There are many ways to qualify for Medicare. There are two parts of Medicare, each of which has its own requirements:

Hospital Insurance (also known as Part A)

If You Are 65 or Older

Most people 65 or older are eligible for Medicare hospital insurance (Part A) based on their own—or their spouse's— employment. You are eligible at 65 if you:

Receive Social Security or railroad retirement benefits;

Are not getting Social Security or railroad retirement benefits, but you have worked long enough to be eligible for them;

Would be entitled to Social Security benefits based on your spouse's (or divorced spouse's) work record, and that spouse is at least 62 (your spouse does not have to apply for benefits in order for you to be eligible based on your spouse's work) ;or

Worked long enough in a federal, state, or local government job to be insured for Medicare.

If You Are Under 65

Before age 65, you are eligible for Medicare hospital insurance if you:

Get Social Security disability benefits and have amyotrophic lateral sclerosis (Lou Gehrig's) disease; or

Have been a Social Security disability beneficiary for 24 months; or

Have worked long enough in a federal, state, or local government job and you meet the requirements of the Social Security disability program.

If you receive a disability annuity from the Railroad Retirement Board, you will be eligible for hospital insurance after a waiting period. (Contact your railroad retirement office for details.)

Eligibility For Family Members

Under certain conditions, your spouse, divorced spouse, widow or widower, or a dependent parent may be eligible for hospital insurance when he or she turns 65, based on your work record.

Also, disabled widows and widowers under age 65, disabled divorced widows and widowers under 65, and disabled children may be eligible for Medicare, usually after a 24-month qualifying period. (For disabled widows/widowers, previous months of eligibility for Supplemental Security Income (SSI) based on disability may count toward the qualifying period.)

If You Have Kidney Failure

There are special rules for people with permanent kidney failure. Under these rules, you are eligible for hospital insurance at any age if you receive maintenance dialysis or a kidney transplant and:

You are insured or are getting monthly benefits under Social Security or the railroad retirement system; or

You have worked long enough in government to be insured for Medicare.

In addition, your spouse or child may be eligible, based on your work record, if she or he receives continuing dialysis for permanent kidney failure or had a kidney transplant, even if no one else in the family is getting Medicare.

If You Do Not Qualify Under These Rules

Certain aged people who do not qualify for Medicare hospital insurance under these rules may be able to get it by paying a monthly premium. They must also always enroll in medical insurance (Part B) to get this coverage. Certain disabled people who lost premium-free hospital insurance due to work can get Medicare hospital insurance again by paying a premium.

Medicare Medical Insurance (also known as Part B)

Almost anyone who is 65 or older or who is under 65 but eligible for hospital insurance can enroll for Medicare medical insurance by paying a monthly premium. Aged people don't need any Social Security or government work credits for this part of Medicare.

If you are already receiving Social Security benefits--

Most people qualify for Medicare when they turn 65. You qualify for it if you're eligible for Social Security or Railroad Retirement benefits. Or you may qualify on a spouse's (including divorced spouse's) record. Others qualify because they are government employees not covered by Social Security who paid the Medicare part of the Social Security tax. In addition, if you've been getting Social Security disability benefits for 24 months or get Social Security disability benefits and have amyotrophic lateral sclerosis (Lou Gehrig's disease), you'll qualify for Medicare. You may also qualify if you have permanent kidney failure and you receive maintenance dialysis or a kidney transplant.

If you are already getting Social Security benefits, you'll automatically be enrolled in Medicare Parts A and B. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will be contacted by mail a few months before you become eligible and given all the information you need.

If you are not already receiving Social Security benefits--

If you are not already getting benefits when you turn 65, you should call 1-800-772-1213 three months prior to your birthday so we can help you decide if you should sign up for Medicare. You should do this even if you plan to continue working or do not think you have enough work credit under Social Security, because Medicare enrollment period rules are very strict. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. People who are deaf or hard of hearing may call our "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days. Our representatives there can make an appointment for you - by phone or in person - at any convenient Social Security office. When you apply for Medicare, we often also take an application for monthly benefits.

Generally, we advise people to file for Medicare benefits 3 months before age 65. Remember, Medicare benefits can begin no earlier than age 65. If you are already receiving Social Security, you will automatically be enrolled in Medicare Parts A and B without an additional application. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will receive a Medicare card about two months before age 65.

There are four parts to Medicare: Medicare Part A, Hospital Insurance; Medicare Part B, Medical Insurance; Medicare Part C (Medicare Advantage), which was formerly known as "Medicare + Choice" and the new Medicare Part D, prescription drug coverage. Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant.

Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.

Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.

Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.

Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.

No. Medicare benefits based on retirement do not begin until a person is age 65. If you retire at age 62, you may be able to continue to have medical insurance coverage through your employer or purchase it from a private insurance company until you turn age 65 and become eligible for Medicare.

Mercy MedicareADVANTAGE is a Medicare Advantage Plan offered through a contract with the Centers for Medicare and Medicaid Services (CMS) – the federal agency that administers Medicare. Mercy MedicareADVANTAGE can provide you with every benefit to which you are entitled under Medicare Parts A and B and we provide Medicare Part D (prescription drug coverage) including the following:

No deductibles (select plans)

Fixed Copay or Coinsurance on some services

Selection of your own doctors

Flexibility of no referrals (select plans)

Reimbursement towards eyeglasses, health club membership

Preventive Care

Worldwide Emergency and Urgent Care

Nurse on Call 7 days a week, 24 hours a day

Mercy MedicareADVANTAGE premiums, copays and benefits vary by county. For complete details about plans available to you, go to mercyhealthplans.com and select your county.

There are many ways to qualify for Medicare. There are two parts of Medicare, each of which has its own requirements:

Mercy MedicareADVANTAGE provides preventive and wellness benefits that you need at zero cost to you. You also receive all the benefits under Medicare without the Medicare deductibles such as:

Annual physical exams

Immunizations

Mammograms

Bone mass measurements

Colorectal screening exams

Prostate screening exams

Mercy MedicareADVANTAGE also provides you with a reimbursement of $150 every two years for routine eyewear.

Mercy MedicareADVANTAGE offers you many advantages in choice of plans, coverage and savings. When selecting a Medicare Advantage plan you should consider:

The cost of what you pay out-of-pocket, including premiums.

Benefits – Are extra benefits and services, like Part D drug coverage

Hospitals, Physicians

Disease Management

Local customer service

Click on our Compare Plan

Call us to schedule a one-on-one consultation.

Arkansas - 888-330-3202 TTY: 800-468-4418

Springfield / Joplin - 800-330-8449 TTY: 800-446-1468

St. Louis - 888-330-3202 TTY: 800-468-4418

The Mercy MedicareADVANTAGE service area includes St. Louis County, St. Louis City, St. Charles County, Warren, Jefferson, Franklin, Lincoln, and in IL, St. Clair, Madison, Monroe, and Randolph. In Southwest Missouri the counties include Cedar, Date, Lawrence, Barry, Stone, Taney, Christian, Greene Webster Polk, Hickory Dallas, Laclede, Pulaski and Phelps counties. In Arkansas Benton, Garland, Washington, Crawford, Franklin Sebastian, Logon, Scott Carroll, Pulaski and White counties.

As a Medicare beneficiary, you can choose from different Medicare options.

Original (fee-for-service) Medicare Plan

Medicare Advantage Plans

Medical Savings Account (MSA)

Medicare Prescription drug plans

There are specific times, called "election periods" when beneficiaries can make changes. The first is the Annual Enrollment Period each year beginning November 15 through December 31. During this time, all Medicare-eligible beneficiaries may choose a Part D prescription drug plan or switch to a different Medicare Advantage program. Coverage under the new plan will begin the following January 1, 2010.

The second is the Open Enrollment Period from January 1through March 31, that allows members to switch to a similar plan, but it must be a same like plan, and you are not permitted to add a drug plan at that time if you currently do not have one. Beneficiaries can not make changes to their health plan after March 31, 2010 except in unique circumstances, known as Special Election Periods such as moving to a different service area, or if you are or become institutionalized, or you lose coverage from an employer plan.

Low Income Subsidy (LIS) is extra help offered by the Medicare and is specifically related to the Part D prescription drug coverage. Beneficiaries are qualified based on income. Applications must be submitted directly to the Social Security Administration (SSA) and those who qualify will receive an approval letter from SSA. For more information you may refer to your “Medicare and You” handbook or to obtain an application to apply for LIS, contact the SSA office directly.

Mercy Health Plans does cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs. Mercy MedicareADVANTAGE has contracts with pharmacies that equals or exceeds CMS requirements for pharmacy access in your area. Through our agreement with Caremark, you will have access to more than 62,000 pharmacies nationwide.

Mercy Health Plans has a network of doctors, specialists, and hospitals. For our HMO plan you are only permitted to use doctors who are part of our network, if you belong to our PPO plan this will allow you the choice to use providers in our network or out of network for additional cost. Please refer to our Provider Directory for an up-to-date list.

Some plans (HMO) do require a referral from your Primary Care Physician (PCP) while others (PPO) allows you to choose the physician or hospital. In some cases your cost may be higher if you use out of network physicians and hospitals. Some special cases may require pre-authorization.

You pay certain co pays or for authorized services and Mercy will keep track of your cost share when claims are submitted and processed. Once you have reached your maximum amount you will not have to pay any more out of pocket costs for the remainder of that year. This is for services that go towards your OOP expenses. You can find more information on which services goes towards your OOP in your Evidence of Coverage (EOC).