General Eligibility Requirements

• U.S. citizens and permanent residents who are at least 65 years of age are eligible for Medicare benefits provided they or their spouse worked for at least 10 years and paid into the system during that time. Coverage automatically extends to a spouse provided one spouse meets the work eligibility requirements. Payment into the system occurs automatically with deductions handled similarly to Social Security.
  
  

Exceptions

• Persons under 65 may also be eligible if they are receiving Social Security or Railroad Retirement Board benefits due to a permanent disability. Coverage will extend to them if they have received the benefits for a minimum of 24 months. In addition, people with permanent renal impairment that requires dialysis or a kidney transplant are also eligible, regardless of age.
  
  

Types

• There are four types of Medicare coverage: Parts A, B, C and D. Part A provides hospital benefits. Although there are strict guidelines, Part A also provides coverage for care in a skilled nursing facility, hospice or at home. Part B extends coverage to outpatient services similar to private medical insurance plans. It covers outpatient hospital care and most medical services, including preventative care. Similar to a private Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), Part C, also called Medicare Advantage, provides both hospital and medical coverage, essentially combining traditional Part A and B. Part C plans almost always include prescription drug benefits. Part D is stand-alone prescription drug coverage and is combined with Part A and B, and usually Part C Medicare Advantage plans.
  
  

Cost

• Hospital costs are covered by Medicare at no cost to the recipient. Part B benefits carry a monthly premium which can be deducted from the monthly Social Security check. The cost is standard for most beneficiaries, except high income individuals may pay somewhat more. Part C participants also pay the standard premium charged to Part B but may also pay an additional premium to the provider and may also incur different out-of-pocket expenses. Part D prescription drug coverage is available for Part A and B participants at an additional cost and is usually included in Medicare Advantage plans.
  
  

Considerations

• While Medicare Advantage may cost more, this coverage often includes additional benefits, such as vision, dental and wellness programs. It is also possible to change Medicare plans during an annual open enrollment period which runs from November 15 to December 31 for the following year.