Medicare

A federal health insurance program primarily for people aged 65 and older, offering comprehensive coverage.

Medicare Eligibility

Medicare, a government program established in 1965, is designed to provide healthcare coverage to people who meet the eligibility requirements.

1. Age or Special Circumstances:

Age: Individuals who are 65 years old or older.
Disability: People under 65 with certain disabilities who have been receiving Social Security Disability Insurance (SSDI) benefits for a specific period, typically 24 months.
End-Stage Renal Disease (ESRD): Anyone, regardless of age, diagnosed with ESRD requiring regular dialysis or a kidney transplant.
Amyotrophic Lateral Sclerosis (ALS): Individuals diagnosed with ALS are eligible for Medicare as soon as they begin receiving SSDI benefits.

2. Citizenship/Residency:

Must be a U.S. citizen or a permanent legal resident (green card holder) who has lived in the United States continuously for at least five years before applying for Medicare.

Different Parts in Medicare

Medicare is divided into several parts, each designed to cover different aspects of healthcare services. Here's a brief overview of what each part covers:

Part A (Hospital Insurance):

Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Part B (Medical Insurance):

Covers doctor’s services, outpatient care, medical supplies, and preventive services.

Part C (Medicare Advantage):

Part C is an alternative offered by private companies approved by Medicare. It includes all the benefits and services covered under Part A and Part B, usually includes Part D, and may offer extra benefits such as vision, hearing, and dental.

Part D (Prescription Drug Coverage):

Helps cover the cost of prescription drugs, including many recommended shots or vaccines.

When can I sign up Medicare

Signing up for Medicare is time-sensitive, and there are specific enrollment periods during which you can sign up for Medicare.

Initial Enrollment Period (IEP):

3 months before your 65th birth month, includes your birth month, and ends 3 months after. 7 months in total.

General Enrollment Period (GEP):

For those who missed IEP, they can enroll annually from January 1 to March 31.

Special Enrollment Period (SEP):

Available if you or your spouse are working and covered by an employer group health plan. Can enroll anytime while covered and up to 8 months after employment or coverage ends, without penalty.

Spouses, Divorcees, and Survivors

Medicare offers eligibility options based on your spouse's, ex-spouse's, or deceased spouse’s work history if you haven't earned enough work credits yourself:

Spousal: If you're 65 or older and your spouse has 40 work credits, you can qualify for premium-free Part A after one year of marriage.
Divorcee: If you're unmarried, 65 or older, and were married for at least 10 years, you can qualify for premium-free Part A based on your ex-spouse’s credits.
Survivor: If you're a widow or widower 65 or older, were married for at least 9 months before your spouse's death, and haven't remarried before age 60, you can qualify for premium-free Part A.

Medicare Advantage (Part C)
vs. Medigap

Explore the differences between Medicare Advantage and Medigap to determine which option best suits your needs:

Medicare Advantage (Part C):

Medicare Advantage (MA) plans bundle Medicare Parts A, B, and usually Part D into one plan. These plans often include extra benefits like vision, dental, and hearing aids and have set networks of doctors and hospitals. They typically offer low premium, which could be as low as "zero". MA require using network providers and may include additional features like lower copayments and a yearly out-of-pocket spend limit, making them a comprehensive and potentially cost-effective solution for health care.

Medigap (Medicare Supplement):

Medigap plans cover additional costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles. These plans allow you to visit any doctor that accepts Medicare, offering flexibility and potentially lowering your out-of-pocket healthcare expenses. Medigap is ideal for those who want broader access to healthcare providers and more predictable annual costs.

Medicare Eligibility for New Immigrants

For new immigrants, especially older individuals, qualifying for Medicare needs meeting specific residency and work requirements.

Generally, you must be a legal permanent resident or a U.S. citizen and have lived in the United States for at least five continuous years.
Additionally, to qualify for premium-free Part A (hospital insurance), you or your spouse need to have accumulated at least 40 work credits, equivalent to about 10 years of work.

It's important to plan ahead and understand these eligibility criteria to ensure you can access Medicare benefits when you need them.