Who is Eligible for Medicare? - Medicare Consumer - Medicare Consumer

Who is Eligible for Medicare?

In order to be eligible for Medicare, you must meet one of two conditions. First, you must be age 65 or over. Or, you may be under age 65 but have a qualifying disability that is officially recognized and meets the requirements for Medicare’s coverage. Within these two categories, there are other conditions that may or may not have an effect on your qualifications.

 

If You’re Age 65 or Over

For those who are age 65 or over, you may be qualified for premium-free Medicare Part A if either you or your spouse has enough work credits and has made payroll taxes into the Social Security / Medicare system. In this case, 40 work credits are needed. These are sometimes referred to as quarters of coverage.

These credits are calculated on income that you work for and that is taxable – which can include wages from an employer, as well as earnings from self-employed work that you have done. It does not, however, include income from interest or dividends on your savings or investments.

You must earn a certain amount of money in order to earn one work credit. In 2015, the amount is $1,220. You can earn a maximum of only four work credits in any one calendar year. Because of that, it typically takes at least ten years to accumulate 40 total credits.

The Social Security Administration keeps a record of your earnings, as well as the number of work credits you have compiled throughout the years. You can view these on your annual Social Security statements.

If you have not worked long enough – or if you have not worked at all – you still may be eligible to get Medicare based on the work record of either your current or your former spouse. The rules will vary based on different circumstances.

For example, if your current or a former spouse has earned 40 work credits, then you could be able to qualify for premium-free Medicare Part A based on his or her work record based on the following:

  • Current Spouse – If you have been married to your current spouse for a minimum of one year, and you are at least age 65 or over and your spouse is age 62 or over, then you qualify for benefits;
  • Late Spouse – If you were married to your late spouse for a minimum of one year immediately prior to his or her passing away, and you are at least age 65 or older, and you did not get remarried prior to your age 60, then you will qualify for benefits;
  • Divorced Spouse – If you were married to your former spouse for a minimum of 10 years prior to the divorce becoming final, and you did not get remarried prior to your age 60, and you are age 65 or older now, and your former spouse is at least age 62, then you will qualify for benefits. (This is the case regardless of whether your former spouse has remarried).

If neither you nor your spouse (or a former / late spouse) has enough work credits to qualify for premium-free Medicare Part A, but you are age 65 or over, you may still qualify for Medicare. However, you will have to pay premiums for this coverage. In 2015, the premium for Medicare Part A can be up to $407 per month.

The premium for Medicare Part B is $104.90 (in 2015) for most people. However, if you income for two years prior is considered to be in a higher bracket, then you may be required to pay more.

 

You Have a Qualifying Disability

You may also be eligible for Medicare if you have a qualifying disability – even if you are under age 65. In this case, you will automatically get Part A and Part B after you have been receiving benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months.

Those who have permanent kidney failure, also known as End Stage Renal Disease, may also be eligible for Medicare prior to turning age 65, as are those who have ALS (Amyotrophic Lateral Sclerosis / Lou Gehrig’s disease). These individuals will automatically receive Medicare Part A and Part B in the month that their disability benefits start.

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