Requirements to apply for Medicare: All the information you need

9 minutos de lectura

Health insurance are those instruments through which companies are committed to the task of covering the health expenses of citizens of the United States. USA.

Whether it is to cover the costs of medical services, medicines and the care related to them, you comply with the requirements to apply for Medicare in the presentation that suits you best.

What is Medicare

Medicare is a program created by the Government of the USA with the aim of covering the social security of citizens. It is therefore specifically responsible for providing medical care to people over 65 years or to young people disabled by severe health problems, such as cancer, kidney failure, among others.

Medicare It is also in charge of financing various training programs for doctors residing in USA. However, its main mission is to operate as insurance for users.

It was created through the Social Security Act of 1965, passed by Congress and President Lyndon B. Johnson that same year. During the signing ceremony of the agreement, the President registered Harry Truman (former US President) as the number 1 beneficiary of the service, giving him the first card of Medicare and the second to his wife, Bess.

Medicare It has different parts to help you cover your specific services. Their distribution is organized by means of parts A, B, C or D, the first two being the original ones and, in turn, the ones most chosen by users.

Medicare Plan A

Part or plan A of Medicare is responsible for the coverage of services and supplies that users need to treat illnesses or medical conditions. Most users do not pay a monthly premium for this mode. In this case, the company is responsible for ensuring the following services:

  • Hospital care. At the same time, hospitals or health centers are obliged to supply:
    • Medicines.
    • Assistance provided by doctors, nurses, and other health professionals.
    • Care in the nursing area.
    • Procedures and surgeries of any nature.
    • Therapies to improve speech, movement, swallowing, bathing, dressing, and other daily activities.
    • Laboratory and imaging tests.
    • Wheelchairs, walkers and the various equipment that allow the insured to carry out primary activities.
  • Skilled nursing facility care. This refers to all the centers to which the patient is referred during their recovery from an illness or procedure. The service does not include retirement homes when the holder is not able to live in his own home.
  • Aids for terminal patients.
  • Visits to your home by doctors, nurses, and other licensed professionals.

Medicare Plan B

Part B of Medicare It serves as an aid for the payment of the treatments and services provided in hospitals and outpatient clinics. Outpatient care can be received at one of the facilities listed below:

  • Emergency rooms or other areas of the hospital when you are not admitted in the first place.
  • Offices of doctors, therapists, nurses and other health professionals.
  • Imaging testing centers.
  • Surgery centers.
  • In your own home.

In addition, there is the possibility of paying for preventive health services of Medicare, such as:

  • Procedures and surgeries.
  • X-ray and laboratory tests.
  • Visits for wellness and other preventive insurance, such as vaccines against flu, pneumonia, and even certain exams, such as mammograms.
  • Feeding tubes.
  • Medicines and drugs that are usually provided by health centers and professionals (especially intravenously) that cannot be applied or consumed on their own.
  • Consultations with service providers.
  • Wheelchairs, walkers and the various equipment that allow the insured to carry out primary activities.
  • Among other services.

For this service, most users pay a monthly premium, plus a small deductible each year. When this amount is reached, a coinsurance is paid, which is the twenty% of the costs of most of the services you request. It is also paid for medical consultations, which generally have a cost of 25 dollars for each appointment with a doctor or other specialist.

However, coverage of services is highly dependent on state and federal laws, what the company decides to cover, and what local care providers decide to cover. This is why it is very important that you inform yourself about what you must pay and what Medicare he is going to pay.

Medicare Plan C or Medicare Advantage

These plans provide the same benefits as Parts A, B, and D. However, medical and hospital care and prescription drugs are offered by private insurance companies that work in partnership with Medicare.

In these cases, the way to use the service is as follows:

  • The customer pays the monthly premium for this type of plan.
  • The plan fully complies with the same services covered by plans A and B.
  • Doctors, hospitals and providers who work with the company must be employed or they will have to pay more for the service.
  • They offer additional coverage in dental, hearing, vision and prescription drug services (Plan D). In particular cases, you may be required to pay an extra amount for certain additional benefits, such as care.

Medicare Plan D

The latter is the company’s prescription drug plan. If you have already contracted the services of plans A or B and want to cover the expenses of your prescription drugs, you can also contract this plan.

As in the case of the previous operation, the coverage is provided by private companies that work with Medicare. The only condition is that if you already use a plan C, you cannot contract plan D from Medicare.

Who can be part of Medicare

The people who can be part of Medicare and apply for health insurance are the members of the following groups:

  1. People who have or are older than 65 years.
  2. Young people disabled by illness.
  3. And people with end-stage kidney disease, especially in chronic cases that require dialysis or transplantation.

Requirements to apply for Medicare

The requirements to apply for Medicare from 65 years are as follows:

  • Be a U.S. citizen.
  • If you are not a citizen of the USA, be a legal permanent resident who has resided in the country for five years.
  • That you or your spouse have worked within the USA to qualify for social security or railroad retirement benefits. Even though the services are not currently being received.
  • If you or your spouse have not made the corresponding social security contributions as government employees or retirees, but have paid payroll taxes for the company during the years of work.

How to sign up

For sign up in any of the social security plans, after ensuring that you meet the requirements to apply for Medicare, you must call the company through 1-800-772-1213. In this way, an appointment is made for you to be interviewed, with which you can proceed by phone or at your local office.

In case English is not your first language, you can request an interpreter to accompany you to the interview without having to pay an additional fee.

If you want to enroll in Medicare while you reside outside of the USAYou should contact your consulate or embassy of the nearest country.

There are several factors that can affect the costs that you have to cover within the service of Medicare plans A and B. They are made up of:

  1. Which of the two services do you hire?
  2. Whether the physician or health care provider accepts the assignment.
  3. The type of service you need and the frequency with which they have to provide it.
  4. If you have other health insurance in a company that works with Medicare.
  5. In the event that you seek to obtain other supplies and services that the company does not cover. If this situation occurs, the additional costs must be paid, unless there is another insurance that takes care of the coverage.
  6. You have Medicaid or other state assistance to help pay for social security costs.
  7. Medigap, or other insurance policy that supplements Medicare services.
  8. In case you and your doctor or healthcare provider sign a separate private contract.

Low Income Help

The beneficiary program that serves as low income help is one of the savings programs that allows a user to request help from each state to pay for Medicare premiums. Specifically, it allows you to request assistance for the payment of Plan B premiums.

The requirements to apply for Medicare and access the benefits of low-income help can be found by entering this link. The main requirement is that the income limit in each of the cases be the following:

  • For individual cases, the monthly income limit must be $ 1,269.
  • Marriages, the monthly income limit must be $ 1,711.
  • Individual resources the income limit must be $ 7,730.
  • Income limit must be $ 11,600.

Who can use the online Medicare application

All users not yet ready to retire They can use the Medicare application online.

It is a process that takes less than 10 minutes. It is not necessary to sign forms or submit any type of documentation. The company is responsible for communicating through the email you provide in case you need more information. In the same way, your Medicare card to the contact address that you link to your registration.

When to request it

The moment to do the application to join Medicare service It is usually between the three months before the date of your 65 years and the three months after. In general, you have a period of seven months to join.

If you do not enroll during this period, you have to pay a penalty, which can range from a one-time fee to paying the monthly premiums at a higher cost.

Once you enroll in Plan A, you can continue with Plan B, or wait until you need this service to request it. You can also switch between the three main types of coverage at least once each year.

The moment you meet the requirements to apply for Medicare You have to consider the following questions to choose according to what suits you best:

  1. The services that the plans cover.
  2. The costs that you have to pay in the different plans, comparing the cost of premiums, deductibles and other related expenses.
  3. Which drugs the plan will cover and if they are all you need.
  4. Hospitals and health professionals that allow you to use.
  5. The quality of care.
  6. And if in case of traveling to another state or outside the country, the health services you need will be covered.

Health is the right of every citizen, regardless of whether they are American or not. For this reason, it is important to look for a company that allows users to access these services, and that they are of high quality and of a reasonable cost.

Medicare is the company that today insures the lives of residents in USA that comply with the requirements to apply for Medicare.


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