Understanding Medicare Coverage and Eligibility Rules

Too often, low-income elderly and disabled New Yorkers go without appropriate medical care because they are worried about how they will pay the bills.

New York Social Security disability lawyers frequently encounter people who qualify for free Medicare hospital benefits, but don’t receive care because they are unaware of their rights.

What is Medicare?

Medicare coverage comes in a number of “parts.” Some are free, while others carry a modest premium.

Medicare Part A – also known as Medicare hospital insurance – pays for inpatient care at a hospital or skilled nursing facility. It also covers some home health care and hospice care services. Medicare Part A is free to all who qualify for Medicare coverage.

In addition, those who qualify for Medicare coverage can choose to purchase Medicare Part B health insurance. Part B provides coverage for medical services and supplies that are not covered under Part A.

Qualified beneficiaries can also choose to purchase in-network comprehensive health plans under Medicare Part C and prescription drug coverage under Medicare Part D.

Usually, Medicare coverage is much cheaper than private insurance. Low-income individuals who cannot afford Medicare premiums may be eligible for financial assistance through state medical assistance programs.

Who Qualifies for Medicare?

Many people mistakenly believe that Medicare coverage is only available to people over age 65. While it is true that seniors over age 65 make up the majority of beneficiaries, Medicare coverage is also available to individuals who qualify for Social Security disability or other disability programs.

Individuals under age 65 are eligible for Medicare coverage if they meet one of the following criteria:

  • They have been eligible for SSD benefits for at least 24 months
  • They receive a disability pension from a railroad retirement board
  • They receive SSD benefits because of Lou Gehrig’s disease
  • They have sufficient work credits in a government job and meet SSD eligibility requirements
  • They meet SSD eligibility requirements, are over age 50 and are the child, widow or widower of someone who has sufficient work credits in a government job
  • They have permanent kidney failure and meet certain other eligibility requirements

Individuals who think they might qualify for Medicare can contact the Social Security Administration to apply for coverage.

If you have questions about your eligibility for Social Security or Medicare benefits, talk to a New York SSD attorney who can help you understand your options.