Conley & Conley Insurance Solutions

How Can I Qualify for Medicare?

Medicare- Physician with chalkboard on isolated white background

When you are looking for a Medicare plan, you will come across a lot of different information about the requirements. Unlike other health insurance plans, not everyone can purchase Medicare or Medicare Advantage. You must meet certain criteria to even qualify for Medicare before purchasing.

You may qualify for Medicare if you:

  • Are 65 years of age or older
  • You or your spouse paid Medicare taxes through work for at least 10 years
  • Have End Stage Renal Disease (permanent kidney failure)

If you do not meet any of the above requirements, you may not qualify for Medicare. Be sure to ask an insurance agent if you have any questions about your Medicare qualifications or policy.

Are Premiums Required for Medicare?

In most cases, you will have to pay premiums for Medicare just as you would for a different health insurance policy. However, there are some instances where you may be eligible for premium-free Part A Medicare. Part A Medicare covers hospital stays, hospice care, skilled nursing care and more.

You may be eligible for premium-free Part A Medicare if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board
  • You or your spouse had Medicare-covered government employment
  • You are eligible to receive Social Security or Railroad benefits
  • You are a kidney dialysis or kidney transplant patient

Keep in mind that even if you qualify for premium-free Part A Medicare, you will still be expected to meet other payments as applicable by your plan, such as deductibles and copayments. This exclusion also only applies to Part A of Medicare plans. Everyone must pay premiums for Medicare Part B and Part D.

When Can You Purchase Medicare?

You are able to purchase Medicare as soon as you are eligible. Those who become eligible through age may enroll in Medicare within six months of their 65th birthday. You must first be enrolled in Original Medicare as well as qualify for Original Medicare before purchasing Medicare Advantage.

Medicare Advantage plans generally require premiums as well as copayments and deductibles as applicable by your plan. Copayments and deductibles may only be covered by a Medigap policy which is available through private insurers.

There may be different enrollment periods for Original Medicare and Medicare Advantage plans, so be sure to speak with your insurance agent and keep track of when you may be enrolled in a Medicare plan. Medicare is crucial for individuals who need health insurance but may be unable to work or no longer working.

Open enrollment is generally between October 15th and December 7th every year. This time period allows you to enroll in, change, or drop your Medicare plan as needed. It is recommended that you review your Medicare plan every year to evaluate any changes in your plan or health needs. For example, you want to make sure that your primary healthcare provider is still covered under your Medicare plan.

Can I Be Denied Medicare?

There are few times where an individual may be denied Medicare, but it does happen. You could possibly be denied Medicare if you do not qualify, such as not being within the qualifying age group and not having a relevant disability.

Other reasons can be your health. Certain pre-existing conditions can disqualify you from Medicare or Medicare Advantage. This more often occurs in Medicare Advantage plans, as these are offered by private insurers who have the ability to choose their clientele.

If you are having trouble finding Medicare, speak with insurance providers about your options. Everyone should have access to Medicare in order to receive the health care they need to remain healthy and happy.

Qualifications for Original Medicare vs. Medicare Advantage

Keep in mind that there is a difference between Original Medicare and Medicare Advantage, although the requirements are generally the same. To qualify for a Medicare Advantage plan or additional coverage, you must already be enrolled in Medicare. Another difference is that Medicare Advantage plans offer a wider variety of coverages at higher limits when compared to Original Medicare, as they are offered through private insurers rather than a government body.

However, this also means that Medicare Advantage can tend to be more expensive.

Be sure to compare quotes and speak with your loved ones and an insurance agent in order to find the right plan for your health care needs. Not all Medicare plans are created equal, and you will want a plan tailored for your lifestyle and health.

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