Medicare Eligibility Requirments
Are you eligible for Medicare?
Medicare is the national health insurance program for all individuals, age 65 and older. As long as you’re of age and a U.S. citizen, then you are eligible for Medicare coverage.
Medicare Eligibility Rules
You automatically qualify for Medicare benefits at age 65 or older if:
- You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years; and
- You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits — usually having earned 40 credits from about 10 years of work — even if you are not yet receiving these benefits; or
- You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
Exceptions to the Age Requirement
In 2003, the Medicare Modernization Act was signed into law and expanded Medicare benefits to include individuals younger than 65 who have disabilities, Lou Gehrig’s disease, and end-stage renal failure. As a result, today, nearly 60 million Americans are eligible for Medicare benefits.
There are four parts of Medicare. All of which are voluntary. As long as you’re eligible for Medicare coverage, you can enroll in any or all parts of Medicare.
- Part A – hospital insurance, which covers all your inpatient medical care.
- Part B – doctors insurance, which covers all your outpatient medical care.
- Part C – private health insurance plans that expand your Medicare benefits to include vision, dental, hearing, and prescription drugs. Part C is also known as Medicare Advantage.
- Part D – prescription drug coverage sold by private insurance companies who work in coordination with Medicare.
Part A and Part B are part of your Original Medicare benefits issued through the government. In comparison, Part C and Part D are private insurance plans, issued by private insurance companies to expand your Original Medicare benefits.
Eligibility for Free Medicare Premiums
As long as you’ve worked 40 quarters in which you paid Medicare taxes, you receive your Part A benefits for free. Individuals who have worked less than 40 quarters (10 years) will pay a monthly premium in relation to the amount of Medicare taxes paid throughout their working career.
The three remaining parts of Medicare do require monthly premiums.
You can find your exact premium cost through the helpful eligibility and premium calculator provide on the Medicare.gov website.
Medicare Eligibility vs. Social Security Eligibility
Many people incorrectly assume that Medicare Eligibility and Social Security eligibility are the same and confuse their Social Security enrollment age for the Medicare eligibility age. Here’s the clarification.
- You are eligible for Social Security beginning at age 62.
- Medicare Eligibility is age 65.
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