When you think of Medicare, you probably assume that it’s for people of retirement age. That’s true, but the program covers more than just those who have worked all their life. You might be eligible right now and not know it.
In 2015 (the most recent numbers available) Medicare covered more than 55 million people in the United States. The bulk of beneficiaries, more than 84 percent, were people aged 65 or older. The remaining received services as a result of a disability.
Like Social Security, Medicare is a U.S. government program funded by tax withholding from most workers' paychecks. When they reach 65 or meet other eligibility requirements, they receive Medicare services. You will probably receive Medicare Part A coverage free of charge because of your payroll deductions, but Medicare has other requirements that will likely cost you. See Medicare 101: Do You Need All 4 Parts?
Who’s Eligible at 65?
Retirees and those still working. To receive full Medicare coverage at 65, you (or your spouse) have to have earned enough credits to be eligible for Social Security. Each $1,260 you earn equals one credit, but you can only earn a maximum of four each year.
You will receive full benefits at retirement if you have earned 40 credits –10 years of work if you earned at least $5,040 in each of those years.
If you paid into a retirement system that didn’t withhold Social Security or Medicare premiums, you’re probably still eligible for Medicare – either through your retirement system or through your spouse.
If you continue to work beyond age 65, things get more complicated. You will have to file for Medicare, but you may be able to keep your company’s health insurance policy as your primary insurer. Or, your company-sponsored insurance plan might force you to make Medicare primary, or other conditions may apply to you (see The Employee's Guide To Medicare). There’s a lot to consider that makes it prudent to talk to a Medicare expert about your choices.
Spouses. Maybe you were a stay-at-home parent or spouse. You can still receive Medicare benefits at age 65 based on your spouse's work record. If your spouse has the required 40 credits and you’ve been married for at least one year, you qualify for benefits.
People in same-sex marriages may qualify for spousal benefits if they live in the state where they were married or in another state that recognizes same-sex marriages – or are civilian or military employees of the federal government. For same-sex couples outside of these categories, the guidelines are vague but couples should apply anyway.
If you’re divorced and don't qualify for Medicare under your own work record, you may qualify based on your ex-spouse's record as long as your marriage lasted at least 10 years and you're currently single.
Disability Benefits: You Can Be Younger You may be eligible for full benefits before the age of 65 if you have a qualifying disability. There is no published list of qualified disabilities. Caseworkers evaluate each case individually.
How to Qualify. In order to receive Medicare disability benefits, you must first receive Social Security Disability Insurance (SSDI) benefits for 24 months. There is usually a five-month waiting period after a worker or widow is labeled as disabled before he or she can receive Social Security Disability benefits. During this waiting period, the person may be eligible for coverage under an employer’s health plan or COBRA if they’re no longer employed.
People who qualify as disabled fall under the same rules as a recipient who receives retiree benefits. There is no difference in coverage.
If a person has end stage renal disease (ESRD) or amyotropic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) there is no 24-month waiting period for benefits. A person diagnosed with ESRD can generally begin receiving benefits three months after a course of regular dialysis or after a kidney transplant. As soon as a person diagnosed with ALS begins collecting Social Security Disability benefits, he or she is enrolled in Part A and Part B Medicare benefits.
There are three time frames to understand. The first, the trial work period, is a nine-month period during which you can test your ability to work and still receive full benefits. The nine months don’t have to be consecutive. Any month in which you earn at least $810 (after expenses) or work more than 80 hours if you're self-employed counts as a month. The trial period continues until you have worked for nine months within a 60-month period.
Once those nine months are used up, you move into the next time frame – the extended period of eligibility. For the next 36 months, you can still receive benefits in any month you aren’t earning “substantial” benefits – generally considered anything over $1,130 per month or $1,820 if you are blind.
Finally, you can still receive free Medicare Part A benefits and pay the premium for Part B for at least 93 months after the nine-month trial period if you still qualify as disabled. If you want to continue receiving Part B benefits, you have to request it in writing.
If you’re disabled, you may incur extra expenses that those without disabilities do not. Expenses such as paid transportation to work, mental health counseling, prescription drugs and other qualified expenses might be deducted from your monthly income before the determination of benefits, which may allow you to earn more and still qualify for benefits.
The Bottom Line
To see if you qualify for benefits, go to Medicare.gov’s eligibility and premium calculator. Here, you can check your eligibility for benefits and get an estimate of your monthly premium.
Your individual situation may not be covered in the calculator. Contact Social Security to discuss your case and get the assistance you need. Experts there will help you understand your particular situation and guide you through the next steps.