Am I eligible for Medicare?

If you’re nearing your 65th birthday, your mailbox is probably bursting with advertisements about signing up for Medicare. While turning 65 is generally the first requirement for Medicare eligibility, there are other factors that come into play, too. In this article, we’ll discuss several scenarios and explain what you’ll need to do once you’re ready to enroll.

 

How do I know if I’m eligible?

In general, people who are eligible for Medicare fall under one of two profiles: those who are 65 and older, and those under 65 receiving social security benefits due to disabilities that prevent them from working.

Typically, if you’re a citizen or permanent legal resident (i.e. green card holder) and have worked in the U.S. and paid taxes, you’ll qualify for Medicare Parts A & B. However, your premiums are affected by how long you and/or your spouse have worked, as well as your income. At a high level, once you’ve worked 10 years or more, you’ll be eligible for Part A at $0/month. And if you have an average income, your Part B premium will be $134/month. Higher incomes and less years worked will typically lead to higher premiums.

 

What if this doesn’t sound like it applies to you?

Even if you do not qualify for premium-free Part A, you may still be able to purchase Medicare coverage.  You can make monthly payments for Part A if you meet one of the following criteria:

  • you’re a U.S. citizen; or
  • you have been a permanent legal resident for at least five years; or
  • you’ve been married to someone who meets one of the above criteria for at least one year.

Disability coverage

If you become disabled and enroll in Social Security benefits, you will become eligible for Medicare on your 25th straight month of receiving benefits. You’re also eligible to receive Medicare if you’re diagnosed with ALS (i.e. Lou Gehrig’s disease) at any time. You may also be eligible if you are diagnosed with End Stage Renal Disease (ESRD).

Real-life examples

Devon is a U.S. citizen who is turning 65 soon and is already receiving Social Security retirement benefits. Devon wants to know if he’s eligible for Medicare and, if so, when can he sign up?

The fact that Devon is already receiving Social Security retirement benefits means he’s eligible for Medicare Parts A & B. He’ll also be automatically enrolled in both parts with an effective date of the 1st date of his birth month. He should receive his Medicare card in the mail about three months before his 65th birthday, and his Medicare Part A and B premium will be deducted from his monthly Social Security payment.

Rosie and Owen are married and both are U.S. citizens. Rosie is turning 65 and retiring, while Owen is still working. They’re both on Owen’s group plan at work. Should Rosie sign up for Medicare Parts A & B?

Actually, in cases like these, it depends on a couple of considerations. If Owen works for a company that has more than 20 people, Rosie can stay on John’s insurance and doesn’t have to sign up for A or B. If John works for a small company (fewer than 20 people), they should check with his company’s HR department to see if Medicare is the primary payer. Rosie should sign up for Part A & B if Medicare is the primary payer because she could risk getting penalties for not having full coverage from her spouse’s employer.

Jeff and Casey are divorced. They’re both U.S. citizens, and Casey has been a stay-at-home mom while Jeff has owned his own company his entire career. Casey is turning 65. Is she eligible for Medicare?

Most likely, yes. If Casey didn’t work outside the home and pay taxes, she most likely won’t qualify based on her own work history, but she can still qualify based on Jeff’s work history. As long as he’s worked more than 7 years, and they were married at least 10 years, she will qualify for Medicare Parts A & B.

Ella is a U.S. citizen who has been working for 8 years and is turning 65 this month. Is she eligible for Medicare?

Ella is eligible for Medicare Parts A & B, but she will need to pay a premium for Part A because she has not worked over 10 years. Since she’s worked for 8 years, she will pay a $227/month premium for Part A in 2017. Unless she works for two more years, she’ll continue to pay for Part A.

To learn more about health care coverage options in special cases like these, read our article  ”Is Medicare my only option after 65?”

Key takeaways

  • There are two main groups of people who are eligible for Medicare: those over 65, and those under 65 who collect social security due to a disability that prevents them from working.
  • Typically, if you’ve worked and paid taxes for 10 or more years, you will qualify for Medicare Part A at $0/month and Medicare Part B at $134/month.
  • Higher incomes and less years worked will typically lead to higher premiums.

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