Qualifying for Medicare is considered a major milestone, but there is some confusion around how qualifying for Medicare Part A and B works, and how plans are issued. In this blog, we’ll discuss what Medicare Part A and B cover, who qualifies for Medicare Part A and B, and who qualifies for automatic enrollment in Medicare.
What does Medicare Part A and B cover?
There are four total parts of Medicare: Medicare Part A, Part B, Part C, and Part D. However, the two main parts of Medicare are Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). So what exactly does Medicare Part A and Part B cover?
Medicare Part A covers:1
- Inpatient care at a hospital
- Skilled nursing facility care
- Hospice care
- Home health care*
You can find more information on the circumstances in which Medicare Part A may be applied on
Medicare.gov.
Medicare Part B covers:2
- Outpatient services
- Certain clinical research studies
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Limited outpatient prescription drugs
You can find more information on the circumstances in which Medicare Part B may be applied on
Medicare.gov.
Who qualifies for Medicare Part A and B?
With so many rules and regulations surrounding Medicare Part A and B, it can be difficult to understand who qualifies for Medicare Part A and Part B coverage. Generally, Medicare Part A and B are available for: people 65+, those under age-65 with disabilities, and those with End Stage Renal Disease. Let’s break that down.
Who qualifies for Medicare Part A?
Those who qualify for premium-free Medicare Part A must meet one of the following criteria:
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- Already receiving retirement benefits from Social Security or the Railroad Retirement Board
- Eligible to receive Social Security or Railroad benefits but haven’t filed for them
- You or your spouse had a Medicare-covered government employment
- Already receiving Social Security or Railroad Retirement Board disability benefits for 24 months
- You have End-Stage Renal Disease (ESRD) and meet certain requirements
Those who do not qualify for premium-free Medicare Part A can purchase Medicare Part A if they meet the following criteria:
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- You (or your spouse) did not pay Medicare taxes while you worked, and you are a citizen or permanent resident of the United States.
Medicare Supplement plans allow you to choose any doctor that accepts Medicare.
Get details about policies that may meet your insurance needs.
Who qualifies for Medicare Part B?
According to the
Centers for Medicare & Medicaid Services, the “eligibility rules for Part B depend on whether a person is eligible for premium-free Part A or whether the individual has to pay a premium for Part A coverage.”
5 Those with a premium-free Medicare Part A qualify for enrollment in Medicare Part B once they are entitled to Medicare Part A coverage. However, those who pay a premium for Medicare Part A must meet the following criteria in order to qualify for Medicare Part B:
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- Be age 65+;
- Be a United States resident; AND
- Be either a United States citizen, OR
- Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for five continuous years prior to the month of filing an application for Medicare
For more information on enrolling in Medicare Part A and Medicare Part B, please head to
Medicare.gov or
CMS.gov.
Will I be enrolled in Medicare Part A and B automatically?
Some people will be enrolled in Medicare automatically, however some won’t.
6 Whether or not you qualify for automatic enrollment in Medicare is largely determined on whether or not you are already getting Social Security or Railroad Retirement Board benefits. However, there are other factors involved in determining if you qualify for automatic enrollment.
Select which situation best applies to you to determine if your enrollment in Medicare Part A and B will be automatic.
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If you are recieving benefits from Social Security or the Railroad Retirement Board at least four months before turning 65
- Do I need to sign up? No. You should automatically receive Medicare Part A and B the first day of the month you turn 65. However, if your birthday is on the first day of the month, Medicare Part A and B will start the first of the previous month.
- When do I sign up? You do not need to sign up.
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If you are not receiving benefits from Social Security or the Railroad Retirement Board at least four months before turning 65
- Do I need to sign up? Yes. To get Medicare Part A and Part B, you will need to sign up with Social Security.
- When do I sign up? Learn about when you can sign up for Medicare Part A and B by going to Medicare.gov.
- How do I sign up? Apply online at Social Security or at your local Social Security office. For more information, head to Medicare.gov.
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If you are under 65 and have a disability
- Do I need to sign up? No. You should be automatically enrolled in Medicare Part A and Part B after receiving either (A) disability befits from Social Security for 24 months or (B) disability benefits from the Railroad Retirement Board for 24 months.
- When do I sign up? You do not need to sign up.
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If you have Amyotrophic Lateral Sclerosis (ALS)**
- Do I need to sign up? No. You should be automatically enrolled in Medicare Part A and B the month your disability benefits start.
- When do I sign up? You do not need to sign up.
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If you have End-Stage Renal Disease (ESRD)
There are a number of ways one can qualify for Medicare Part A and B, and a series of factors that determine if you qualify for automatic enrollment in Medicare. For more information on Medicare Part A and B, qualifying for Medicare, and automatic enrollment, please head to
Medicare.gov.
* Some home health care may be covered under Medicare part B.
** Also known as Lou Gehrig’s disease and qualifies for automatic enrollment in Medicare Parts A and B.
Sources
- Medicare.gov, What Part A covers, 2021
- Medicare.gov, What Part B covers, 2021
- Medicare.gov, Part A costs, 2021
- HHS.gov, Who is eligible for Medicare?, 2021
- CMS.gov, Original Medicare (Part A and B) Eligibility and Enrollment, 2020
- Medicare.gov, How do I get Parts A & B?, 2021