The Eligibility Requirements for Medicare

You might have heard of Medicare, but do you really know what it is and who is eligible? Medicare is a federally operated health insurance program available to those who are 65 or older. A common misconception about Medicare is that you are enrolled once you turn 65, but that is false. You have to meet certain qualifications to enroll in the program and then you can enroll in it if you meet the criteria.

 

Qualifications


You need to be a United States citizen or a permanent resident with a minimum of a five-year residency. It’s also possible to qualify for the program if your employment or your spouse’s employment record qualifies them for Social Security. A person must earn 40 credits according to the Social Security program’s design or worked for a total of 10 years. You’re also eligible to enroll if you or your spouse worked for the government and paid into Medicare during your employment.

 

It’s worth noting that if you’ve earned 40 credits through payroll taxes, you’ll be exempt from paying for premiums for Medicare Part A. Credits are not a requirement to qualify for part B or D benefits. Your spouse’s work record could also qualify you for benefits if they are at least 62 years old, but you must be 65 or older. You may be eligible for benefits through your deceased or divorced spouse depending on their work history. This also applies to same-sex couples as a result of a 2015 Supreme Court Court decision.

 

Qualifying if you’re under 65


You can receive Medicare benefits if you aren’t 65 yet if you meet certain eligibility requirements. You are required to have received Social Security benefits before you can enroll in Medicare.

 

Other eligibility criteria that can qualify you to enroll in Medicare include:

- Receiving a pension from the Railroad Retirement Board

- Suffer from Lou Gehrig’s disease

- You have permanent kidney failure that requires a transplant or dialysis, as long as you or your spouse paid Social Security taxes for the required length of time.

 

 

Qualifying without mine or my spouse’s employment record

 

- As long as you’re 65 and a citizen or resident of the United States, you may be able to enroll in the Medicare program if you complete the following:

- Fund your part A premiums, which covers hospital visits. Anyone with less than 30 credits must pay the full premium amount, which was $411 as of 2016. Someone with 30-39 credits has an average premium of roughly $234. Those who have earned 40 credits are not responsible for paying premiums for part A.

- Pay Part B premiums. The premiums are the same for Part B as they are for Part A in Medicare. This portion of your premium covers outpatient medical services and doctor visits. All enrollees are responsible for paying this part of the insurance policy, even if they have earned the required 40 credits.

- Part D. This is the portion of the policy that covers prescription drugs. You’ll pay a premium that varies depending on the drug program that you choose to enroll in.

 

The Medicare program does not require that you enroll in every part available. You are able to enroll in certain parts while opting out of coverage for others depending on your individual needs and financial circumstances. There are a few exceptions to the rule. These are:

 

- You must enroll in Part B if you want to enroll in Part A, but you can enroll in Part B without opting into Part A.

- You must enroll in Part A or Part B of Medicare if you want to enroll in Part D, which helps cover the cost of prescription drugs.

- You must enroll in both Part A and Part B if you want to buy a Medigap supplemental or Medicare Advantage Plan (HMO or PPO)

 

You’ll likely receive a statement from the Social Security Administration (SSA) informing you of how many work credits you have and if you’re eligible for the program. If you haven’t received a statement or want to know if you qualify, it’s best to contact Social Security by calling their toll free number 1-800-772-1213. Whoever answers the phone should be able to help you determine if you qualify to enroll in the Medicare insurance program.