When you think of Medicare, you probably assume it’s for retirees. And that’s true. The standard age of eligibility is 65. But the program also covers people with disabilities and those with end-stage renal disease (ESRD) and ALS (Lou Gehrig's disease).
- Medicare is the U.S. national health insurance program for those 65 and older or those with qualifying disabilities, end-stage renal disease, or ALS.
- You may be able to keep your private health insurance if you work past the age of 65, but conditions often apply.
- Stay-at-home parents with no work history may still be eligible for Medicare benefits depending on their spouse's work history.
- Medicare is a U.S. government program funded by tax withholding from most workers' paychecks.
- To receive Medicare disability benefits, you must first receive Social Security Disability Insurance (SSDI) benefits for 24 months.
If you qualify for Medicare and don't know where to start, eHealth Medicare, an independent insurance broker and partner of Investopedia, has licensed insurance agents at 1-855-267-0952, TTY 711, who can help connect you with Medicare Advantage plans, Medicare supplement plans, and Part D prescription drug plans.
Who’s Eligible at 65?
Like Social Security, Medicare is a U.S. government program funded by tax withholding from most workers' paychecks. When you reach 65 or meet other requirements, you're eligible to receive Medicare services. Most people get Medicare Part A free of charge. But you'll have to pay for Part B and Part D prescription drug coverage (if you choose to enroll). Some Medicare Advantage plans charge premiums as well (on top of your Part B premium).
Retirees and Those Still Working
You're generally eligible to enroll in Medicare during your seven-month initial enrollment period (IEP). It begins the three months before you turn 65, and ends three months after. You may face a late enrollment penalty if you don't enroll during this time.
When your coverage starts depends on when you sign up. As of January 1, 2023, if you enroll during the last four months of your IEP, your coverage will begin the first day of the month after you enrolled. If you sign up during the first three months, coverage begins as soon as you're eligible.
If you work beyond age 65 and have health insurance coverage through your employer, you may be able to forego Medicare enrollment without facing a late enrollment penalty. But check with your HR department or a Medicare representative to be sure, since there are exceptions. And note that if you get Medicare while you have health insurance through work, your work coverage may remain your primary insurance, or it may need to be secondary. That depends on the size of the company you work for.
Note that if Medicare taxes weren't withheld from your or your spouse's pay for at least 10 years (40 quarters), you'll probably have to pay a premium for Part A. (If you or your spouse had at least 40 quarters worth of Medicare taxes withheld, you won't.) If you or your spouse paid Medicare taxes for less than 30 quarters, you'll pay the full Part A premium of $506 in 2023. But if you paid in for 30 to 39 quarters, you'll pay a reduced Part A premium of $278 in 2023.
There’s a lot to consider that makes it prudent to talk to a person knowledgeable in Medicare about your specific choices. This could be your human resources department or a Medicare representative.
If you were a stay-at-home parent or spouse and have no work history, you may still receive Medicare benefits at age 65 based on your spouse's or ex-spouse's work record. If your spouse has the required 40 quarters and you've been married for at least one continuous year, you qualify for benefits.
People in same-sex marriages have the same rights as other married couples to be covered under their spouse's Medicare benefits.
If you're divorced and don't qualify for Medicare under your work record, you may qualify based on your ex-spouse's record as long as your marriage lasted at least 10 years and you are currently unmarried.
ESRD and ALS
If you're diagnosed with ALS (Lou Gehrig's disease) or end-stage renal disease (ESRD), you are eligible for Medicare coverage immediately.
Medicare and Disability
You may be eligible for full Medicare benefits before the age of 65 if you have a qualifying disability.
How to Qualify
To qualify for Medicare benefits as a result of a disability, you must first receive Social Security Disability Insurance (SSDI) benefits for 24 months. There is usually a five-month waiting period after you are labeled as disabled before you can receive SSDI benefits. During this waiting period, you may be eligible for coverage under your employer’s health plan or, if no longer employed, through COBRA. However, if you have a disability as a result of Lou Gehrig's disease (ALS), you may not have a waiting period.
What If You Still Work?
There's a limited period of time during which you can receive SSDI benefits and work, but you can continue to receive Medicare benefits even once disability payments have stopped. This is known as the extended period of Medicare coverage, and it allows you to keep your Medicare coverage for at least 93 months after you have completed your trial work period.
Trial Work Period
There are three timeframes 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 SSDI and Medicare benefits. The nine months don't have to be consecutive, and a qualifying month is one during which you earned at least $1,050 in 2023. The trial period continues until you have worked for nine months within a 60-month period.
Extended Period of Eligibility
Once those nine months are up, you move into the next time frame—the extended period of eligibility. For the next 36 months, you can still receive SSDI in any month you aren't earning substantial gainful activity (SGA) income. Plus, you receive a three-month grace period the first time you earn SGA-level income, during which you're still paid SSDI benefits. The 2023 monthly SGA amount is $1,470 if you aren't blind; $2,460 if you are. You'll continue to receive Medicare benefits regardless of income.
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.
Extended Period of Medicare Coverage
Once you're consistently earning SGA-level income, you'll no longer receive SSDI, but the 93-month clock for extended Medicare coverage is triggered.
So you can receive Medicare benefits during the trial work period, the extended period of eligibility, and the extended period of Medicare coverage.
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 situation is not covered in the calculator, contact Social Security to discuss your case and get the assistance you need. Social Security representatives will help you understand your particular situation and guide you through the next steps.
Can I Get Medicare Before I Turn 65?
Yes, if you have a qualifying disability, end-stage renal disease (ESRD), or ALS (Lou Gehrig's disease). Someone who's received Social Security Disability Insurance (SSDI) benefits for 24 months is eligible. Individuals who are diagnosed with ALS or end-stage renal disease are eligible for Medicare coverage immediately.
Can I Get Medicare If I Never Worked?
Yes, if your spouse qualifies based on their work record and you've been married for at least one continuous year, you may be eligible for Medicare. This also applies to divorced people, as long as they were married to their ex-spouse for at least 10 years and the unemployed individual is unmarried.
What Is the Difference Between Medicaid and Medicare?
Medicare is a federal program that provides health insurance for those aged 65 and older and those with certain qualifying health conditions. Medicaid is both a federal and state program that provides health insurance for those with low incomes.
Can I Get Medicare If I Am Still Working?
Yes, but whether it makes sense to do so isn't always straightforward. If you have qualifying coverage through work, you may be able to delay enrolling in Medicare without incurring a late enrollment penalty. If you choose to enroll in Medicare while you're covered under an employer's plan, Medicare may become the primary insurer, depending on how large your employer is.