How To Qualify For Medicare

Medicare Qualification: Are You Eligible?

Medicare is a healthcare program that provides insurance for adults older than age 65, as well as younger individuals who are disabled. If you fall into one of those two categories, here’s what you need to know about qualifying for health benefits through Medicare.

How To Qualify For Medicare

Eligibility Requirements for Seniors

Adults immediately qualify for Medicare coverage upon turning 65 if they meet one of two criteria:

  • Currently qualify for Social Security retirement payments
  • Are a U.S. citizen or a permanent resident for at least five years

In addition, you or your spouse must have worked long enough to achieve eligibility. While the number of hours (called credits) earned varies based on individual circumstances, it usually requires a work history of about 10 years. Alternatively, you qualify if you or your spouse is a current or former government employee who paid Medicare payroll tax.

Having enough work credits means that you won’t pay premiums for Part A, which is Medicare coverage primarily for inpatient hospital care. However, you do not need work credits to qualify for outpatient care (Part B) or prescription drug coverage (Part D).

Those who want to enroll in Part A but do not have enough work credits must pay the maximum premium if they have fewer than 30 work credits. In 2016, this premium was $414, or $234 for those who have 30 to 39 work credits.

Keep in mind that individuals who enroll in Part A must also enroll in Part B, while Part B can be administered without Part B. Part D is for those enrolled in Part A and/or B. Enrollment in both A and B allows you to purchase Medicare Advantage plan (Part C, such as an HMO or PPO) or a Medigap supplemental insurance policy.

Eligibility for Disabled Individuals

If you have been receiving Social Security Disability Insurance (SSDI) checks for at least 24 months, you are eligible for Medicare. This is known as the two-year waiting period. Individuals in this category will automatically be enrolled in Medicare in the 25th month after initiating SSDI. People who have Amyotrophic Lateral Sclerosis (ALS) are not subject to this waiting period.

Eligibility for Those with Kidney Failure

People with end-stage renal disease also qualify for Medicare regardless of age and current SSDI status. To be eligible, these individuals must:

  • Be undergoing dialysis treatments or have had a kidney transplant;
  • Apply for Medicare benefits
  • Be eligible for SSDI or railroad retirement benefits
  • Have paid Medicare taxes for a sufficient amount of time as specified by the Social Security Administration or be a dependent of a spouse or parent who has paid these taxes

Eligibility for Low-Income Residents

If you do not have enough work credits to qualify for Part A and cannot afford to pay the premiums, your state may have programs that can help. These programs often pay premiums as well as deductibles and coinsurance costs. In addition, a federal program called Extra Help provides automatic assistance for Medicare applicants who have full Medicaid or Supplemental Security Income, or who already take part in a state assistance program.