Compare 2024 Medicare Advantage plans.
How do I get Medicare eligibility?
First, let’s quickly discuss the way to obtain Medicare coverage. According to the U.S. Department of Health and Human Services, there are generally three ways to haveMedicare eligibility.
- Age: if you are 65 or older, you generally are eligible for Medicare. According to the Kaiser Family Foundation, the distinct majority of Medicare beneficiaries qualify by age.
- Disability: According to the Social Security Administration (SSA), everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. Generally a disability that gives you Medicare eligibility must be “severe.” According to SSA, disability is defined as “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which
- can be expected to result in death or
- which has lasted or can be expected to last for a continuous period of not less than 12 months.”
- Mental disorders such as schizophrenia and bipolar disorder, endocrine disorders such as diabetes mellitus, and cancer may qualify you for disability under Social Security and therefore Medicare eligibility.
Certain health conditions such as end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) may also give you Medicare eligibility without the 24-month waiting period. Starting in 2023, if you have ESRD, you’re generally also eligible for aMedicare Advantage plan.
Do Medicare benefits run out?
No, Medicare benefits do not run out. Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with End-Stage Renal Disease. As long as a beneficiary is eligible for Medicare, they will continue to have access to its benefits.
NEW TO MEDICARE?
Learn what you need to know in 15 min or less.
What Income do you lose Medicare?
Medicare eligibility is based on age, certain disabilities and conditions such as End-Stage Renal Disease (ESRD), but it is not based on income. This means that no income threshold would create a scenario where a beneficiary would lose their Medicare benefits. However, there is a program called Medicare Savings Programs (MSP) which help with the cost of Medicare premiums, deductibles, and co-insurance, and it is available to people with low income and resources.
The income limits for MSPs differ based on the state, and in some states, the program is not available. In 2022, the income limit for the Qualified Medicare Beneficiary (QMB) program, which pays for all Medicare cost-sharing, is $1,153 for an individual and $1,546 for a couple. For the Specified Low-Income Medicare Beneficiary (SLMB) program, which pays for the Medicare Part B premium, the income limit is $1,379 for an individual and $1,851 for a couple.
Please also note that if you qualify for the SLMB Program you will also getextra Helppaying for your prescription drugs and will pay no more than $9.85 in 2022 for each drug your Medicare drug plan covers.
Why would my Medicare coverage become inactive?
There are a few reasons why a person’s Medicare benefits may become inactive:
- Non-payment of premiums: If a person does not pay their Medicare premiums, their coverage can be discontinued..
Moving out of the country:Medicare does not provide coverage if you move outside the United States:
- Medicare Part A (hospital insurance), is available if you return. No monthly premium is withheld from your Social Security benefit payment for this protection.
- You can continue to pay for Part B benefits or drop them while living abroad.
- If a person moves out of the United States, their Medicare coverage will no longer be valid.
- Incarceration: If a person is incarcerated and in a federal prison, the benefits will stop, but resume coverage upon release. For the duration of the incarceration the facility will pay for the medical care.
- Enrolling in a Medicare Advantage plan:If you enroll intoa Medicare Advantage Plan, most of the Part A and Part B coverage will come from the Medicare Advantage Plan, as opposed to the Original Medicare coverage.
It’s important to note that if a person’s Medicare coverage is discontinued, they may be able to re-enroll during the Annual Enrollment Period (AEP) or a Special Enrollment Period (SEP).
Do you lose Medicare if you go back to work?
No, you do not lose Medicare if you go back to work. As previously mentioned, Medicare eligibility is based on age, certain disabilities and conditions like End-Stage Renal Disease (ESRD), not on employment status. Beneficiaries can continue to receive Medicare benefits even if they are working.
Additionally, if you go back to work and have employer-sponsored health insurance, you may choose to use that instead of Medicare, but you have the option to keep your Medicare coverage as well and use it as a secondary insurance.
How can I lose my Medicare eligibility?
If you qualify for Medicare by age, you may have Medicare for life. Medicare has certain coverage limits on how many days it will pay for inpatient hospital care and skilled nursing facility care in your lifetime. However, even when these maximums are reached, you can still receive Medicare coverage for other services, such as doctor visits.
If you have Medicare eligibility before age 65 because ofAmyotrophic Lateral SclerosisALS, you may have Medicare for life. According to the Mayo Clinic, there is no cure for ALS and eventually the disease is fatal.
If you have Medicare eligibility because of permanent kidney failure (and are not 65 or older and do not have another disability) your Medicare coverage will generally end 12 months after the month you stop dialysis treatments or 36 months after the month you have a kidney transplant.
If you have Medicare eligibility before age 65 because of a disability, returning to work will not automatically end your Medicare benefits. According to the Social Security Administration SSA, you may receive 93 months of hospital and medical insurance (Medicare Part A and Part B) after your trial work period as long as you still have a disabling impairment. Your Medicare Part A coverage will be premium free. After your premium-free Medicare coverage ends, you can purchase Medicare Part A and Part B insurance if you continue to have a disability at the end of the 93-month period. You also can generally keep Medicare if you receive health care coverage through work. Medicare is often the secondary payer and your employer coverage is the primary payer.
Keep in mind that you are responsible for telling Social Security if you return to work and if your medical condition improves. SSA expects that medical advancements and rehabilitation can help many people with disabilities recover.
If you lose your Medicare eligibility and don’t have health insurance, you may be eligible for Medicaid. Medicaid eligibility is determined partially by your Modified Adjusted Gross Income.
