The federal government health insurance program, Medicare, provides medical coverage to particular residents. Medicare eligibility is guaranteed for all legal residents once they reach a certain age. However, you may qualify for Medicare earlier if you have certain qualifying conditions.
Medicare coverage costs will vary by how many years you have paid taxes, your current income, and more. Also, you may have to pay penalty fees if you enroll late. Do not miss your enrollment period by learning about eligibility, how to apply, and related fees.
The government established Medicare to help the elderly and select others to afford medical care. The Centers for Medicare and Medicaid Services (CMS) is the agency in charge of the program. However, the Social Security Administration (SSA) processes applications and provides information about Medicare.
The SSA is in charge of Medicare enrollment since your work history influences how much you will pay for Medicare. For instance, you can get Medicare Part A for free if you have enough work credits. The SSA keeps track of your work history and earnings through your Social Security number (SSN).
Most people qualify for Medicare enrollment around their 65th birthday. However, applicants must be U.S. citizens or have a legal presence and meet residency requirements. You can qualify to enroll once you are 65, provided you are:
- A U.S. citizen.
- A permanent legal resident who has lived in the country for at least five years.
Meeting the Medicare eligibility requirements means you can qualify to enroll in any of Medicare’s four parts. If you meet these requirements, you qualify to sign up for coverage. Keep in mind; Medicare coverage may be free or come at a cost.
You or your spouse may qualify for free Medicare Part A if you meet the above age and citizenship requirements and receive (or can qualify to receive) benefits from Social Security retirement or railroad retirement. You or your spouse may also qualify if you are 65 or older, meet the citizenship requirements, and paid Medicare taxes while working for a government job.
Although they are both government-funded health care programs, Medicaid is different from Medicare, but some people have dual eligibility. An applicant may qualify to be partial- or full-dual based on the support Medicaid gives.
States determine if applicants qualify for Medicaid, and eligibility requirements for the program vary by area. Generally, individuals can enroll in Medicaid if their household income is less than the Federal Poverty Level (FPL).
You can request an appeal if the SSA denied your application and you believe you can qualify for Medicare enrollment or free coverage. To appeal a denied eligibility decision, you will need to submit an appeal in writing to the Qualified Independent Contractors (QICs) in your jurisdiction. QICs process Medicare claim appeals for CMS. Every district has online appeal portals, but you can also submit an appeal by fax.
While the majority of Medicare members are seniors older than 65, some younger individuals can qualify. Applicants with certain medical conditions also qualify for Medicare enrollment. Find out if you or your loved one has one of the qualifying conditions to sign up for the program.