Who Can Get Medicare?

Find Out Who’s Eligible for Medicare

Medicare is a government-sponsored health insurance program that covers people 65 or older, as well as people with certain disabilities. It also provides healthcare for some younger persons who have been diagnosed with end-stage renal disease. It is administered by the Centers for Medicare & Medicaid Services (CMS), which operates as part of the U.S. Department of Health and Human Services, but it is not funded directly by taxpayers; rather, its funds are derived from premiums paid to insurance companies that operate under government contract within each state’s boundaries. Lindsay Malzone, an expert in Medicare, can tell you all about Medicare and its history.

To be eligible to receive Medicare benefits, a person must be 65 or older and under the age of 65 with certain disabilities, or be diagnosed as having the end-stage renal disease (permanent kidney failure requiring dialysis); and have been entitled to Social Security Income (SSI) for at least 24 months. People who get SSDI automatically qualify for Medicare after they’ve received payment from them for two years. A person’s eligibility may also depend on whether he is considered low income according to state standards, which can vary widely between states. For example, in California, an individual earning more than $1700 per month would not be eligible but that same amount makes you ineligible in Kentucky where median monthly earnings are lower.)

Lindsay Malzone

The program was established in 1965 under the Social Security Act, and originally provided care for people over 65 or with disabilities. In 1973, a separate program was established to provide healthcare coverage for those with end-stage renal disease (ESRD).

In 1972, Title XVIII of the federal statute establishing Medicare also created another insurance system that offers private health plans in what is called the Medicare Advantage program. It allows beneficiaries to enroll in managed care programs such as HMOs or PPOs rather than receiving their benefits through fee-for-service payments from traditional Medicare. The latter method reimburses medical providers directly without involving an insurer while allowing patients free choice of doctors and hospitals.

However, it did not cover prescription medications until 2006 when President George W Bush signed into law the Medicare Prescription Drug, Improvement and Modernization Act. It expanded the scope of benefits to include prescription drugs for people over 65 or with disabilities who choose to join a plan that offers this benefit through stand-alone plans (i.e., plans that offer no other medical services).