What you should know
  1. The age requirement for Medicare enrollment is when you turn 65 unless you’re entitled to disability benefits or have permanent kidney failure.
  2. If you don’t qualify for premium-free Part A, you can pay a premium to get it.
  3. You must enroll in Original Medicare (Parts A and B) to opt for Medicare Advantage (Part C), Part D prescription drug coverage, or a Medicare supplement (Medigap).
  4. You can use Medicare’s eligibility premium calculator tool to determine whether you are eligible for coverage.

Medicare, the federal health insurance program, is coverage available to people age 65 and older and younger people who live with qualifying disabilities. To be eligible for enrollment, you must be age 65 and a U.S. citizen or lawful permanent resident, unless you’re receiving Social Security retirement benefits, U.S. Railroad Retirement Board (RRB) benefits, or Social Security Disability Insurance (SSDI).

Note: If you do become eligible for Medicare benefits and do not enroll, you may have to pay a late enrollment penalty once you sign up unless you have other creditable coverage. There are also special enrollment periods to sign up if you meet specific criteria, and open enrollment periods each year to make changes.

Medicare insurance coverage has four distinct parts:

  • Part A: Hospital insurance, which helps cover hospital inpatient stays, skilled nursing facility care, hospice, and home health services
  • Part B: Medical insurance which helps cover outpatient doctor visits, durable medical equipment, and some preventive services
  • Part C: Medicare Advantage, which bundles together Parts A, B, and usually D, and is offered through private insurance companies
  • Part D: Prescription drug coverage, which helps cover the cost of prescription drugs

You must enroll in Original Medicare (Parts A and B) to opt for a Medicare Advantage Plan (Part C), Part D prescription drug coverage, or a Medicare supplement (Medigap).

Who qualifies for Medicare?

The age requirement for Medicare insurance is three months before you turn 65 unless you’re entitled to disability benefits or have permanent kidney failure, also called end stage renal disease (ESRD). In those cases, the age requirement of 65 is not enforced, but restrictions and timeframes apply.

Most people who are eligible don’t have to pay a premium for Part A because they have worked at least 10 years (40 quarters) and made Medicare tax payments or have worked for the Railroad Retirement Board or in a civil service job.

If you’re 65 or older, you can receive Medicare Part A benefits premium-free under any of these circumstances:

  • You’re receiving or are eligible to receive Social Security benefits or coverage from the Railroad Retirement Board
  • Your spouse ― living or deceased, including divorced spouses ― is eligible to receive Social Security or RRB benefits
  • You or your spouse worked long enough in a government job through which you paid taxes for Medicare benefits
  • You’re the dependent parent of a fully insured deceased child

If you’re younger than 65, you can receive Medicare Part A premium-free under any of these circumstances:

  • You have been entitled to Social Security or RRB disability benefits for 24 months
  • You have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS); in this case, there’s no waiting period, and your Medicare benefits begin the first month you get disability benefits
  • You worked long enough in a government job through which you paid Medicare taxes, and you’ve met the requirements of the Social Security disability program for 24 months
  • You’re the child or widow(er) age 50 or older, including a divorced widow(er), of a worker who has worked enough years under Social Security or in a Medicare-covered government job, and you meet the requirements of the Social Security disability program
  • You have permanent kidney failure ― end-stage renal disease or (ESRD) ― and get maintenance dialysis or a kidney transplant and one of the following applies:
    • You’re eligible for or receive monthly benefits under Social Security or the Railroad Retirement Board retirement system
    • You’ve worked long enough in a Medicare-covered government job
    • You’re the child or spouse, including a divorced spouse, of a worker ― living or deceased ― who has worked enough years under Social Security or in a Medicare-covered government job

Is there a way to get Medicare benefits if you don’t qualify for free?

If you don’t have eligibility for premium-free Part A, you can buy Medicare Part A by paying premiums if you are 65 or older and a U.S. citizen/permanent resident.

You’ll pay a premium of either $259 or up to $471 each month in 2021 depending on how long you or your spouse worked and paid Medicare taxes. If you or your spouse paid taxes for 30 to 39 quarters, your Part A monthly premium will be $259. If you or your spouse paid taxes for less than 30 quarters, your premium will be $471 per month.

If you’re paying premiums for Medicare Part A, and if you continue to work and pay Medicare taxes, those quarters will count toward your total number of quarters worked. Your premiums for Part A will be free once you work 40 total quarters.

In most cases, if you choose to buy Part A coverage, you must also have Medicare Part B and pay monthly premiums for both. If you choose not to buy Part A, you can still buy Part B. Whether you pay Part A premiums or not, and regardless of whether or not you opt for Original Medicare Parts A and B, or a Medicare Advantage or Medigap plan, you’ll always pay a Part B premium.

You can get help paying for insurance premiums if you qualify for a Medicare Savings Program; eligibility is based on if your income and resources are below a certain limit. To find out if you’re eligible and your expected premium go to the Medicare eligibility premium calculator tool.

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Leron Moore
Medicare consultant

LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.

Moore holds a bachelor’s degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.

He’s passionate about educating, informing, and resolving issues concerning Medicare and MA Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.

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