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What are the Medicare Requirements?

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  • Written By: wiseGEEK Writer
  • Edited By: O. Wallace
  • Last Modified Date: 28 December 2017
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Medicare requirements usually refer to people’s questions regarding Medicare eligibility. Not everyone qualifies for all kinds of Medicare, and it’s important to determine what Medicare requirements people must meet in order to enroll in this US federally run system for delivering healthcare. This gets confusing because there are several Medicare parts, and eligibility for each part may be determined differently.

The basic Medicare requirements for people to get hospital insurance, which is also known as Part A, is that a person is 65 or older has certain qualifying disabilities. Disabilities can vary and the best verification for this is through the Social Security Department. Additionally, the person must qualify by having worked to earn a certain amount of credits that make them eligible for Medicare or they must have a spouse that is 62 years old or older who has earned these credits. Many people qualify by receiving either social security payments or railroad retirement, but they can still be working and apply provided they meet age and credit Medicare requirements.

Anyone who gets Part A can apply for Part B and will qualify provided they pay a monthly premium. Part B is medical insurance. Yet to confuse matters, anyone who qualifies by age, even if they haven’t worked to earn their full credits, can still buy Part B. This is one way of insuring that people won’t be turned down for minimal health insurance after they’ve reached a certain age.

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Thus far, people must be eligible based on certain rules, and one of the Medicare requirements for Part B coverage is to pay premiums. There is some financial help for this when people have significantly low income.

Another of the Medicare requirements is to enroll in Medicare Part D, called prescription drug coverage. This costs some money too but offers discounts on drug pricing. Alternately, Medicare enrollees can choose to pay money on top of their premium to join a health plan that will cover drug costs and medical costs. These plans are many in number and are called Medicare Advantage Plans, and they range in type from health maintenance organizations (HMOs) to preferred provider organizations (PPOs). It should be noted that people don’t have to participate in Medicare Advantage Plans, but if they don’t, they do need to enroll in prescription drug coverage or they may receive fines.

Another optional plan is Medigap, which is offered by private insurers and may help people meet costs they would ordinarily have to pay. Medicare is not totally funded health care. It doesn’t cover everything, and people on standard A and B will need to make coinsurance payments to make up the difference on costs. Medigap can help bridge this gap, but people will need to pay monthly premiums to get it.

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