Medicare Eligibility
Medicare is designed for older persons aged 65 and above. It is also made available to people under 65 living with disabilities or certain medical conditions.
Who Is Eligible For Medicare?
Wondering if you are eligible for Medicare? Here's what qualifies you.
You become eligible to sign up for Medicare 3 months before you turn 65. This is due to the Initial Enrollment Period that spans over seven months. These seven months are broken down as follows:
● Three months before you turn 65
● The month you turn 65 (your birth month)
● Three months after the month you turn 65
However, the age of 65 is not the only determining factor. You must be aged 65 and fit into these categories to qualify for full Medicare benefits:
● A U.S. citizen or a permanent legal resident who has lived in the United States for at least five years
● Receiving (or eligible to receive) benefits from Social Security or Railroad Retirement Board
● You or your spouse has paid Medicare taxes while working for at least ten years (40 quarters). This means you have earned 40 Social Security Credits.
You get an automatic enrollment into Medicare if you are 65 and already receiving retirement benefits from either Social Security or the Railroad Retirement Board.
If you are not drawing your Social Security benefits at age 65 then enrollment into Medicare is not automatic. In this case, you will need to apply for your Medicare benefits and missing the deadline to do so could result in lifetime late enrollment penalties. Learn more about how to apply.
How About Persons Under 65?
People under 65 can also be eligible for Medicare if they:
● Have end-stage renal disease (ESRD)
● Have amyotrophic lateral sclerosis (ALS)
● Have qualified for Social Security retirement benefits and have received Social Security Disability Insurance (SSDI) for at least 24 months (not necessarily consecutive)
● Have qualified for certain disability benefits from the Railroad Retirement Board for 24 months
● Have family relationship coverage, when a person's parent or a spouse paid Medicare taxes for a specified period
Some of these conditions give you automatic enrollment into Medicare. An example is Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS). Aside from automatic enrollment, you do not need a waiting period of two years (after being eligible for or receiving disability benefits) before your Medicare coverage kicks in. Your Medicare benefits are available immediately after you become eligible.
You also get automatic enrollment if you have received SSDI (Social Security Disability Insurance) for at least 24 months. The same benefits apply to persons with ESRD. However, to qualify, you must require regular dialysis or a kidney transplant. Also, you must meet the work requirements for yourself or a family member.
If you need regular dialysis, your Medicare coverage will begin on the first day of the fourth month of your dialysis treatment. For a kidney transplant, your Medicare coverage begins the month you're admitted to the hospital for a kidney transplant. Hence, all healthcare costs you may have incurred within the month (even if they were before your transplant) will be covered.
Disability benefits through Social Security are not extended to persons under age 18. In other words, the earliest you can start receiving Medicare benefits due to a disability is age 20 (18 years plus two years waiting period), or age 18 if you have ALS.
If you qualify for Medicare because of a disability, you're eligible for premium-free Medicare Part A without meeting work requirements. And as long as you meet the disability requirements, you can remain covered for more than eight years after returning to work. After that, you may have to start paying for Medicare Part A.
What if I Do Not Meet These Requirements?
Are you aged 65 or older but do not qualify for Medicare? This may be due to your work record or that of your spouse. However, It is not the end of the road, and there's still hope.
As long as you are a U.S. citizen or have been a legal resident for at least five years, you can enroll in Medicare and enjoy its coverage benefits. The following are alternative ways to get Medicare benefits:
Buy Medicare Part A And Pay Monthly Premiums
Once you do not qualify for Medicare, you equally do not qualify for a premium-free Part A. However, becoming a Medicare beneficiary is not an impossible mission.
As long as you are 65 or above, you can buy Medicare Part A and pay monthly premiums. Your monthly premium depends on how long (in quarters) you've worked and the work credits you've earned.
You earn work credits based on your income and when you pay Medicare taxes. In 2022, for every $1,510 you earn, you earn one work credit. If you have worked for less than 30 quarters or earned fewer than 30 work credits, you pay a monthly premium of $499. If you've accrued 30 to 39 credits meaning you've worked and paid Medicare taxes for 30-39 quarters, you pay $274. If you continue working and earn 40 credits, you will no longer pay monthly premiums.
Pay The Standard Monthly Part B Premium
From age 65 and above, you can buy Medicare Part B and pay the same monthly premium that other subscribers pay.
In 2023, the standard amount is $164.90. You may pay a higher rate depending on your yearly income due to IRMAA.
Pay The Standard Monthly Part D Premium
From age 65 and above, you can buy a Medicare Part D plan if eligible and pay the same monthly premium that other enrollees in the same plan pay.
Note, You must be enrolled in either Part A or B to get Part D.
Also, you must be enrolled in Original Medicare (Part A and B) to purchase a Medicare Advantage plan (Part C) or a Medigap plan.
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