What Are Some Factors That Determine Eligibility for Medical Insurance?


Quick Answer

Medical insurance eligibility requirements vary. For example, Medicare generally requires that members be at least 65 years of age and be U.S. citizens or permanent residents for at least five years, according to MedicareResources.org. Children, parents, disabled people and pregnant women are also eligible under other plans, states HealthCare.gov.

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Full Answer

There are two main types of medical insurance, Medicare and Medicaid, as CMS.gov indicates. Medicare has four main parts, Part A, Part B, Part C and Part D, as MedicareResources.org explains. People who are 65 years and above and who either paid Medicare taxes for the past 10 years or have a spouse who paid Medicare taxes receive automatic enrollment in Part A. Those who are under 65 years old but are disabled and have received Social Security benefits or Railroad Retirement Board disability benefits for two years are also eligible.

Individuals can also qualify for Part A if they have end-stage renal disease, according to MedicareResources.org. A person with amylotrophic lateral sclerosis and who qualifies for Social Security Disability Insurance is eligible. Individuals can still qualify for Part A even if they have not paid Medicare taxes, but they must pay certain premiums in those cases.

Eligibility for Medicaid varies among states, but states generally use criteria such as income, family size, disability and family status among others to determine eligibility, explains HealthCare.gov. As of 2015, an individual who makes $16,243 or a family than makes $23,850 collectively per year may qualify depending on the state in which they live.

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