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Medicare Eligibility: How to Qualify for Medicare


When many of my clients approach the age of 65, they often call me in a state of panic since they are getting bombarded with numerous mailings from various Medicare supplement companies and private PPO and HMO Medicare Advantage companies. Coupled with that are suggestions from friends, TV commercials and random robotic phone calls from anywhere in the United States. Since there are many variables that contribute to a person’s eligibility, people often seek me out for either; additional feedback and guidance.

Aside from all the confusion about who is entitled to Medicare and why, there are many ways to qualify and receive Medicare benefits. Medicare has four parts, each of which has its own requirements:

Medicare Part A is also commonly known as Hospital Insurance: There are a few ways to qualify for this Part A but the most common is that you worked in the United States for 10 years where you have a payroll history. Medicare Part A is often referred to as the Medicare entitlement. However, the reality is, you already paid for it during payroll taxes. This Medicare Part A helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this part of Medicare, so it's premium free. If you didn’t work for at least ten years you may be eligible for this part of Medicare if you were married for at least ten years to someone who has ten years of payroll history. Otherwise, there is also a way to buy up into Medicare Part A if necessary.

Keep in mind that you would be entitled to Social Security benefits based on your spouse's (or divorced spouse's) work record, and that spouse is at least 62 years of age. Your spouse does not have to apply for medicare or social security benefits in order for you to be eligible based on your spouse's work.

If You Are Under 65: you are eligible for Medicare Part A and Part B if you already receive Social Security disability benefits and you have amyotrophic lateral sclerosis (Lou Gehrig's) disease. You are also eligible for Medicare Part A and Part B if you have been on Social Security disability benefits for at least 24 months.

Under various circumstances, your spouse, your divorced spouse, widow or widower and even a dependent parent may be eligible for Medicare Part A when they turn 65 years of age based on your work record. Disabled widows and widowers under age 65, disabled divorced widows and widowers under 65, and disabled children may be eligible for Medicare Part A and Part B, usually after a two year qualifying term.

You would be eligible for Medicare Part A and Part B at any age if you receive maintenance dialysis or a kidney transplant and you are getting monthly benefits under the Social Security system.

Medicare Part B helps pay doctor bills and other services. Once you are 65 and eligible for Medicare Part A, you can enroll for Medicare medical insurance (Part B) by paying a monthly premium. These Monthly premiums can vary based on your income history. If you are age 65 or older, you do not need any Social Security or government work credits to enroll in Medicare Part B.

Medicare Advantage Plans are often referred to as Medicare Part C. This is the piece of Medicare that often confuses people. These Private PPO and HMO plans generally cover most if not all of the same benefits a traditional Medigap policy or Medicare Supplement would cover except they are now subject to copays and coinsurance payments. Many of these Medicare Advantage plans have a zero-monthly premium but are often subject to a statewide network called a PPO or HMO.

Prescription Drug Coverage is usually referred to as Medicare Part D: Anyone who has Medicare Part A or Medicare Part B is eligible for prescription drug coverage. Obtaining a stand-alone Medicare prescription drug plan is voluntary and you pay an additional monthly premium for the coverage. Most of the Medicare Advantage Plans have prescription coverage built into it. If you decide to put of obtaining a Medicare Prescription plan during your initial enrollment period, which usually occurs during the 7 month window when turning 65 years of age, you can then only obtain that drug plan during the annual enrollment period, which is always October 15th the December 7th each and every year. Putting off obtaining a prescription drug plan can lead to a lifetime of penalties so it would be in your best interest to contact an independent Medicare Supplement Agent who has knowledge of these drug plans and the consequences for delaying enrollment.

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Neil Primack helped me navigate the Medicare maze. He is very knowledgeable and we quickly found insurance that was just what I was looking for. I would recommend Neil to friends needing help.
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Neil Primack certainly deserves a five star rating. He clarified the Medicare supplement choices and lessened the many concerns that I had in choosing a new policy. Neil was considerate, kind, and immediately available.
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Neil was extremely helpful with the application process and suggesting appropriate plans. I would recommend him to anyone looking for Medicare supplemental insurance.
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