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If you’re familiar with employer-sponsored health-care plans, you may expect your whole family to be covered under one health insurance plan. Medicare, however, covers beneficiaries only on an individual basis. The Medicare beneficiary’s benefits generally don’t extend to his spouse, even if his spouse is a dependent. Medicare benefits also don’t typically cover the beneficiary’s children, even if the children are minors.. If your spouse or children are eligible for Medicare, then they each have to apply for their own benefits separately.
Who qualifies for Medicare coverage?
Original Medicare, Part A and Part B, is generally available for American citizens and legal residents of at least five continuous years age 65 and over. Medicare is also available to those under 65 with disabilities, including Lou Gehrig’s disease and end-stage renal disease. Once you qualify for Original Medicare, you may also choose to enroll in private plans such as Medicare Advantage (Medicare Part C), a Medicare Part D Prescription Drug Plan (Medicare Part D), or Medicare Supplement insurance (Medigap). Depending on the laws of your state, a Medicare Supplement plan may not be available to you if you’re under 65 with Medicare coverage.
Is your spouse a dependent?
If you retire at 65, you can transition from employer-sponsored health insurance to Medicare. However if your spouse is a dependent on your employer-sponsored plan, she cannot transition with you to Medicare unless she is also 65 or has a disability. For example, if your spouse is 61 when she loses health insurance through your employer plan, she will generally have to wait four years to be eligible for Medicare. To maintain health-care coverage in those four years, she can apply to an individual plan from a private health insurance company or a health insurance broker like eHealth. Your dependent spouse can also apply for Medicaid, which provides health coverage to millions of low-income adults, children, and people with disabilities.
Medicare for children
A child may be eligible for Medicare if he has a disability. There is often a two-year waiting period for Medicare coverage for people with disabilities, meaning if a child was born with a disability he might have to wait until his second birthday to get Medicare. If you child has end-stage renal disease or Lou Gehrig’s disease there is generally no waiting period for Medicare coverage. If your dependent child does not have a disability, she may still be eligible for Medicaid or CHIP insurance. Medicaid is currently available to children who reach 133 percent of the federal poverty level, although most states cover children at higher income levels, according to Medicaid.gov. CHIP, or the Children’s Health Insurance Program, provides benefits to eligible children through both Medicaid and separate CHIP programs. CHIP serves children up to age 19 whose family incomes are too high to qualify for Medicaid. Forty-six states and the District of Columbia cover children up to above 200% of the Federal Poverty Level through the CHIP program.
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