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What Are The Requirements to Qualify For A Medicare Plan

Requirements to Qualify For A Medicare Plan

Typically, the ones who qualify for Medicare are people aged 65 or older and young disabled people with chronic conditions such as kidney failure. Medicare has two main parts; Part A is hospital insurance that covers any hospital expenses. Part B, on the other hand, is for outpatient services such as doctor visits. However, since these two Medicare parts still don’t cover many out-of-pocket costs, some people begin to consider enrolling in a Medicare plan that offers benefits from private insurance companies. There are two solutions available for replacing Medicare. 

Right here, we will explore these solutions and how anyone can qualify for them. 

Medicare Advantage Plans Vs Medicare Supplement Insurance Plan

Medicare Supplement Insurance Plan

Medicare advantage plan is the perfect alternative solution designed for people who want to enjoy Medicare Part A and B benefits with some added advantages. These additional benefits might include partial or total coverage for vision care, hearing aids, routine dental care, and many other services that aren’t normally covered in the original parts. Both Medigap and Medicare advantage plans are almost similar in the qualifications that are required from people who want to enroll in these plans.

Medicare supplement insurance plans (or Medigap), on the other hand, don’t work as a stand-alone plan. You need to be enrolled in Medicare Part A and B. Yet, these plans are extremely beneficial for covering extra costs that otherwise wouldn’t have been covered by Original Medicare. These plans are mainly sought for certain expenses required by Medicare such as copayments and deductibles. But how can you qualify to enroll in these plans? 

The Qualified Age for Medigap 

The most important Medigap requirement for eligibility is age. Most people can’t enroll in Medicare supplement insurance plans until they turn 65. However, there is a requirement in many states for insurance companies to offer at least one Medicare supplement insurance plan to people who have Medicare even if they are under the age of 65.

Young people can still qualify for Medigap in certain cases. While federal laws don’t force insurance companies to sell Medicare supplement insurance plans, they still offer it voluntarily to people who are under 65 years. Yet, these insurance policies might cost more for younger people. Some insurance companies might even require an evaluation of your health and the health conditions you have to make any decision regarding your case. They can then use these evaluations to demand any premium increase because of health conditions.

Medicare Supplement Open Enrollment Period

There is an opening window for people who want to enroll in Medicare supplement insurance plans. This open enrollment period lasts only for 6 months starting from the first day you turn 65. However, you still must be enrolled in both Medicare original parts to qualify for Medigap. This 6-month open window can be very confusing. It often raises too many questions, but you can find the needed answers and more on medicarewire.com where this one-time enrollment period is explained in detail to avoid any misunderstandings. This open enrollment period allows people to enroll without the fear of being charged more. 

Eligibility Requirements

Other than being of age and being enrolled in Original Medicare, other requirements must be checked off when you are trying to register in Medicare supplement insurance plans.

  • You must be a USA citizen or at least a permanent legal resident for at least 5 continuous years.
  • You must be living within the service area of the plan or the designated regions that are licensed by the state and approved by Medicare.  
  • Even if you are not 65 or older, you can still qualify if you have end-stage renal disease (ESRD). ESDR is a permanent kidney failure that requires dialysis or a transplant.
  • People who receive disability benefits from the Social Security Administration or the Railroad Retirement Board are usually eligible for Medigap for24 months in a row.
  • If you are diagnosed with Lou Gehrig’s disease (ALS), you automatically qualify to register for a Medigap plan.

Older people who have paid Medicare tax for more than 10 years might be automatically enrolled in Medicare Part A once they turn 65. They can also be automatically enrolled in part B; however, this part requires a premium subscription to be paid every month.

While Original Medicare might be perfect for standard medical bills in hospitals and outpatient services, there are still some gaps that aren’t filled by Part A and Part B. These gaps such as copayments and deductibles have been covered, alternatively, by other plans such as Advantage plans and Medigap. To qualify for these plans, you only need to be 65 years or older, living in the same area where the service is available, and most importantly, be enrolled in Original Medicare.  

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