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Demystifying Us Medicare Eligibility For Canadians

Medicare Basics: Parts A, B, C & D

by Jonah Ravel B.A., F.Pl., CFP®Jun 10, 2019Health Coverage & Insurance, Immigration

Theres widespread misinformation out there about the eligibility requirements for Canadian retirees to be able to enroll in US Medicare. With US health care such a threshold issue, both Canadian resident snowbirds who winter down south and Canadians who may be planning to move to the US full-timeare eager to learn whether they will qualify for Medicare coverage.

Generally, youll read that to be eligible for US Medicare coverage, you need to be: a) at least 65 years old AND b) either a US citizen or a green card holder whos been living continuously in the US for at least five years.

The age 65 requirement is true barring certain qualifying disabilities or medical conditions. However, the US citizenship / five-year US residency with a green card requirement is not necessarily true. Canadians who arent US citizens / green card holders and who dont even live in the US year-round can get on to Medicare.

In another blog, Ill provide an overview of the various parts of Medicare. For now, Ill just be zeroing in on the eligibility requirements for Original Medicare, which consists of Part A and Part B .

Eligibility for Part A

Free Part A

You qualify for free Part A Medicare as long as you or your spouse have at least 40 credits .

Paid Part A

To be eligible for paid Part A, you must also be enrolled in Part B.

Eligibility for Part B

If you qualify for free Part A

The Part B Decision

Who Is Eligible For Health Care In Canada

Our national health insurance program is designed to ensure that all insured persons have access to medically necessary hospital and physician services on a prepaid basis. The Canada Health Act defines insured persons as residents of a province. The Act further defines a resident as:

âa person lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but does not include a tourist, a transient or a visitor to the province.â

Therefore, residence in a province or territory is the basic requirement for provincial/territorial health insurance coverage. Each province and territory is responsible for determining its own minimum residence requirements with regard to an individualâs eligibility for benefits under its health insurance plan. The Canada Health Act gives no guidance on such residence requirements beyond limiting waiting periods to establish eligibility for and entitlement to insured health services to three months. Most provinces and territories also require residents to be physically present 183 days annually, and provide evidence of their intent to return to the province.

Requirements To Purchase Part B

Medicare Part B is also known as medical insurance. Part B helps to pay for the basic medical costs you have, such as doctor visits, preventive care and basic medical treatments. If you are a non-citizen, you can purchase Medicare Part B under specific conditions. You are required to be 65 years of age or older. You also are required to prove that you were legally admitted to the United States and that your status is still legal at the moment of applying for Part B. Along with that, you must have lived in the United States for at least five consecutive years.

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Citizenship And Residency Requirements

In most cases, to be eligible for Medicare, you need to be a U.S. citizen living in the U.S.

You can also qualify for Medicare if you’re a permanent U.S. resident who has been living in the U.S. for five continuous years prior to the month you apply for Medicare.

Even though these two eligibility criteria are specifically for Medicare Part B, they also apply to most other parts of Medicare. That’s because Part B enrollment is required for enrollment in Medicare Part C, Medicare Part D, Medigap and the Medicare Part A paid plans.

However, if you qualify for the free Medicare Part A plan because of your work history, you can be enrolled in Part A plan without being enrolled in Part B.

Can An Immigrant Get Medicare

Detailed Explanation of the Transition from Social Security and Medicare

Medicare of health coverage has four different parts. U.S. citizens, in most instances, are enrolled in Part A and Part B of Medicare automatically at the age of 65. If they have paid Medicare tax, they receive Part A coverage for no additional fee. However, if you are not a US citizen, you are not eligible to purchase Part A or receive it for free. Instead, non-U.S. citizens may purchase Medicare Part B.

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How Do You Receive Your Medicare Benefits When You Meet Medicare Eligibility Requirements At Age 65

If you meet Medicare eligibility requirements and you have received Social Security benefits for at least four months prior to turning age 65, you will typically get Medicare Part A and Part B automatically the first day of the month you turn age 65.

If youre not enrolled in Original Medicare automatically, you may need to file an application with the Social Security Administration. You can enroll in Medicare Part A and Part B during the period that begins three months before your 65th birthday month, includes your birthday month and ends three months after your birthday month.

Note: You have a choice if you want to keep or refuse enrollment in Medicare Part B. If you refuse it, you dont lose your Medicare Part B eligibility. However, you may have to wait for a valid enrollment period before you can enroll. You may also have to pay a late enrollment penalty for as long as you have Medicare Part B coverage.

Should Immigrants Consider Short

Immigrants who are unable to afford ACA-compliant coverage might find that a short-term health insurance plan will fit their needs, and its far better than being uninsured. Short-term plans are not sold through the health insurance exchanges, so the exchange requirement that enrollees provide proof of legal residency does not apply with short-term plans.

Short-term plans provide coverage thats less comprehensive than ACA-compliant plans, and for the most part, they do not provide any coverage for pre-existing conditions. But for healthy applicants who can qualify for coverage, a short-term plan is far better than no coverage at all. The premiums for short-term plans are far lower than the unsubsidized premiums for ACA-compliant plans, but most lawfully present immigrants will qualify for premium subsidies in the exchange, especially in 2021 and 2022 as a result of the American Rescue Plans subsidy enhancements.

Recent immigrants who are eligible for premium subsidies in the exchange will likely be best served by enrolling in a plan through the exchange the coverage will be comprehensive, with no limits on annual or lifetime benefits and no exclusions for pre-existing conditions. But healthy applicants who arent eligible for subsidies , may find that a short-term policy is their best option.

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What Happens If I Miss My Medicare Enrollment

If you miss your initial enrollment period, you can still sign up for Medicare, but you could face late enrollment penalties. Anyone can sign up during the Medicare general enrollment period, which happens from Jan. 1 to March 31 each year. If you meet the qualifying circumstances, you can sign up any time through a Medicare special enrollment period.

What Other Health Care Services Do Provinces And Territories Provide

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Provinces and territories may also offer âadditional benefitsâ under their respective health insurance plans, funded and delivered on their own terms and conditions. These benefits are often targeted to specific population groups , and may be partially or fully covered. While these services vary across different provinces and territories, examples include prescription drugs, dental care, optometric, chiropractic, and ambulance services.

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What Are Typical Healthcare Costs For Non

Non-US citizens who receive Employment-based insurance incur the partial cost or do not incur any health care cost if fully covered by the employer.

Suppose youre a non-US citizen who is not getting medical insurance from your employer or school. In that case, you can browse plans and estimated prices on ACAs website at any time, given you fulfill the eligibility requirements mentioned above.

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Requirements For Medicare Eligibility As A Green Card Holder

To be eligible for full Medicare benefits as a green card holder, you need to be 65 or older, and you or your spouse need to have worked in the U.S. for at least 10 years .

You may still be eligible for Medicare if youve worked fewer years, but youll likely pay a higher cost for the benefits. Those who have worked in the U.S. for the required 10 years or more are eligible for Medicare Part A without the premiums. If you dont qualify for premium-free Part A benefits, you may still be able to purchase coverage.

The cost of Medicare Part B is based on how much you made in your working years rather than how long you worked. For this reason, most individuals still have to pay a premium for this coverage, even if theyve worked in the country for 20 to 30 years. Those who have to purchase Part A coverage are only eligible to do so after purchasing Part B coverage.

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What Do I Pay For With Medicare

Both Part A and Part B have deductibles. With Part A, there is a $1,364 deductible for each benefit period you may pay this deductible more than once in a year. The Part B deductible is only paid once per year and is currently $185.

You may also pay coinsurance for certain covered services. With Part B, you generally pay 20% of the allowable charges. There is a daily coinsurance amount under Part A for inpatient stays lasting longer than 60 days.

Some services have a flat copayment, which is due at the time you get care at the hospital outpatient department or doctors office. You will either pay a coinsurance amount or a copayment, but rarely both.

Medicare Advantage plans have different cost-sharing systems. You usually have just one annual deductible, and most plans have a copayment when you see the doctor or get outpatient services.

Part D plans usually have an annual deductible and charge a copayment amount each time you fill a prescription. Again, Medicare Advantage and Part D plans are private insurance plans, so you should check with each insurance company or a Medicare plan insurance agent for details about available plans.

How Does Immigration Status Affect Medicare Enrollment

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First, to qualify for Medicare, an immigrant must be a lawful permanent resident of the United States. For example, if your immigrant parent has a green card and has lived in the U.S. at least five years, he or she may qualify for Medicare. Undocumented immigrants are not able to get Medicare.

Many older people who immigrate later in life have little or no work history in the United States. This can affect their Medicare costs.. If this situation applies to your parents, they will likely need to meet the 5-year permanent residency requirement. Once they meet this requirement, they can generally enroll in Medicare Part A and Medicare Part B . They can enroll in Medicare Part D if they have Part A and/or Part B.

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Younger Than Age : Who Is Eligible For Medicare

As long as you meet the citizenship/legal residence requirements described above, you may be eligible for Medicare when you are younger than age 65 if one of the following circumstances applies to you:

  • You have been receiving Social Security disability benefits for at least 24 months in a row
  • You have Lou Gehrigs disease
  • You have permanent kidney failure requiring regular dialysis or a kidney transplant. This condition is called end-stage renal disease .

Read more details about enrollment in Medicare when youre under 65.

Healthcare & Medicare Information

NOTE: Information below touches on only a few points of this very complex subject. The Medicare website is a rich source of information and personalized advice.

For more information on the healthcare & Medicare issues facing Americans abroad, see here.

If you already live abroad, you should contact the US Federal Benefits Unit serving the country where you reside for advice. They have direct access to the Social Security files, and have experience with problems specific to people residing outside the US. You can find the Federal Benefits Unit serving your location here: ssa.gov/foreign/foreign.htm .

The single most basic fact to remember is that you are NOT covered by Medicare while living abroad . That said, you may still need to consider enrolling in one or more parts of Medicare.

Workers who have contributed at least 40 quarters to Social Security are eligible for Medicare coverage at age 65 even if your Social Security “full retirement age” is over 65.

Individuals who are eligible for railroad retirement benefits, or who have worked long enough in a US federal, state, or local government job can also qualify for coverage.

Certain other categories of individuals may qualify for one or more parts of Medicare earlier than age 65 or under certain conditions.

For greater detail on qualifying for Medicare, see: faq.ssa.gov/link/portal/34011/34019/Article/3771/What-is-Medicare-and-who-can-get-it

There are a few narrow exceptions to this rule:

Part A is Hospital Insurance

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Medical Conditions And Disabilities

If you have certain disabilities, you may be eligible for premium-free Medicare Part A benefits even if youre under 65 years old.

Social Security Disability Insurance recipients

If you have a disability and have been receiving SSDI benefits for at least 24 months , you will automatically be enrolled in premium-free Medicare at the beginning of the 25th month.

ESRD

If your doctor has diagnosed you with ESRD and youve received a kidney transplant or youre on dialysis, you qualify for Medicare benefits if one of the following criteria applies:

  • you qualify for Social Security retirement benefits
  • you qualify for Railroad Retirement Board benefits
  • your spouse or parent worked long enough to be eligible for Social Security retirement benefits

When you become eligible for Medicare benefits depends on whether you receive dialysis at home or in a treatment facility:

  • If youre receiving dialysis in your home, you can apply for Medicare the first day you begin your dialysis program. You need to be sure to apply before the third month of treatment.
  • If you receive dialysis in a treatment facility, you can apply for Medicare on the first day of the fourth month of your treatment.

If youre scheduled to receive a kidney transplant, you can apply for Medicare on the first day of the month youre admitted to the hospital to start preparing for the transplant. But if your transplant is delayed, your Medicare benefits wont start until 2 months before the month your transplant takes place.

Is Medicare Free For Green Card Holders

Medicare 101

Medicare Part A is only premium-free for green card holders if they have worked and paid Medicare taxes in the United States for 10 years or more. The same work requirements are also necessary to receive Social Security retirement benefits.

If the green card holder has a work history of fewer than 10 years, they will likely pay a premium for Medicare Part A. All Medicare beneficiaries including green card holders and U.S. citizens pay a premium for Medicare Part B and Medicare Part D.

What can green card holders expect in terms of monthly premiums? In 2022, Medicare Part A premiums can cost up to $499 per month, while the 2022 standard Medicare Part B premium is $170.10 per month. Medicare Part D premiums may vary, depending upon the Medicare plan selected. In addition, other types of Medicare coverage, available from private insurance companies, may also charge monthly premiums.

Note: To a avoid Part A and/or Part B late enrollment penalty, be sure to sign up when youre first eligible for Medicare.

Not sure whether or when youre eligible for Medicare Parts A and B or how much youll pay? Check out this Medicare calculator to learn more about your specific eligibility and premium amount. Green card holders can also visit the U.S. Medicare department online at Medicare.gov or call 1-800-MEDICARE .

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Travel Outside The Us

Medicare usually doesnt cover health care while youre traveling outside the U.S. There are some exceptions, including some cases where

may pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S. However, Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port.

Medicare may pay for inpatient hospital, doctor, and ambulance services you get in a foreign country in these rare cases:

  • You’re in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
  • You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
  • You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

In the situations above, Medicare pays only for services covered under

Do Green Cardholders Qualify For Medicare

Green card applicants can qualify for Medicare without enough work credits. But, youll likely need to pay for Part A premiums. Since Part A costs are based on how long youve worked in the United States and paid taxes towards Medicare, costs could vary.

Those that have worked a minimum of ten years could qualify for premium-free Part A. Now, Part B is a little different. Youre costs depend on how much you make each year. High-income earners will pay a Part B IRMAA. Also, if youre eligible for Medicare and delay enrollment, penalties could raise the cost of your premiums if you enroll later on.

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