Medicare Eligibility | Qualifying for Medicare Health Insurance

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Who Qualifies for Medicare

Most people age 65 or older qualify for Medicare. People receiving disability benefits for 24 months or longer, and those with ALS or kidney failure also qualify. The minimum age to qualify for Medicare without a disability is 65.

Medicare eligibility depends on your age and you or your spouse's work history, or your disability status. These factors will determine the type of Medicare coverage you are eligible for, and if you have to pay premium costs or not. 

Age & Work History Requirements for Medicare

If you are at least 65 years old, a US citizen or a permanent resident (green card holder for at least five years) and you or your spouse meet the minimum work history requirements, you automatically qualify for Medicare health insurance.

The easiest way to know if you qualify for Medicare is if you or your spouse currently qualify for Social Security or Railroad Retirement benefits (RRB). You or your spouse don't have to be receiving SS or RRB benefits to get Medicare, but simply qualifying for either let's you know you can get Medicare once you turn 65. 

Minimum Work History
Social Security's minimum work history is generally speaking 40 credits where you paid Social Security and Medicare taxes while you were working. That's equivalent to ~10 years of work history throughout your lifetime. RRB also requires a minimum of 10 years of covered service in the railroad industry, or at least 5 years after the year 1995.

You can also qualify for Medicare if you or your spouse was/is a Medicare Qualified Government Employee. These are state or local government employees that are only required to pay Medicare taxes under a Section 218 Agreement. 

Qualifying means you're automatically able to get Medicare Part A coverage with zero premium costs, and have the ability to sign up for Medicare Part B, Part C (Medicare Advantage), Part D, and/or other supplemental Medicare coverage.

If you or your spouse are currently receiving Social Security benefits (which you can get as soon as age 62) your annual statement will tell you if you also qualify for Medicare and when you can and should sign up.

In some cases you can also qualify for Medicare on your spouse's work history even if you are divorced or if they have passed away.

Determine your eligibility officially with the eligibility calculator. This site will ask a number of questions including date of birth, work history and tax info for you and your spouse if applicable.

Getting Medicare If You Don't Qualify At 65

For those 65 years or older without the necessary work history between yourself or your spouse, you can still get Medicare, you just have to buy-in and decide if it's worth the premium costs. 

Medicare coverage comes in several 'parts'. Part A is the hospital insurance coverage and it's necessary to have Part A before you can become eligible for any other parts or plans within the Medicare program. When buying into Medicare Part A, in most cases you will also be required to sign up for a Part B (medical insurance) premium.

Purchasing Part A Premiums

For those 65 or older with inadequate work history, Part A is offered at a monthly premium ranging from $252-$458/month, depending on your work history. The more work history you have, the lower your premium becomes. You can still work while receiving Medicare and your ongoing work history will lower your Part A premium costs over time. And if you or your spouse work enough to gain at least 40 credits after you have 'bought in' to Part A, you can qualify for Medicare and eliminate the need to pay Part A premiums at all.

Paying for Part A premiums this way is costly, but the cost in many cases is still less than private health insurance and paying that premium does open you up to becoming eligible for Part B, C, D and other supplemental Medicare insurance; Part A is the only portion of Medicare that has a work history requirement.

Getting Medicare Under 65 - Disabilities, Serious Illnesses

If you are under 65 years old, you can get still receive full Medicare benefits if you:

  • Receive Social Security disability benefits for at least 24 months
  • Receive certain Railroad Retirement Board disability benefits for at least 24 months
  • Have ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig's disease
  • Have permanent kidney failure (ESRD)

There is no age requirement for receiving Medicare benefits under any of the above situations, and you will get the same access to all Medicare benefits as someone qualifying once they turn 65 - Medicare Part A coverage with zero premium costs and the ability to sign up for Medicare Part B, Part C (Medicare Advantage), Part D, and/or other supplemental Medicare coverage.

Disability Medicare Coverage
You don't have to get disability benefits for 24 months consequently to qualify, just a grand total of 24 months. But you do have to maintain disability insured status to remain eligible, which is determined by the Social Security Administration. 

The minimum is 24 months if you are considered totally disabled and it rises to 30 months if you are considered occupationally disabled. 

ESRD and ALS Medicare Coverage
Generally speaking, you qualify for Medicare if you have ESRD (End Stage Renal Disease) after 3 months of regular dialysis or directly after a kidney transplant.

ALS patients qualify for Medicare immediately upon collecting Social Security disability.

Medicare Health Insurance Guides

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