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Medicare Coverage Requirements

Elderly and disabled citizens of the United States have access to Medicare, a federally-administered health care program. It is a comprehensive program that includes medical, hospital and drug coverage. The program does not take into account income or assets. All citizens who meet the eligibility requirements nationwide may access Medicare coverage. Individuals must meet the enrollment period and citizenship requirements and one of the four additional criteria (either age or medical-related circumstances).

  1. Citizenship

    • The first requirement to enroll for Medicare coverage is that the individual must be a United States citizen. Furthermore, in order to receive premium-free Part A coverage, the individual should have worked in the United States for 10 years. The employer should have paid into Medicare taxes.

    Enrollment

    • In order to sign up for Medicare coverage, you are required to be in a Medicare enrollment period. There are only certain times each year that you can sign up. When a Medicare-qualified person first becomes eligible, he can sign up during the initial enrollment period. He may also sign up during the open enrollment period (Jan. 1 to March 31 annually) or the annual coordinated election period (Nov. 15 to Dec. 31). An individual may also qualify for a special enrollment period. Special enrollment periods are given to those who have exceptional circumstances that would allow for an exception to the usual enrollment period, including losing qualified health coverage. Individuals should inquire with the Social Security Administration for more information about special enrollment periods.

    Age

    • Age is one way that an individual can quality for Medicare coverage. While the federal retirement age is higher, individuals need only be 65 to qualify for Medicare. If the individual is receiving federal retirement before 65 through the Social Security retirement or railroad retirement programs, then he will be automatically enrollment in both Medicare Parts A and B once they turn 65. Otherwise, you will have to enroll through the Social Security Administration.

    Disability

    • In order to qualify for Medicare coverage when disabled, you must qualify for Social Security Disability Insurance or railroad disability annuity checks. You will not qualify for Medicare coverage until you have received these benefits for at least 24 months. After this time, you will be automatically enrolled into both Part A and Part B.

    Amyotrophic Lateral Sclerosis

    • Those with amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig's disease, are automatically qualified for Medicare coverage. Once they receive a diagnosis and receive their first check from Social Security Disability, they are immediately Medicare-eligible.

    End-Stage Renal Disease

    • There are a few ways that those diagnosed with end-stage renal disease can qualify for Medicare coverage. First, they can begin dialysis treatment. After they begin dialysis treatment, they will become Medicare-eligible after four months of receiving treatment. They can also begin a self-dialysis training program that will make them Medicare-eligible immediately. If they stop the self-dialysis program, their benefits will stop, and they will have to wait until they complete the four months of dialysis treatment to receive benefits again. Finally, those receiving a kidney transplant may also be qualified for Medicare coverage. They become eligible as soon as they become hospitalized for the transplant.

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