Most people have group health insurance while they are working that may include coverage for a spouse and children, but many may be surprised to learn that Medicare is individual insurance. Every Medicare recipient must meet specific criteria to receive benefits.

Medicare Recipients Over the Age of 65

Most people become eligible for Medicare when they turn 65 years of age, as long as they are an American citizen or have lived in the U.S. as a legal permanent resident for five consecutive years or more. Most people qualify for premium free Part A (Hospital Insurance) when they turn 65 due to the number of quarters they worked and paid taxes. Most people enroll in Part B (Medical Insurance) when they first qualify to avoid paying late enrollment penalties later on.  Medicare recipients can get their benefits through Original Medicare, the federal program that administers Part A and Part B, or through a Medicare Advantage plan that is offered by a private insurance company that contracts with Medicare to provide Part A and Part B benefits, but many offer additional coverage.

Medicare Recipients Under the Age of 65

Individuals under the age of 65 can qualify for Medicare under these specific conditions:

  • Social Security Disability Insurance (SSDI) recipient. Individuals receiving SSDI will be automatically enrolled in Original Medicare after 24 months of consecutive benefit payments.
  • Railroad Retirement Board (RRB) recipient. Individuals receiving RRB benefits will be automatically enrolled in Original Medicare after 24 months of consecutive benefit payments.
  • Individuals with amyotrophic lateral sclerosis (ALS). Individuals with ALS, also referred to as Lou Gehrig’s disease, can be enrolled in Original Medicare automatically once an individual starts receiving SSDI benefit payments.
  • Individuals who have end-stage renal disease (ESRD). Individuals sign up for Original Medicare through their local Social Security office.

Many people who qualify to Medicare due to a disability get their coverage through Original Medicare, but you may have the option of enrolling in a Medicare Advantage Special Needs Plan (SNP) that caters to individuals with your specific needs. Medicare Advantage SNP options may be limited in certain locations.

Coverage for Dependents of Medicare Recipients

If your child does not meet the above eligibility requirements for an individual Medicare benefits plan, there may be other options available for their healthcare coverage.

  • COBRA. If your dependents have lost coverage from your employee health insurance due to your transition to Medicare, they may be eligible for this temporary form of insurance.
  • Private insurance. There are a variety of private health insurance companies with plans that can cover anyone in your household who is not eligible for Medicare benefits.
  • CHIP. Children who do not meet Medicaid’s income qualifications may be eligible for the Children’s Health Insurance Program. Benefits can vary depending on each state’s regulation.
  • Medicaid. Eligibility guidelines for Medicaid can vary from state to state, but this may provide comprehensive coverage for recipients who qualify. Check with your local Medicaid office to see if your child qualifies.
  • Local community health departments. Some areas may have local clinics and community health departments that offer free, low-cost or sliding scale options for individuals without any other form of healthcare coverage.

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