Who Is Usually Eligible for Medicare?

Most U.S. citizens become eligible for Medicare when they turn 65. They are typically automatically enrolled in Medicare Part A once they begin receiving Social Security benefits. Enrollment in Medicare Part B requires a more formal application process, as do the private Medicare Advantage plans (Medicare Part C) and Medicare Part D.

Age-based eligibility isn’t the only way to qualify for Medicare. There are also some specific medical conditions which may qualify younger people for Medicare, including:

• Qualifying for and being on Social Security Disability Insurance (SSDI) for more than 24 months

• Having Lou Gehrig’s Disease (ALS)

• Being diagnosed with end-stage renal disease (ESRD)

What if a Senior Also Qualified for Medicaid?

Having dual eligibility in Medicare and Medicaid does offer some unique benefits for low-income seniors. People who qualify for both may be able to have their Medicare premiums covered by Medicaid and receive price reductions on deductibles and copayments for some health care services.

Medicaid might also fully cover some services not entirely covered by Medicare, or provide discounted copays. Because Medicaid is a hybrid federal/state program, different states offer different Medicare coverage solutions and features.

For example, Medicare in Arizona utilizes the Arizona Long Term Care System (ALTCS) for qualifying residents older than 65 (or those who are younger with eligible disabilities) who require nursing care. Like many Medicaid programs, there are a specific set of eligibility requirements for the program, including:

• Being an Arizona residents

• Being at least 65 years of age or having an eligible disability

• Requiring a nursing facility level of care (NFLOC) that can only be received in a nursing home

• Having one of the requisite medical conditions or physical/cognitive limitations (dementia, Alzheimer’s disease, difficulty with tasks of daily living, etc.)

• Meeting the program’s income and asset limits

Income and asset eligibility requirements vary depending on your marital status. There are a variety of potential retirement savings, tax planning and estate planning strategies that may help Arizona retirees meet the asset and income eligibility requirements without sacrificing their savings. It may be beneficial to consult with a retirement planner to learn about your options.

Deciding Between Medicare and Medicaid

Seniors or retirees evaluating whether Medicare, Medicaid or a combination of both is right for them should take several considerations into account:

Financial Situation: Assess your current financial standing and anticipated medical expenses. If your income is limited, you might qualify for Medicaid or dual eligibility.

Coverage Needs: While Medicare provides comprehensive coverage, Medicaid might be better suited for those who anticipate requiring services like long-term care.

State of Residence: Since Medicaid is administered at the state level, you’ll need to meet the Arizona residency eligibility requirements to make full use of the Arizona Medicaid benefits. The good news is Arizona has no length of residence requirement, meaning you don’t need to have lived in Arizona for any specific length of time prior to eligibility. As long as you’re an official resident of the state and you meet the asset and income requirements, you’re eligible for Arizona Medicaid.

Get Help Choosing the Right Medicare Solution

While the basic Medicare Part A and Part B programs have their limitations, they’re still an invaluable entitlement earned by seniors and retirees in Arizona who spent decades paying into the system. These programs ensure the financial burden that accompanies any age or health-related challenges you face in retirement won’t derail your plans or force you to drain your retirement savings.

Medicaid is an equally important benefit, especially for older Arizona workers who might be concerned about their finances and not having enough money to comfortably retire.

It’s not uncommon for soon-to-be-retirees to feel flummoxed when they first learn how many different “Parts” there are and how much choice there is when it comes to Medicare plans. If you have questions about Medicare plans, copays and how you can structure your retirement finances to minimize the risk of overpaying for long-term care or memory care (should the need arise), talk with Fullerton Financial Planning by calling (623) 974-0300. Our retirement advisors are ready to answer your questions and help you make informed decisions.