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Medicare Eligibility

Medicare was established in the United States in 1965 through the Social Security Act of 1965. Medicare is a social insurance program administered by the United States Government and provides health insurance coverage to people who are 65 years of age or older. However, Medicare eligibility can be open to individuals under age 65 in certain circumstances.

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Medicare insurance is financed by a portion of the payroll taxes paid by workers and their employers. The program is also financed in part by monthly premiums deducted from Social Security checks. Medicare is broken into four parts; Part A, hospitalization insurance; Part B, medical insurance; Part C, Medicare Advantage plans; Part D, Prescription Drug Plans.

It is recommended that consumers apply for Medicare three months before their 65th birthday because the enrollment date for Medicare ends three months after the 65th birthday.

Individuals who are 65 or older meet Medicare eligibility requirements if:

•The individual is eligible or receives Social Security Benefits;

•The individual is eligible to receive Railroad Retirement Benefits;

•An individual or spouse worked long enough in a government job that Medicare taxes were paid; or,

•An individual is the dependent parent of a fully insured deceased child.

If you are under 65, you can get Medicare Part A (hospital insurance) without having to pay premiums if you have:

•Received Railroad Retirement Board disability benefits for 24 months.

•End-Stage Renal Disease and you meet certain requirements.

You do not have to pay a premium for Medicare Part A if you meet these specific conditions, but you have to pay the Medicare Part B premium if you want it.

Anyone who meets Medicare eligibility requirements for Part A (hospital insurance) can enroll in Medicare Part B (medical insurance) by paying a monthly premium.

Any participant who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and a consumer must pay an additional monthly premium for the coverage.

Receiving Medicare eligibility benefits before age 65 is largely associated with the Social Security Administration with regards to disability of the participant, dependency status, and work credits earned. Also some consumers may be eligible for Medicare when they turn 65 but may not be eligible for Social Security benefits.

People who receive additional health insurance from a private health insurance company or from an employer-sponsored health plan should talk to an insurance agent. An insurance agent can help a consumer decide what plan offers the best benefits and coverage for the individual. Individuals who wait to purchase Medicare coverage outside of the enrollment dates are likely to face higher Medicare premiums.

Individuals who meet requirements for Medicare eligibility can also apply for Medicare Advantage plans and Medicare Part D plans within their enrollment dates. These plans are administered through private insurance companies and require additional premiums because of the extra benefits that the plans provide.

To compare Medicare Advantage plans and talk to an agent to talk about your Medicare eligibility, use our risk-free service.