Why might a person not be eligible for Medicare Part A? A person must be age 65 years or older to qualify for Medicare Part A. Unless they meet other requirements, such as a qualifying disability, they cannot get Medicare Part A benefits before this age.
Californians with an annual income of less than $20,121 for an individual or $27,214 for a couple are eligible for a Medicare Savings Program. These programs provide help from the State of California to pay for your Medicare premiums, and sometimes your deductibles and copayments.
The spouse of a Medicare plan holder becomes eligible for their own plan when they turn 65 years old, even if they never worked outside the home. This is because they qualify based on their spouse's work record. If a Medicare enrollee's spouse has a disability, they may qualify at a younger age.
Just because you don't bring home a paycheck doesn't mean you're not working. A stay-at-home parent can get a Social Security check just like any other worker.
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
Depending on your state and how you qualify, Medicaid can cover some of your health care and certain Medicare costs, such as premiums, copays, coinsurance and deductibles. If you are eligible for full Medicaid coverage, you also automatically qualify for Extra Help for Medicare Part D coverage.
Reasons for Medicare coverage denial
A person has a Medicare Advantage plan, and they use a doctor who is outside of the plan network. The Medicare Part D prescription drug plan's formulary does not include the medication. The beneficiary has reached the maximum number of allowed days in a hospital or care facility.
Medicare Part A is free if you: Have at least 40 calendar quarters of work in any job where you paid Social Security taxes in the U.S. Are eligible for Railroad Retirement benefits. Or, have a spouse that qualifies for premium-free Part A.
In general, a single person must have no more than $2,000 in cash assets to qualify. If you're over 65, the requirements are more complex. Whatever your age, there are strict rules about asset transfers. Medicaid may take into consideration any gifts or transfers of cash you've made recently.
People aren't automatically enrolled in Medicare if they aren't getting Social Security or aren't eligible for Social Security retirement. They can sign up by completing an application for Part A (Hospital Insurance) (CMS 18-F-5 (PDF)) or by contacting the Social Security Administration (SSA).
You are eligible for Medicare if you are a citizen of the United States or have been a legal resident for at least 5 years and: You are age 65 or older and you or your spouse has worked for at least 10 years (or 40 quarters) in Medicare-covered employment.
Whether you're eligible for Medicare doesn't typically depend on whether you're employed or unemployed. However, when you become eligible for Medicare, your employment history might affect how much you pay for Medicare Part A (hospital insurance).
Eligibility rules are based on citizenship, age and disability. Workers pay into the program to accumulate credits but also pay premiums. Expect prescription, Medigap premium or Medicare Advantage expenses.
If you have Medicare Part B medical insurance, your premiums are automatically deducted from your Social Security check and your monthly premiums are based on your income. Most Part B enrollees will have $185 deducted from their Social Security each month in 2025. The amount increases if you have a high income.
eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.
People age 65 or older, who are citizens or permanent residents of the United States, are eligible for Medicare Part A. You're eligible for Part A at no cost at age 65 if 1 of the following applies: You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB).
Whether you're new to Original Medicare or have been enrolled for some time, understanding the limitations of your coverage is important as you navigate decisions about your healthcare. One of the main reasons why Original Medicare doesn't cover 100% of your medical bills is because it operates on a cost-sharing model.
Spousal Benefits for Retired Workers
A spouse who has never worked in paid jobs or has not worked to earn sufficient credits to be eligible for his/her own retired worker benefits can receive a spousal benefit that is 50 percent of the eligible worker's full benefit.
If your spouse dies, do you get both Social Security benefits? You cannot claim your deceased spouse's benefits in addition to your own retirement benefits. Social Security only will pay one—survivor or retirement. If you qualify for both survivor and retirement benefits, you will receive whichever amount is higher.
If you are in a nursing home for more than 90 days and Medicaid pays for more than half of your nursing home costs, your SSI benefits may be reduced. The amount of your reduction will depend on how much money you have in countable assets.