Do I Qualify for Medicare?

Healthcare is hardly an easy topic to navigate these days. From job-based benefits to deciding which spousal plan to be on, and choosing between state insurance or private company options, there’s a lot to think about. And floating around in the sea of healthcare questions: who qualifies for Medicare?

There are a number of elements that dictate whether or not an individual qualifies and each case is different. The best way to have 100% clarity is to contact the government directly, but here are a few of the main parameters that determine eligibility to help get you started.

What are the requirements to be eligible for Medicare?

A common misconception is that Medicare has an age limit. The truth is that while anyone over 65 qualifies, you can be eligible earlier with extenuating circumstances. For example, those with End Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant) can be eligible. As the Health and Human Services (HHS) explains, “Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance).” Additionally, there is a Part D that handles prescription drug coverage.

Not everyone has to pay for Part A, which we’ll get to a bit later, but everyone who qualifies has to pay for Part B if they want the coverage. Billed every three months, the monthly premium is deducted from Social Security, Railroad Retirement, or Civil Service retirement checks.

How many years do you have to work to be eligible for Medicare?

The AARP explains succinctly that “nobody is automatically entitled to Medicare. To qualify, you must meet certain requirements,” one of which includes a certain number of years worked. You must work for roughly 10 years before you can be eligible. This number is calculated through earning a total of 40 credits, with one credit given out each quarter through payroll taxes. It’s important to note that you can also qualify through your spouse’s work record (same sex marriages included, regardless of where the couple lives or where they were married) even in the case of divorce or death.

What is Medicare Part A and who qualifies for it?

As noted earlier, Medicare Part A is hospital insurance. “You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years,” the HHS explains. In order to qualify for the premium-free version, you must be receiving benefits from Social Security of the Railroad Retirement Board, be eligible for those benefits but are not yet receiving them, or you/your spouse hold a government position that covers Medicare.

Even if you don’t qualify for the premium-free Medicare Part A, you could still qualify for the version that requires a premium for the services. Medicare.gov actually has a useful calculator tool that you can use to help determine your eligibility and what your premium, if any, might be.

Additionally, even if you’re younger than 65, if you’ve been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months you might still be able to get Medicare Part A without paying premiums. Also, anyone with Lou Gehrig’s disease is eligible for benefits during the first month that their disability benefits start.

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