Since 1965, Medicare has provided medical insurance to individuals. Unfortunately, Medicare is not the program that covers health insurance for families. This program is designed to cover one individual at a time, which means that a man, woman or child must apply and be approved individually by Medicare to receive coverage. If you are wondering who is eligible for Medicare in your family, there are a number of factors that actually determine who is eligible. In general, you become eligible for Medicare if you are aged 65 years or older or if you are younger than 65 and meet specific criteria for disabilities. This guide goes through different parts of Medicare and who is eligible to receive coverage.
Who is Eligible for Medicare Part A (hospital insurance)
Medicare Part A covers most hospital stay costs and some follow-up medicare care. To be eligible for Medicare Part A, you must meet the following requirements.
- You must be age 65 or older
- Most people receive Medicare Part A coverage for free
- You may pay for Medicare if you do not have a long enough work history
- You qualify if you are under 65 if you have a disability or other condition
- You have end-stage renal disease
- You are automatically enrolled in Part A if you receive benefits from Social Security after 24 months of being on disability
Once you become eligible for Medicare Part A, you are automatically eligible for Part B as well.
Who is Eligible for Medicare Part B (medical insurance)
Eligibility for Part B is much like eligibility for Part A. However, typically if you are eligible for Part A, then you will automatically be eligible for Part B.
- You are 65 years or older
- You are under 65 but have a disability or condition that you receive Social Security income for
- You have End-Stage Renal Disease
- Part B is optional when you first enroll, so make sure to sign up to avoid a late penalty for signing up later
Who is Eligible for Part C
Medicare Part C or Medicare Advantage follows the same eligibility rules for Part A and Part B, which means that you can receive Medicare Advantage if you are already approved or enrolled in Medicare.
- You already receive Part A
- You are enrolled in Part B
- You live in a service area that is eligible for Part C
- You don’t have End Stage Disease
- You don’t require hospice care
Medicare Advantage plans are offered by private health insurance companies, but they still must be approved by the government. If you already receive Medicare, then you can switch to Medicare Advantage during an open or special enrollment period.
Who is Eligible for Part D
Medicare offers prescription drug coverage to anyone who is eligible for Medicare. However, you need to sign up for prescription drug coverage when you become eligible, or else you will pay a late enrollment fee.
To get Medicare drug coverage, you have to join a plan that is approved by Medicare but offered through a private insurance company like Humana or Aetna. There are typically two methods of getting Medicare prescription drug coverage.
- Medicare Prescription Drug Plan
These plans are known as PDPs and add drug coverage to Original Medicare or Part A and Part B. These plans may be also included under Medicare Cost plans or Medicare Private Fee for Service plans.
- Medicare Advantage Plan
If you decide to get a Medicare Advantage Plan or Part C, then your coverage will switch from Original Medicare to Medicare Advantage and include prescription drugs. These plans are typically HMOs or PPOs that you receive through a private insurance company. and complete your enrollment form. Then you can call the plan provider and also call 1-800-MEDICARE to complete the process. In order for children to receive medical care that is sponsored by the government, they must be eligible to receive CHIP or Medicaid. Some states did not sign up for Medicaid expansion but still have CHIP plans. You can see what states are providing what kind of children health insurance on Georgetown University’s Medicaid and CHIP program finder. Most states have Medicaid expansions, but some states like Florida have their own unique programs.
Once you pick out the Medicare drug plan that you want, you have to go to Medicare Plan Finder
How to Cover Children in Medicare
CHIP is the Children’s Health Insurance Program and provides health coverage to about 8 million children in families with incomes too high to qualify for Medicaid but who can’t afford private coverage. CHIP was signed into law in 1997 and provides federal matching funds to states that have CHIP coverage.
CHIP is administered by the states and is jointly funded. States have designed CHIP programs in one of three ways.
Medicaid for Children
Medicaid along with CHIP provides health benefits to over 40 million kids in the United States. These are typically low income families who need help with medical expenses. The federal government has set minimum guidelines for Medicaid eligibility, but states have been able to expand coverage under Affordable Care Act. The average income eligibility for children is 241% below the Federal Poverty Level.
Children in families with income over $44,700 a year are now eligible for Medicaid and CHIP in states that have expanded Medicaid programs. However, if you are in a state that did not support Medicare expansion, the average income to qualify per year is $28,000 or less depending on the number of children. You can see if you are eligible and apply for Medicaid through HealthCare.gov
Medicare is designed for individuals who are elderly or who have some kind of disability or condition. Medicaid is designed to take care of children and young dependents. Parents can find out more information about these programs by visiting HealthCare.gov or you can browse MedicarePartC.com for answers to more questions regarding Medicare coverage, eligibility and costs. If you want to sign up for a low cost Medicare plan, you can also speak with us at 1-888-228-MEDI.
and complete your enrollment form. Then you can call the plan provider and also call 1-800-MEDICARE to complete the process.
In order for children to receive medical care that is sponsored by the government, they must be eligible to receive CHIP or Medicaid.
Some states did not sign up for Medicaid expansion but still have CHIP plans. You can see what states are providing what kind of children health insurance on Georgetown University’s Medicaid and CHIP program finder. Most states have Medicaid expansions, but some states like Florida have their own unique programs.