How Old Do You Have to Be to Get Medicare 

Last Updated: 05.08.20

 

The age at which one becomes eligible for Medicare is that of 65, also known as that at which you start looking for other specialized products, but if you want more details on this, you can check it out here. In terms of Medicare, there are other ways in which individuals can benefit from the program, such as those with disabilities, even if they are not 65 yet. 

With this being said, Medicare is definitely very helpful, given that we’re talking about a U.S. government program, so you want to see all the applicable rules before you venture into any expenses. The program is funded through taxes, and people who reach the age of 65 can benefit from it. 

Of course, there are other categories for eligibility, so you may fall into one of these even if you have not yet reached that particular age. The program can cover various medical services, given that you’ve been contributing through payroll deductions. On the other hand, some aspects can cost money as well. 

For this reason, it’s a good idea to know what all the categories are and what they entail in terms of requirements. 

 

Retirees 

In order to benefit from the Medicare program at the age of 65, you need to have earned the necessary amount of credits to qualify for Social Security. If you did contribute to a retirement system that doesn’t hold Medicare or Social Security premiums, you are most probably still eligible for the program. 

It’s important to note that you can benefit from Medicare through your spouse as well, but let’s take a better look at the Social Security credits system. For each $1,360 earned annually, you get one credit, and you cannot get more than four credits per year. 

The program starts applying after earning 40 credits, which basically means around ten years of work, for those who have earned a minimum of $5,440 each year. In case you want to continue to work after the age of 65, things are not that easy anymore. After this age, it’s necessary to file for Medicare, but you may still be able to benefit from the company’s health insurance as well, as a primary insurer. 

The details here depend on many factors, including the policies applicable to the company in which you are working or you will work after the age of 65. The company’s insurance plan may require you to go for Medicare as primary, so you need to be aware of any conditions that apply in your case and then assess your options. 

You can also discuss these matters with a Medicare expert if you are not sure what the best course of action is in your case. 

Spouses

Since we’ve mentioned spouses, you should know that this category can benefit from Medicare as well. In the case of stay-at-home parents who don’t have a work history, the spouse’s work record can apply after the age of 65. This means that even if you don’t have a record yourself, you can still get Medicare coverage for certain situations. 

However, in order to use a spouse’s Medicare credits, the marriage must be longer than one year and the same minimum number of credits applies. There are ways in which you can get Medicare coverage even if you are divorced. If your spouse has a work record that is eligible for the program and you’ve been married for more than ten years, you can apply as well. 

However, the person who doesn’t have a work record and needs to benefit from that of the spouse after getting divorced also needs to be currently single in order to be eligible for the program. 

As we’ve mentioned, there are other situations in which you can benefit from Medicare, even if you have not yet reached the age of 65, so let’s see what some of these are. 

 

Disability Benefits

If you have a qualifying disability, you may be eligible for the program. The important part here is that there are no published lists of such qualified conditions, so caseworkers need to evaluate each case individually and then decide whether benefits are going to be warranted or not. 

To get these Medicare disability benefits, you first need to receive a Social Security Disability Insurance that comes with benefits for 24 months. You also need to know that usually there’s a rather long five-month waiting period from the moment in which a person is assessed as disabled before he or she can start receiving SSDI benefits. 

The important part is that there is no difference in terms of coverage and benefits between a Medicare recipient who is retired versus one who has a disability. With this being said, there are some exceptions to all the information above. 

The most important one being that if the recipient suffers from amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD), there is a much lower waiting period that’s usually around three months. This applies in particular to people who need to receive regular dialysis or who have had a kidney transplant. 

In the case of ALS, as soon as a person is diagnosed, he or she will be enrolled in either Part A or Part B Medicare and start receiving the corresponding benefits. 

Those Who Are Still Working

If you are working, you can still benefit from the Medicare program for those with disabilities, if you are going through a transition period. There are three main time frames that matter in this process and that you need to be aware of. The first one is the trial-work period, which lasts nine months and during which the recipient has his or her ability to work tested, while still receiving the benefits. 

These nine months don’t necessarily need to be consecutive, so this is not going to be an issue. The second time frame is an extended period of eligibility and lasts for 36 months. During this time, the recipient can still receive benefits if he or she doesn’t gain substantially from working. 

The third and final step is the one in which one can still receive Medicare benefits for another 93 months or more if the person still qualifies as disabled. However, for Part B benefits, the recipient needs to request this in writing. 

For individuals who have disabilities, the great part is that there are more expenses that could be deducted before receiving benefits, such as special transportation, prescription drugs, or other services, which means that they allow the recipient to earn more while still qualifying for benefits. 

 

Other Types of Coverage 

If you don’t fall into any of the categories mentioned above, there are still ways to get Medicare coverage, even if you are not yet at the age of 65. One option is to purchase a package. For instance, if you have fewer than 30 Social Security credits, you can pay around $458 as the maximum premium. 

The fee is lower if you have more credits but you are still under 40, and it was $252 in 2019 for those who had between 30 and 39 credits. In case you continue to work as well and eventually earn the necessary minimum of 40 credits, then you can stop paying the premium and just benefit from the program. 

You can also choose which Part (A or B) you want to pay premiums for. Part B, for instance, can cover doctor visits, as well as other services, and the rates increase according to the recipient’s income. For this reason, if you want to know what the best alternative is in your case, you should also take into account talking to a specialist in Medicare coverage. 

In terms of premiums, there is nothing to worry about if you want to enroll in Part B, but without doing the same in Part A. However, if you do buy into Part A, you will also enroll in Part B. It’s important to understand all the parts of the program, given that, for example, you can benefit from Part D if you are enrolled in either Part A or B. 

The program’s website is also a very useful resource that you should definitely use as you assess your options. You can get more information on your eligibility, as well as use the premium calculator to see what your options are in terms of monthly fees. 

 

 

Ioana Moldovan

Ioana is a lifelong learner with extensive work experience in the public health field. She is passionate about science and psychology and is constantly curious about how these can change people’s lives for the better. Her goal is to gather valuable information that can help her readers.

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