Eligibility Requirements for Medicare

Medicare is a form of U.S. government health care extended to qualifying seniors age 65 and older or to those who are disabled or have permanent kidney failure. Medicare should not be confused with Medicaid, though they are both health care coverage offered by the government.

Most U.S. citizens will qualify for Medicare, and it represents a great savings for many as they age and their health care requirements increase.

While most will qualify for Medicare, there are exceptions that will make an individual ineligible. Those exceptions and the requirements needed to be a part of the program are outlined below. Medicare comes in several different parts, which all cover different aspects of your health care. Part A is the segment of Medicare that does not cost most U.S. citizens anything to have. The others vary in cost and price. Use the information provided below to determine whether you qualify to receive Medicare benefits.

Work and Tax Requirements to Qualify for Medicare

Medicare is offered to those who are one of the following:

  • 65 years of age
  • Disabled
  • A United States citizen for at least five continuous years
  • Have end-stage renal failure
  • Have Lou Gehrig’s disease, also known as ALS.

However, that is just the first round of eligibility. Aside from those who are disabled, a senior who is 65 years of age must also meet the work requirements. You must have worked a culmination of at least 10 years, or 40 quarters, in the course of your lifetime. If you did not work that much time, but your spouse did, you would also qualify under him or her.

Who is eligible to get Part A for Free?

With the exception of Part A, most other parts of Medicare will cost you a monthly premium. Part A is offered at no cost if you meet the following requirements:

  • You are already receiving Social Security benefits, or benefits from a Railroad Retirement Board.
  • You or your spouse were already covered by government employment offering Medicare.
  • You are eligible for Social Security or Railroad benefits but have not filed for them yet.

Retirement and Medicare Eligibility

In the past there has been some confusion regarding the retirement age and eligibility for Medicare. Before the change in the full retirement age, which is 67, most seniors would retire and immediately begin receiving Medicare. Now, the rules are a bit different. Though the current retirement age for Social Security is 67, you will qualify to receive Medicare by age 65. However, if you are still employed and receiving health care with your employer, then you have to make some decisions. If the coverage will be similar and the premiums will be lower to go on Medicare, then you are allowed to drop your employer’s coverage and enroll in Parts, B through D. This is a good strategy if both you and your spouse qualify for Medicare. If your spouse is not 65 years of age yet, then you should stay with your employer’s coverage until your spouse reaches the age of eligibility.

Exceptions to this include those businesses that have fewer than 20 employees. In these cases, you would go through the Medicare enrollment process, and it would be the primary payer with the employer’s plan covering whatever Medicare would not cover. This is just Part A, of course. You would not want to enroll in a Part B through D and pay double premiums. If your employer is a small company then make sure the business’s insurance company offers a type of gap coverage as a secondary payer. Sometimes smaller plans limit providers. If this is the case, then you will want to opt for a Medigap plan.

What if you retire but are still covered until age 70 through the company?

Some companies extend retirement benefits to employees who have worked for the company for many years. Corporate retiree benefits are considered secondary to the Medicare benefits in this situation. Check with the human resources department before you leave to make sure the benefits extended to you will cover the gaps in Medicare’s coverage.

Eligibility for Medicare If You Are Disabled

If you are under the age of 65 and disabled then you may be eligible for Medicare coverage as well. However, it is not an automatic enrollment initially. If you are disabled, you will qualify for Medicare if you:

  • Have received Social Security Disability benefits for at least 24 months
  • Have End Stage Renal Disease or ALS.

It can take up to five months for your Social Security Disability benefits to begin, so the 24-month wait period does not begin until you have begun receiving the Social Security benefits. After the 24 months have lapsed, the government will automatically enroll you in Medicare Part A and B. Beneficiaries cannot be denied coverage based on underlying condition or the length of term required for care. As long as your doctor has ordered care for any of the following, then you would be eligible:

  • Mental illness
  • Alzheimer’s Disease
  • Parkinson’s Disease
  • Multiple Sclerosis

Eligibility for Medicare If You Are Disabled but Working

Because the government wants all those who can work to work, your Medicare benefits will cover you for up to nine months after you obtain a job. For an additional seven and three quarter years after this trial work period you will also be partially covered. You have to continue to be considered legally disabled under Social Security rules to remain eligible during all of these time periods. There are limits on how much you can earn and still receive Medicare, however. If after the initial nine month trial period you earn at least $1,234 (as of 2014) you would continue to receive benefits.

However, if you exceed the Social Security Disability Income (SSDI) income threshold, you could see a reduction or cessation of those benefits. At that point you would still be eligible to receive Part A, but Part B through D would now have to be paid out of pocket. If you are working and are disabled and are unable to pay the premiums there are many state-run programs that can assist with those payments. As of 2017 you must have resources that total less than $7,560 for individuals, and $11,340 for couples. Additionally, you must have no more than a monthly income of $1,234 for singles, and $1,666 for couples.

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