Who Qualifies for Medicare
Medicare helps tens of millions of seniors and people with disabilities nationwide pay for healthcare. Medicare doesn’t pay all of your medical bills, by any means. Nonetheless, it still gives a lot of protection against today’s high healthcare costs if you don’t have other health insurance. To qualify for Medicare, you must meet certain rules, depending on the following circumstances:
If you’re age 65 or older: You qualify for Medicare as soon as you reach age 65 if you or your spouse has worked long enough to entitle you to Social Security or Railroad Retirement benefits, even if you’re not yet receiving them. You usually need at least 40 credits (amounting to about ten years of work) to become eligible for these retirement benefits, which are paid through monthly checks.
Anyone with enough work credits can claim these benefits from the age of 62 onward, though doing so means accepting lower payments than when starting at or after full retirement age. (For people born between 1943 and 1954, full retirement age is now 66.) But remember — even if you claim these benefits early, you still have to wait until age 65 to qualify for Medicare.
The annual statement you receive from Social Security says whether you qualify for Medicare or, if you’re not eligible yet, when you will be. If you lose your statement, call Social Security at 800-772-1213 to ask for a replacement.
If you’re younger than 65 and have disabilities: You’re entitled to Medicare at any age if you have a severe illness, injury, or disability that prevents you from earning more than a certain amount of money each month and you’ve received Social Security disability benefits for at least 24 months. These months need not be consecutive.
Anyone diagnosed with Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis, or ALS) doesn’t have to wait 24 months to join Medicare. If you think you may qualify and want to find out the earnings limits that apply to your circumstances, call Social Security at 800-772-1213 or visit the website.
If you have permanent kidney failure: You’re entitled to Medicare at any age if you have end-stage renal disease (ESRD) — usually defined as needing a kidney transplant or regular dialysis — and if you or your spouse has paid into Social Security through work for a certain length of time. This period depends on how old you are. For specific eligibility information, visit the Social Security website or call them at the number listed above.
If you don’t qualify for Medicare: If you’re 65 or older but don’t have enough work credits, you may be able to buy into the system by paying premiums. You can buy in only if you’re an American citizen or a legal resident (green card holder) who has lived in this country continuously for at least five years.
The premiums for Medicare Part A (hospital insurance) are pretty hefty for people who don’t qualify for Medicare — the amount varies depending on how many work credits you have — but they’re probably less expensive than insurance you can buy yourself. Purchasing Medicare Part A makes you eligible for other Medicare benefits, like prescription drug coverage. If you work long enough to earn enough credits to qualify for Medicare in the future, you no longer have to pay Part A premiums.