medical conditions. The initiative seeks to assist them in paying for healthcare, though, it isn’t entirely free.

Medicare plays an important role in ensuring the health and financial security of its beneficiaries. It includes essential health care, like admission into hospitals, medical visits, and prescribed medications.

Medicare Types or Parts

medicare types

It also has four parts which are:

  • Part A – Coverage for hospitalization and facilities. This involves hospital stays, operations, and other procedures.
  • Part B – Coverage for medically necessary outpatient services like doctor’s visits, as well as preventive care.
  • Part C – Coverage is optional Medicare supplement provided by private insurance providers. Prescription medications, dental and vision care, and other health-related services are also included in this package. Private insurance manages everything with this program, including replacing a medicare card and processing of claims.
  • Part D – This is part of the government’s Medicare program, but it’s offered and administered by private insurers. Also, it covers a variety of prescription drug costs.

Who Are Eligible For Medicare?

You’re eligible for Medicare if you meet any of the criteria below.

  • 65 years old and US citizen

When you reach this age and become eligible for Social Security, you’ll be automatically enrolled in Medicare Part A. This has long been considered a conventional retirement age when an employee’s health insurance coverage ends. Medicare offers health insurance at a point in one’s life when health-care and prescription-drug prices are likely to rise.

If you’re retired and getting Social Security or Railroad Retirement Board (RRB)  payments, you’ll get Part A and Part B automatically on the first day of the month you turn 65. If you’re still employed, you’ll need to enroll in Medicare Part B when you reach the required age, as registration is not automatic.

  • You’re permanently disabled and receiving disability benefits for two years

If you’re not even 65 but have been earning disability payments from Social Security Disability Insurance or the Railroad Retirement Board for, at least, two years, you’re eligible for Medicare. On the first day of your 25th month of disability coverage, you’re automatically enrolled in Medicare Part A and Part B.

  • You have end-stage renal failure and need a kidney transplant or regular dialysis

You must either be eligible for, currently receiving Social Security or Railroad Retirement Board benefits, or have served long enough under Social Security, the  Railroad Retirement Board, or as a government, employee to qualify for Medicare.

  • You’ve been diagnosed with Lou Gehrig’s disease or Amyotrophic Lateral Sclerosis (ALS)

On the first day of the month when you begin receiving disability benefits, you’ll be eligible for Medicare and will be automatically enrolled in Medicare Parts A and B, unlike other disabilities wherein you still need to wait for two years to be eligible.

These are the criteria for an individual to be eligible to get Medicare. You need to know about medicare basics and be able to enroll with Medicare the moment you become eligible. Not being able to do so will most likely cost you more.

Medicare Late Enrollment Penalties

Medicare late enrollment will result in long-term financial penalties that are applied to your monthly premiums. A late enrollment penalty will greatly raise the amount of money you must pay for each portion of Medicare.

  • Part A – You can also buy Medicare Part A if you didn’t work enough hours during your lifetime to be qualified for it. You must, however, pay a monthly fee. Some people must purchase Part A because they’re not eligible for the premium-free version. If you’re required to purchase Part A yet don’t do so when you first become eligible for Medicare, your monthly premium will increase. You’ll be charged the higher price for twice as many years as you didn’t sign up.
  • Part B – If you don’t get Part B when you first become eligible, your monthly premium can increase for each 12-month period during which you should have gotten Part B but didn’t. For as long as you have Part B, you’ll have to pay this tax any time you pay your premiums. The penalty increases as you go without Part B coverage for a longer period.
  • Part C – There is no penalty for enrolling late in Medicare Part C as this is optional only or additional insurance. During some enrollment times, you can turn to this form of plan.
  • Part D – If you don’t sign up when you’re first qualified and don’t have any creditable prescription drug coverage (such as from an employer or union), you’ll almost certainly be charged a late enrollment penalty if you enter a plan later.

Final Words

Healthcare is an important part of human lives that everyone should have, especially when they get old or become disabled. Getting Medicare can be complicated, but remember that this shouldn’t prevent you from getting one.

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