Who is Eligible for Medicare?
Many people think of Medicare and Social Security going hand in hand. However, they have different eligibility and entry requirements. While most people plan to enter Medicare in retirement, there are a few reasons you might become eligible earlier than expected.
Eligibility for Medicare depends on a combination of work and payroll tax history, citizenship or resident status, age, and health conditions. In this article, we will discuss:
- Medicare Eligibility for Those 65 and Older
- Medicare Eligibility for Those Younger Than 65
Aging Into Medicare At Age 65
If you meet the citizenship and work history requirements you can enroll in Medicare at age 65. This is referred to as aging into Medicare, and it’s the primary way Americans enroll within the program. Your first enrollment period is known as your Initial Coverage Election Period (ICEP). You can enroll anytime during:
- Three months prior to the month you turn age 65
- The month you actually turn age 65
- Three months after the month you turn age 65
Your ICEP is a seven month window. As an example, if you turn 65 in February of 2020, your enrollment window begins on November 1, 2019. Your enrollment ends on May 31, 2020. At any time during this period you can enroll in Medicare Parts A and B.
Qualifying For Medicare Before Age 65
Most people enter Medicare at age 65, or later if they keep working. However, there are a few reasons why you might enter Medicare early.
Early Medicare Eligibility Due to Disability:
You may apply for Medicare early if you are permanently disabled. In order to qualify due to disability, you must receive Social Security Disability income (SSDI), or disability income from the Railroad Retirement Board, for 24 consecutive months.
On the first day of the 25th month, you’ll be eligible for Medicare. Since you’re already in the Social Security system, you will automatically be enrolled in both Parts A and B. You won’t have to take any action to get into Medicare.
If you also want a Prescription Drug or Medicare Advantage Plan, you’ll need to enroll in those separately. Your enrollment window for these Plans is just like the Initial Coverage Election Period for aging into Medicare, except it’s centered on your 25th month of disability:
- 3 months before your 25th consecutive month of Social Security Disability Income (SSDI)
- The 25th month of receiving SSDI
- 3 months after your 25th month of receiving SSDI
You may also be able to purchase a Medicare Supplement Insurance Plan, depending on the State in which you live. Many States require you to be age 65 to purchase a Medigap Plan, even if you’re eligible for Medicare due to disability.
Early Medicare Eligibility Due to Health Conditions:
You may also qualify for early Medicare due to failing health. Enrollment is automatic if you have been diagnosed with:
- A.L.S. (Lou Gehrig’s Disease), or
- End Stage Renal Disease (ESRD)
There is a waiting period of no more than five months from your diagnosis of ALS. In the case of ESRD, you enter Medicare fourth months from the date you begin dialysis.
If you have ALS, you can enroll in a Prescription Drug or Medicare Advantage Plan once your Medicare coverage has begun. Medicare Supplement Insurance can be purchased, but again, you may need to be age 65.
If you have ESRD, you may not be able to enroll in a Medicare Advantage Plan. Depending on your State’s Medigap laws, you will be able to enroll in Medicare Supplement Insurance, but perhaps not until you turn 65.
Citizenship and Payroll Taxes
In order to be Medicare eligible, you must meet one of these citizenship requirements:
- You are a U.S. citizen, or
- You are a permanent legal resident with five or more years of residence in the U.S.
Once you satisfy one of these criteria, you will then enter Medicare by aging into the program, disability, or diagnosis of ALS or ESRD.
Medicare Eligibility and Spouses
Spouses can enroll in Medicare even if they’ve never worked, or haven’t worked enough to qualify on their own. If your spouse worked and paid payroll taxes for the required 10 years, you qualify for premium-free Part A, as long as:
- Your spouse is still alive and you’re married, or
- You’re a widow, but you were married for at least nine months, or
- You’re divorced, but you were married for at least ten years
Have A Plan For Starting Medicare
If you’re approaching Medicare eligibility age, now is a great time to brush up on your Medicare coverage options. You’ll also want to consider Medicare Advantage and Medigap Plans. Working with a Medicare insurance specialist is a great way to get started.
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