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. That's because the bulk of beneficiaries, more than 80%, were people aged 65 or older, but others received services at a younger age due to a qualifying disability.
- Medicare is the U.S. national health insurance program for those 65 and older or for those with qualifying disabilities.
- To receive full Medicare coverage at age 65, you (or your spouse) must have earned enough credits.
- You may be able to keep your private health insurance if you work past the age of 65, but conditions—such as making Medicare your primary coverage—often apply.
- Stay-at-home parents with no work history may still be eligible for Medicare benefits depending on their spouse's work history.
- Caseworkers evaluate each situation to determine if an individual has a qualifying disability and is eligible for Medicare before the age of 65.
Who’s Eligible at 65?
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 aspects that will likely cost you.
Retirees and Those Still Working
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. To receive full Medicare coverage at 65, you (or your spouse) must have earned enough credits to be eligible for Social Security.
Each $1,360 you earn annually equals one credit, but you can only earn a maximum of four credits each year. You will receive full benefits at retirement if you have earned 40 credits—10 years of work if you earned at least $5,440 in each of those years (as of 2019).
If you continue to work beyond age 65, things get a bit 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. There’s a lot to consider that makes it prudent to talk to a Medicare expert about your choices.
Maybe you were a stay-at-home parent or spouse and have no work history. 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 ten years and you are currently single.
When Am I Eligible For Medicare?
You may be eligible for full benefits before the age of 65 if you have a qualifying disability. There are no published lists of qualified disabilities, but caseworkers evaluate each case individually and decide if benefits are warranted.
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 SSDI benefits. During this waiting period, the individual may be eligible for coverage under an employer’s health plan or, if they’re no longer employed, through COBRA.
People who qualify as disabled are 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 amyotrophic lateral sclerosis (ALS), which is more commonly 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. Meanwhile, as soon as a person diagnosed with ALS begins collecting Social Security Disability benefits, he or she becomes enrolled in Part A and Part B Medicare benefits.
What if You Work?
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. 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 gainful activity.”
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. That's where you can check your eligibility for benefits and get an estimate of your monthly premium. If your individual situation is not be covered in the calculator, contact Social Security to discuss your case and get the assistance you need. Experts will help you understand your particular situation and guide you through the next steps.