Medicare is available for the elderly and disabled citizens of the United States. It offers comprehensive, affordable health care that includes hospital, medical and drug coverage, regardless of socioeconomic status. Requirements are the same, regardless of where you live in the United States. Eligibility requirements are no different for New Mexico residents than for the rest of the country, but there are state services dedicated to helping recipients navigate the enrollment process. Eligible recipients must meet citizenship and enrollment period requirements and at least one of four additional criteria, involving age or special medical circumstances.
Enrollment
There are certain times when Medicare-qualified individuals are eligible to enroll in Medicare. They can sign up when they first become eligible, which is called their initial enrollment period. They can also sign up during the annual coordinated election period (which lasts from Nov. 15 to Dec. 31 each year) and the open enrollment period (which lasts from Jan. 1 to March 31 each year, though individuals may not sign up for Part D prescription plans during this time). Sometimes people can qualify for special enrollment periods. A special enrollment period is granted if an individual has an exceptional circumstance that would warrant an exception to the usual enrollment period. People signed up for the federal program Extra Help or a state pharmaceutical assistance program can have one special enrollment period per month. New Mexico, however, does not currently have a state pharmaceutical assistance program.
New Mexico residents who are struggling with understanding Medicare eligibility and the enrollment process can get one-on-one counseling through the New Mexico State Health Insurance Assistance Program, sponsored by the New Mexico Aging and Long-Term Services Department (see Resources).
Citizenship
In order to be considered Medicare-eligible, an individual must be a United States citizen. In order to receive premium-free Part A, he must have worked a minimum of 10 years in the United States for an employer that paid into Medicare taxes.
Age
Most individuals whose age qualifies them for Medicare are not yet eligible for full retirement. However, they still only need to be 65 to qualify for Medicare. If for whatever reason they qualified for Social Security retirement or railroad retirement benefits at an earlier age (younger than 65), then they can expect to be automatically enrolled in Medicare Part A and Medicare Part B when they reach 65.
Disability
Disabled individuals who qualify to receive Social Security Disability Insurance or railroad disability annuity checks are not eligible for Medicare until the 24th month of receiving these benefits. They are then automatically enrolled into Medicare.
End-Stage Renal Disease
People diagnosed with end-stage renal disease, specifically those who are undergoing dialysis treatment or have received a kidney transplant, are also eligible for Medicare. Dialysis recipients will become Medicare-eligible after the fourth month of dialysis. To receive benefits earlier, they can opt for a self-dialysis training program. Medicare benefits are retroactive, once the program begins. If the program is stopped at any point, Medicare coverage will cease, and the beneficiary will not be Medicare-eligible until the fourth month after dialysis treatment. Those undergoing kidney transplants become eligible as soon as they are hospitalized in preparation for the transplant.
Amyotrophic Lateral Sclerosis
Sufferers of Lou Gehrig's disease, also known as amyotrophic lateral sclerosis (ALS), are automatically eligible for Medicare. They are Medicare-eligible the first month they begin to receive Social Security Disability Insurance benefits.
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