Medicare Eligibility

For over five decades, Americans 65 and older, and Americans with disabilities have been provided with life-saving access to Medicare. But not everyone can automatically qualify.

Medicare Part A Eligibility

To qualify for Premium-Free Part A, you must already be entitled to Medicare based on your own income or family member, such as a partner, partner, or any children.

To be entitled to Medicare Premium-Free Part A, you must have accumulated a certain number of quarters of coverage (QCs). You must also submit a valid application for Railroad Retirement Board (RRB) or Social Security. The precise number of QCs required for each person is dependent on whether you are applying based on your age, if you have End-Stage Renal Disease (ESRD), or other disabilities. 

  • Suppose you are a state, federal, or local government employee. In that case, you may qualify to pay only the Part A percentage of the FICA tax. However, the QCs you earn may only be used to meet the quota for Premium-Free Part A. 
  • You are already automatically enrolled in both Medicare Parts A and B if you have been receiving Railroad Retirement Board benefits or social security for over 16 weeks and are currently living in the United States (Puerto Rico exempt). Suppose you are living in Puerto Rico, and you qualify for automatic enrollment. In that case, you are only qualifying for Premium-Free Part A.

Medicare Part B Eligibility

The eligibility qualifications for Part B vary on whether or not you are valid for Premium-Free Part A or if you have to pay a premium for Part A coverage. Anyone who is valid for Premium-Free Part A is also allowed to enroll in Part B. Qualification for Part B can only occur at particular times.

If you pay a premium for Part A, you must also meet the following requirements for Part B.

You must be:

  • Over the age of 65
  • A U.S. citizen OR
  • An immigrant who has attained permanent civilian status and has been living in the United States for over five years.

It is important to note that Part B is entirely voluntary and requires the payment of a monthly premium following the entire time of coverage.

Suppose you are already receiving Railroad Retirement Board benefits or Social Security at least sixteen weeks before being qualified for Medicare, and you currently live in the United States (Puerto Rico exempt). In that case, you are automatically qualified in both Premium-Free Parts A and B.

What if I am under the age of sixty-five?

You may be eligible for Medicare benefits if you are disabled or suffer from certain diseases. Often, people with disabilities have lower-incomes, require more health care, and have great difficulty paying for and obtaining the care they need.

Are you going to be enrolling in Medicare soon? Contact Grutz Financial to learn how we can help you get started with the enrollment process.

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