What Is a Medicare Beneficiary?

Medicare is a United States federal government program run by the Health Care Financing Administration, which is part of the Department of Health and Human Services. Medicare is designed to provide health-care coverage for people over the age of 65. Medicare does cover the cost of medical care and treatment for some people under 65, such as those with end-stage renal disease, where the patient needs ongoing dialysis treatment or a kidney transplant. The medicare program is divided into separate parts, with each part providing different aspects of health-care coverage. Beneficiaries are those persons eligible to enroll in the Medicare program.

Basic Medicare Entitlement

• Part A Medicare coverage is a hospital insurance plan, and all eligible Medicare beneficiaries qualify for Part A. If you have paid Medicare taxes while you were working, you will not typically pay anything toward part A Medicare coverage once you reach the age of 65 and enroll for Medicare. After you enroll, you are eligible to receive the benefits provided by part A. Part A covers eligible beneficiaries for the cost of inpatient care in a hospital or a medical facility providing in-patient nursing services. It does not cover long-term nursing-home care. Part A also provides cover for home-care services and hospice care.

Beneficiaries Under 65 Years of Age

• If you are under 65 and disabled, you may be eligible for Medicare Part A as a result of your disability, but you will have to pay for this coverage. If you return to work, you may remain a Medicare beneficiary for up to eight and a half years following your return to work. If you are a widow or widower between the ages of 50 and 65, you may also be eligible to apply for Medicare if you do not receive disability benefits, but you receive any other Social Security benefit.

Special Enrollment

• While enrollment as a Medicare beneficiary is usually automatic for people who live in the 50 states or Washington D.C. upon reaching the age of 65, you may enroll for Medicare under certain other circumstances. You may become a Medicare beneficiary if you, a dependent child or your spouse suffers kidney failure requiring dialysis or a transplant. You may apply for Medicare if you have enrolled in the past but stopped the coverage. If you turned down the option to enroll for Medicare when you became eligible, you can enroll to become a Medicare beneficiary at a later date.

Medicare Part B

• All beneficiaries eligible for Medicare part A may automatically apply for Part B coverage. Beneficiaries typically pay a premium for part B coverage, and this includes coverage for services that part A cover does not cover, such as doctor services or occupational therapy and outpatient care. You can even become a Medicare part B beneficiary if you do not have the part A hospital coverage. You have to be over the age of 65 and a U.S. citizen or a legally resident foreigner who is over the age of 65 and has lived in the United States for more than five years.