Medicare is a government health insurance program designed to enable access to quality, affordable health care for people age 65 and older. It’s a useful and popular program, but one that intimidates many people. In order to help you get prepared for entering this program, we’ve prepared this short guide to the Wisconsin Medicare eligibility rules and regulations.
Like we said, Medicare is designed to provide quality health insurance benefits. While Original Medicare, Parts A and B, provides comprehensive coverage, it does have some gaps. Besides these gaps, you’re also expected to pay a share of the cost for your care. These costs can add up, so most Americans choose to also use at least one of the three private Medicare Insurance plans available. Since Original Medicare is the basic coverage you’ll need to have before adding these private plans, we’ll review the eligibility rules for that first.
Medicare is available to all citizens and permanent legal residents of the United States. This is the basic, and only, eligibility requirement. There is a difference between being eligible and being able to use your benefits, however. People who are eligible for Medicare have to wait for a triggering event in order to enter the program. There are four triggering events:
If you meet the ESRD, ALS, or disability eligibility requirements, you can enter Medicare early, before age 65. When this happens, your entry into Medicare is automatic. However, most people end up entering Medicare because they’ve turned 65 years old.
If your triggering event is turning 65 years old, you’ll need to decide whether you want to start Medicare at 65 or delay your enrollment. You might consider this if you plan to keep working and you’ll be covered by your employer plan.
If you want your coverage to start at 65, you’ll have a seven month window of time during which you can enroll, unless your enrollment is automatic. Your Medicare enrollment will be automatic at 65 if you’re already receiving Social Security retirement benefits when you turn 65.
Whether you're enrolled automatically or manually, your initial enrollment period is also the time for you to choose your private Medicare Insurance plan if you want to add this coverage.
The eligibility rules for these private plans are all similar to those for Original Medicare, but with a few small differences.
To add Part D drug coverage, you’ll need to be enrolled in either Part A or Part B. You can be any age to get this coverage.
To enroll in a Part C Medicare Advantage plan, you have to have both Part A and Part B in place. As with Part D, you can be any age and still get Medicare Advantage coverage.
To be eligible for Medicare Supplement Insurance, you also have to be active in both Part A and Part B. In many states, you also have to be at least 65 years old to get this coverage. However, Wisconsin requires insurance companies to offer this coverage to people who enter Medicare before age 65. Unfortunately, premiums for people under 65 in Wisconsin tend to be quite high. Because of this, if you meet the Wisconsin Medicare eligibility rules before turning 65, you might prefer to stick with Part C or Part D coverage until you turn 65 years old.
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MedicareConsumer.com is a non-government agency and is on a mission to help current and future Medicare recipients find the best Medicare supplement plan for their unique needs. Medicare insurance logos as seen on MedicareConsumer.com belong to the respected trademark owners in our available network of Medicare insurance carriers. Any and all rate quotes for Medicare supplement plans are free to consumers and you are not obligated to purchase any plan from any carrier.
Participating sales agencies do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.
Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP]organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a special enrollment period.