Medicare Eligibility is About More Than Your Age

Chris Smith Chris is a writer with an expertise in Medicare subjects. Having undergone a triple bypass and cardiac rehabilitation under the Medicare umbrella, Chris brings the voice of firsthand experience to his writing.
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Not everyone is automatically eligible for Medicare when they turn 65 and some people are eligible even before. Here are the factors to consider.

The future of healthcare is an important topic in American life, but also one associated with a lot of stress and confusion. It doesn’t have to be that way.

Not a day goes by where we don’t hear the words “Medicare for All,” especially now that it’s campaign season. It hard to know how the various government proposals will actually impact your their family’s health care. But as you get older, the government funded healthcare insurance plan known as Medicare will probably be the healthcare option that will play the most significant role in your health for the rest of your life.

If you’re approaching 65, you probably want to know as much as you can about Medicare and what it entails. When Medicare was created  in 1965, less than half of that population was covered for hospitalization and even fewer people had coverage for doctor visits. Over the years, Medicare has evolved to include options  in coverage that offer comprehensive care at affordable prices. 

To make sure you don’t miss out, we’re covering:

  1. The Basics of Medicare Eligibility
  2. Frequently Asked Questions (FAQ) About Medicare

The Basics of Medicare Eligibility

Eligibility for Medicare Part A and Medicare Part B are usually automatic providing these qualifications are met:  

  • Citizenship. You need to be at least 65 years old and either a U.S. citizen or a permanent legal resident who’s lived in the U.S. for five continuous years.
  • Minimum Premium Payment. Medicare is the retirement health insurance plan that you’ve probably been working toward your whole working life.  To be eligible, by the time you hit 65, you’ll need to have paid Medicare premiums through payroll deductions for at least 10 years (or 40 fiscal quarters).
  • Certain Government Workers! Some federal and state workers only pay for Part A through their payroll deductions.Therefore, they will only be eligible for Part A Medicare. 
  • Disability. If you are receiving Social Security or Railroad Retirement Board (RRB) disability benefits, you will be automatically eligible for Medicare Part A twenty—four months after the first month you receive disability payments. Disabled persons and persons with certain medical conditions are also eligible for Medicare no matter how old they are or what their premium payment history is. Here are those conditions:
    • Lou Gehrig’s Disease. If you are diagnosed with ALS and you receive Social Security disability benefits, you are eligible for both Part A and Part B coverage effective the date of your first disability payment.
    • End Stage Renal Disease. If you are diagnosed with ESRD and need regular  dialysis or a kidney transplant, and you have paid in a sufficient amount of  of premium payment, you can be eligible for both Part A and Part B regardless of your age. 

To recap, for many seniors, being eligible for Medicare insurance is a matter of turning 65, being a citizen or legal permanent resident, and paying into the program through payroll deductions for at least 10 years. 

For people who have a disability or certain medical conditions, they may be eligible for Medicare despite their age and monthly premium payment history

“What About Me?”—Answers to Your Most Pressing Medicare Eligibility Questions

While the eligibility requirements seem straightforward, they raise many questions for a significant number of people who don’t precisely meet them.

Let’s take a look at the two most common eligibility concerns.

‘I’m approaching 65 but I don’t have 10 years of premium payments.’

  • Stay at home parents If you’ve spent most of your adult life at home raising a family, you can still qualify for Medicare if your spouse qualifies. If your spouse (living, dead or divorced) has at least 10 years of premium payment, you qualify.
  • Late bloomer. If you do not qualify on your own or your spouse’s work record, you can still get Medicare at age 65. In that case you just have to buy into it. 

You can purchase Part A which is free for fully qualified persons and pay the same premium for Part B that everyone else does. The price will just depend on the number of work credits (quarters) that you or your spouse has. 

If you continue to work after 65 and hit 40 credits (10 years), you will no longer need to pay for Part A.

‘I plan to work after I’m 65 years old and have employer provided health care.’

If you work  when you are age 65 or older and your employer (or your spouse’s) provides health insurance, you do not have to enroll in Medicare until you either end your employment or your employer ends the benefit. As a practical matter, you might as well enroll for Part A (it’s free) at age 65. In fact, your employer’s plan may require it. 

One downside of passing on Part B until you end your employment is you may lose your eligibility for Medicare Advantage insurance (Part C).

Still confused? We know it’s not a walk in the park to get all this right. We get it. If you are eligible and uncovered, and have questions regarding Medicare eligibility or any other aspect of this important health care plan, you should talk to a licensed professional. 

The complete qualifications are complicated so it’s always recommended that you contact your local Social Security Office or consult with the hospital’s social worker for assistance.


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