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Medicare Coverage Eligibility
In order to be eligible to receive Medicare benefits there are a number of requirements that participants must meet. The information below will serve as an introductory guide for individuals to determine their eligibility for benefits through the Medicare program.
Individuals that are 65 and over most often automatically qualify for coverage under the Medicare program. If you meet the requirements below and are 65+ you should be eligible to receive health insurance coverage through the Medicare program.
Are a legal resident or U.S. citizen
Have resided in the United State for at least five years
Worked for at least 10 years in Medicare covered employment
If you meet the above requirements and have had Social Security deductions taken from your payroll you are more likely than not to receive Medicare information in the mail prior to your sixty-fifth birthday. This card offers participants both Medicare Part A (hospital care) and Medicare Part B (medical care) coverage.
Information on Optional Medicare Part B
Coverage in Medicare Part B is optional and individuals may decline to participate in this coverage. A monthly premium is required to be paid by enrollees in order to receive coverage in Medicare Part B.
Medicare Part B is optional and can be declined. The Part B option of Medicare requires a monthly premium to be paid monthly to participate.
Enrollment in Medicare Part B is required if:
You have not applied for Railroad Retirement benefits or Social Security
You were employed by the federal government
You have kidney disease
Medicare benefits are also offered for individuals under the age of 65 for a number of reasons including:
You have End State Renal Disease (ESRD), or
You have received Social Security Disability Income (SSDI) payments for 24 months, or
You have received Social Security Disability Income (SSDI) payments for 1 month and have ALS/Lou Gehrig’s Disease
Medicare Part A and Medicare Part B is not an all inclusive health insurance plan. Some medical expenses are not covered including:
Each of these is considered an out-of-pocket expense. Supplemental insurance plans, Medigap, can be purchased to cover these additional expenses. Another option that Medicare enrollees have is to enroll in a Medicare Advantage Plan.
List of services not covered by Medicare Part A & Part B
Below is a comprehensive list of services and expenses not covered under Medicare Part A and/or Medicare Part B.
Deductibles, coinsurance, or copayments for certain health services
Routine eye care and glasses
Yearly physical exams (medicare Part B will cover 1 physical within the first 6 months)
Some diabetic supplies
Hearing aids, exams, or tests
Custodial care at home or in a nursing home including: assistance bathing, dressing, going to the bathroom and eating
Laboratory tests for screening purposes
Dental care (with few exceptions)
Health care outsite of the United States (with few exceptions)
Orthopedic shoes (with a few exceptions)
Routine foot care (with a few exceptions)
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