Who can get Medicare or Medicare Advantage coverage?

Medicare and Medicare Advantage coverage are available to individuals based on specific eligibility criteria. Here's a breakdown of who can get Medicare or Medicare Advantage coverage:

Medicare:

• Medicare Part A: Most individuals age 65 or older who are citizens or permanent residents of the United States are eligible for premium-free Medicare Part A (hospital insurance) if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
• Some individuals under 65 may also be eligible for Part A based on disability or certain medical conditions such as ALS or end-stage renal disease.
• Medicare Part B: Individuals who are eligible for Medicare Part A can enroll in Medicare Part B (medical insurance) by paying a monthly premium.
• Most people are automatically enrolled in Part B if they are receiving Social Security or Railroad Retirement Board benefits.
• Those who are not automatically enrolled can sign up during the Initial Enrollment Period.

Medicare Advantage:

• Medicare Advantage (Part C): To be eligible for a Medicare Advantage plan, you must have both Medicare Part A and Part B. This means you must be eligible for Original Medicare. Beyond this, eligibility requirements for Medicare Advantage plans may vary depending on the specific plan and the insurance company offering it.
• In general, individuals must live in the plan's service area and not have end-stage renal disease (ESRD), although there are some exceptions.
• It's worth noting that there are other circumstances and programs that may affect Medicare eligibility or provide additional assistance, such as individuals with end-stage renal disease (ESRD) who may qualify for Medicare coverage in certain situations.

Disabilities that may qualify for Medicare or Medicare Advantage

• Social Security Disability Insurance (SSDI): If you have a disability and have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months, you will automatically be enrolled in Medicare. The 24-month waiting period typically begins on the date you were determined to be disabled by the Social Security Administration.
• Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig's disease, individuals diagnosed with ALS are eligible for Medicare immediately, without the need to wait for the 24-month waiting period.
• End-Stage Renal Disease (ESRD): Individuals with end-stage renal disease, which is permanent kidney failure requiring dialysis or a kidney transplant, may be eligible for Medicare. Eligibility criteria may vary depending on factors such as whether you receive regular dialysis treatments, have had a kidney transplant, or meet certain other requirements.
• It's important to note that Medicare eligibility for disabilities is subject to specific rules and regulations, and the requirements may vary depending on individual circumstances. To determine your eligibility and understand the specific steps to enroll in Medicare based on a disability, it is advisable to contact the Social Security Administration (SSA) or visit their website (www.ssa.gov) for detailed information.
• Additionally, individuals with disabilities who qualify for Medicare may also have the option to enroll in Medicare Advantage (Part C) plans or Medicare Prescription Drug (Part D) plans to enhance their coverage. Consulting with a licensed health insurance agent or a Medicare advisor who specializes in disability benefits can provide personalized guidance based on your specific situation.

MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further help and explanation.