Qualifying for Medicare

Whether you’re seeking affordable health care or comprehensive coverage, becoming eligible for Medicare can be a momentous achievement. But at what age can you apply for Medicare, and how do you know when you qualify for coverage? Find out when you’re eligible for Medicare based on your age and health status.

At What Age Are You Qualified For Medicare?

Most people become eligible for Medicare at age 65. If you’re quickly approaching your 65th birthday, you’ll qualify for full Medicare coverage if you meet the following criteria:

  • You’re a United States citizen or you’ve been a legal resident for at least five years.
  • You or your spouse have worked and paid Medicare taxes for at least 10 years.
  • You or your spouse have worked for a government agency and contributed Medicare taxes.

When you qualify for full benefits, you receive what’s known as premium-free Medicare Part A. That means you don’t have to pay a monthly premium for the portion of your health care coverage that includes hospital stays and nursing home care. Because Part A meets the federal government’s standards for minimum essential coverage, you can choose not to purchase additional health care coverage if your age qualifies you for premium-free Part A.

However, many retirees opt to buy Medicare Part B, which includes most outpatient and preventive care and offers more comprehensive health care insurance. Many also opt to buy Medicare Part D, which includes prescription drugs, along with one of the 10 standardized Medicare Supplement Insurance Plans.

It’s in your best interest to decide if you want a Medigap Plan and Medicare Part D plan prior to turning 65. Your initial enrollment period begins three months before you turn 65 and ends three months after your birthday. Enroll during this period, and you’ll have the best chance of getting the plan you want without having to delay coverage.

Keep in mind that Medicare plans cover individuals, so both you and your spouse must qualify separately, based on your age. Your spouse might still affect your eligibility, though. If you’re turning 65 and you don’t have enough work history to qualify for premium-free Part A, you’ll become eligible if your spouse is at least 62 and has at least 10 years of work history under his or her belt.

Can You Pay For Full Medicare Benefits?

If you aren’t eligible for full free coverage based on your work history, you can pay a monthly premium to get Medicare Part A.

As Medicare.gov explains, the cost of the Part A premium depends on the year and how much you’ve paid toward Medicare taxes throughout your life. In 2017, your monthly premium:

  • Is $413 if you contributed Medicare taxes for fewer than 30 quarters during your working life.
  • Is $227 if you contributed Medicare taxes for between 30 and 39 quarters during your working life.

Keep in mind that when you buy Part A, which covers hospital stays and nursing home care, you may also opt-in to Part B, which covers doctor visits and preventive care. Almost all Medicare recipients have to pay a premium for Part B, and your cost depends on the year, the type of benefits you receive, and other factors. In addition, Medicare Part D and Medicare Supplement Insurance are both optional for enrollees.

When Does A Health Condition Make You Eligible For Medicare?

When it comes to checking Medicare eligibility, age isn’t the only factor that qualifies you for care. If you’re under 65 and have a serious disability, you can become eligible for Medicare. If you meet one of the following criteria, you qualify for full, premium-free Part A:

  • You have Lou Gehrig’s disease, which is also known as ALS.
  • You have permanent kidney failure, which is also known as End-Stage Renal Disease.
  • You have received Social Security disability benefits for 24 months or more.

Like enrollees who qualify based on their age, those who become eligible due to disability or health condition must pay for Part B to get coverage for doctor visits, preventive care, and durable medical equipment. Medigap plans are also available for a monthly premium.

How to Avoid the Part D Penalty


Now that you know when you qualify for Medicare coverage, you can help your family and friends get access to helpful healthcare information, too. Spread the knowledge, and share this article with your loved ones.

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