WHAT IS MEDICARE?
Medicare is the nation’s largest health insurance program, currently converging about (44) million Americans. Enrollment is expected to rise to 79 million by 2030.
President Lyndon Johnson signed the Medicare program into law on July 30th, 1965 and Medicare became effective July 1, 1966
Medicare is a federal health insurance program administered by The Centers for Medicare and Medicaid (CMS) for three groups of people:
- Medicare-eligible due to age
- Medicare-eligible to certain disabilities
- Medicare-eligible with end-stage renal disease (ESRD)
WHO IS ELIGIBLE FOR MEDICARE?
MEDICARE-ELIGIBLE DUE TO AGE:
An individual, age 65 or older will generally be entitled to Medicare if he or she has worked at least 10 years in Medicare-covered employment, i.e, paid the applicable FICA taxes.
A person age 65 or older may also be eligible for Medicare if his or her spouse worked at least 10 years in Medicare-covered employment.
Typically, Medicare coverage will begin on the first day of the month in which the individual attains age 65. The date of Medicare entitlement is, however, dependent on the month of enrollment into Medicare.
MEDICARE-ELIGIBLE DUE TO CERTAIN DISABILITIES:
In order for an individual to become eligible for Medicare due to disability, the individual must have a medical condition that meets Social Security’s definition of disability and the medical condition is expected to last at least 12 months.
The individual must also receive disability benefits from Social Security or the Railroad Retirement Board for at least 24 months.
The 24-month waiting period is waived for individuals that suffer from Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. These individuals are eligible for Medicare’s first month of disability benefit entitlement.
Example: If a person became disabled on May 15th, 2020, Social Security disability benefits would first become payable in November 2020. Disability benefits commence the 6th full month after the disability begins. After a person has been entitled to disability benefits for 24 months, he or she is entitled to Medicare.
MEDICARE-ELIGIBLE DUE TO END-STAGE RENAL DISEASE (ESRD):
Eligibility for Medicare coverage because of End-stage Renal Disease is for patients for whom a regular course of End-Stage Renal Disease is for patients for whom a regular course of dialysis or a kidney transplant has been prescribed by a physician because they have reached that stage of renal impairment that kidney transplant or regular course of dialysis is necessary to maintain life.
Eligibility to Medicare is not automatic. To be eligible the patient must have:
- Worked long enough under Social Security or Railroad Retirement Board
- Been receiving or eligible for Social Security or Railroad Retirement Board benefits; or
- Be the spouse or dependent child of a person who has worked the required amount of time, or who is receiving benefits from Social Security or the Railroad Retirement Board.
These individuals must have applied for Medicare benefits and been approved for Medicare coverage by Social Security or the Railroad Retirement Board.
If a Medicare beneficiary under the age of 65 has had a successful kidney transplant their Medicare coverage will end 36 months after the month of the transplant. The transplant is considered successful if it lasts 36 months without rejection.
Usually, Medicare coverage begins the first day of the third month after the month in which a regular course of dialysis begins.