/Who Is Not Eligible for Medicare?

Who Is Not Eligible for Medicare?

If you want to sign up for Medicare, you may be wondering where to start. There are many factors to consider, including the different costs, plans, and rules. However, the best place to begin might be to verify if you’re even eligible. Most people are, but there are some circumstances where you would not qualify. So, who is not eligible for Medicare?

What is Medicare?

Before understanding Medicare eligibility, it’s helpful to brush up on your Medicare knowledge. Founded in 1965, Medicare is a federally run health insurance program for people 65 and older. The program contains two different parts. First is Medicare Part A, which covers your inpatient hospital needs. When you are officially admitted into a hospital, Part A will help cover needs, including room and board, meals, and general nursing. Part A can also cover skilled nursing facility stays, hospice care, and more.

The second part is Medicare Part B. Part B helps cover your outpatient care, which commonly includes lab work, surgeries, preventative services, doctor’s appointments, and more. Part B pays for 80% of Medicare-approved services while you are responsible for 20%. Fortunately, other supplement plans are available to help cover this 20% called Medigap plans.

The other additional parts include Medicare Part C, commonly known as the Medicare Advantage plan program. Advantage plans are a different way to obtain your Part A and Part B benefits through a private insurance carrier rather than the federal government. Last is Medicare Part D, which helps cover your retail prescription drugs.

Who cannot sign up for Medicare?

Although most people living in the U.S. can sign up for Medicare, there are a few situations in which you would not be eligible. Let’s take a closer look.

U.S. Citizenship

You must be a U.S. citizen or permanent resident to be eligible for Medicare. To be a permanent resident means you have a Permanent Resident card, also known as a “green card.” Those with permanent residency can work and live in the U.S. indefinitely. However, you must be a permanent resident for at least five consecutive years before qualifying for Medicare.

Under 65

If you are under 65, you are likely not eligible for Medicare. There are only a few ways to qualify when younger than 65. For example, if you have a qualifying disability, you may be able to sign up early. However, you need to have been receiving Social Security benefits for at least 24 months before you can transition to Medicare.

Another way to be eligible for Medicare under 65 is to have a qualifying health condition. This can either be end-stage renal disease or amyotrophic lateral sclerosis (ALS). Without a disability or one of these diseases, you do not qualify for Medicare under 65.

What if you’re not eligible for Medicare?

If you are not eligible for Medicare, you may have a few other options to consider. First, you may look into the Health Insurance Marketplace program developed by the Affordable Care Act in 2010.

Both individuals and families can sign up for Marketplace health insurance. Be sure to verify you qualify for one of these plans online. If you cannot sign up for Medicare or a Marketplace plan, you can also look into employer coverage if it’s available to you.

Final Thoughts

Generally, Medicare is available to those 65 and older. People under 65 with qualifying disabilities and health conditions can also enroll in Medicare. Additionally, you must be a U.S. citizen or permanent resident of at least five years. If you fall outside these guidelines, you likely do not qualify.