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Patient Eligibility Coverage with Medicare

Unveiling Patient Eligibility Coverage with Medicare


Medicare is a national health insurance program the US government administrated by CMS (Centers for Medicare and Medicaid Services). This program first pays for services, but Medicaid never pays first for services but after. Generally, This program provides health services to those who are 65 years and, other individuals with disabilities, and those suffering from end-stage renal disease. This program covers everything from hospital insurance to Medicare insurance and even drug coverage for patients. The program is specially designed to offer health insurance coverage to eligible patients who best fit the patient eligibility criteria. The article will unveil patient eligibility coverage. There are several factors to consider to determine patients’ eligibility. These factors are described in the following paragraphs.


Programs generally serve people 65 years or above. They must be USA residents or permanent citizens of the country living in the country for at least five years. If an individual is a US citizen and the spouse of that individual paid taxes for at least ten years. Then a patient becomes eligible for premium-free hospital insurance. Eligibility enrollment has specific timeframes and rules. Initial enrollment is seven months surrounding the 65th birthday. In case a patient misses the enrollment period, it will lead to facing enrollment penalties even for eligible patients.


Some individuals become eligible even before 65 years of age. These people must have had some disability for at least 24 months or suffer permanent kidney failure. Individuals receiving railroad retirement benefits or social security or serving for a longer tenure but still need to collect benefits is enough to make a person eligible for the program. Individuals or their spouses must be government employees and pay social security and Medicare taxes during working. However, people with ALS (Amyotrophic Lateral Sclerosis) disability are eligible for the program before 24 months.

End Stage Renal Disease

Kidney failure or end-stage renal disease are eligible for the program irrespective of their required age. These people can benefit from coverage in the fourth month of their kidney dialysis. Medicare cover all the services that need to treat the kidney. The patient is eligible for kidney dialysis or a kidney transplant through the program.

Medicare Coverage

However, the coverage of Medicare for the eligible patient has been divided into four parts. As mentioned below.

Medicare Part A

In this Part of Medicare coverage is called Hospital Insurance. It covers inpatient hospital care, facility care, skilled nursing, and related home health care services.

Medicare Part B

This Part is most commonly known as Medical insurance. In Part B, outpatients can benefit from home visits from doctors, preventive care services, medical supplies, and other services required to treat outpatients.

Medicare Part C

This part is known as Medicare Advantage, which offers the combined benefits of Part A and Part B of the program. Medicare-approved private insurance companies provide these advantage plans. The advantage plan has its eligibility criteria and could vary in cost and coverage.

Medicare Part D

Prescription drug coverage or Part D . All beneficiaries are eligible for prescription drug coverage under Part D. Private insurance companies offer Part D, but Medicare approves it.


What is critical for the program is that program has copyrights, deductibles, and coinsurance. The insurance plan beneficiary is responsible for paying the entire coverage cost. Furthermore, certain treatments and services have specific coverage limitations and patient eligibility requirements. An individual must contact the social security administration to accurately determine the patient’s eligibility for coverage program and insurance benefits. Social Security Administration offers personalized guidance to every individual based on their circumstances. That will not only help the patient to check their eligibility but also assist the patient in getting inside about the Medicare coverage options best suit them.

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