Eligibility Requirements for Medicare

Medicare eligibility depends on age and disability status. The Medicare eligibility age is 65 or older. Those who meet the age requirement may qualify for no-cost monthly premiums for their Part A coverage.

To qualify, individuals must also be a U.S. citizen or have a legal permanent residence in the country. Those younger than 65 years of age may be eligible if they have a specific disability such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Medicare Part A is usually free to most beneficiaries. However, if you sign up for Medicare Part B, you must pay a premium for the coverage. Also, those who want prescription drug coverage under Medicare Part D must pay a premium. Additionally, those who earn higher incomes may pay additional costs on top of the standard premium rate. The sections below outline who qualifies for Medicare and at what age are you eligible for Medicare.

Who Qualifies for Medicare

Medicare eligibility depends mostly on age. The rules for Medicare eligibility also consider the disability status of the individual and whether the individual has a life-ending disease. The federal health insurance plan provides cost-effective health coverage to those 65 years of age or older. Individuals younger than 65 may qualify if they have a specific disability or end-stage renal disease. Residents must also be U.S. citizens or have permanent citizenship status.

Related Article: Senior Health Resources

A person qualifies for Medicare Part A at no cost if they meet the following criteria:

Disability Benefits

Individuals who are currently receiving Social Security disability benefits or Railroad Retirement Board disability for at least two years qualify for an autimatic  . Their coverage begins on the 25th day of the month of disability benefits.

Work Credits

To meet Medicare qualifications, a person must also have the appropriate number of work credits. An individual earns work credits each year, based on their earnings for the year. Up to a maximum of four credits may be earned for each year worked. In general, a person must have 40 credits (10 years of work) to qualify for Medicare.

Survivors Benefits

A beneficiary also qualifies for Medicare if their spouse receives Social Security or Railroad Retirement Board disability benefits. For Medicare purposes, the term “spouse” refers to one who is living, deceased or divorced. Beneficiaries may also meet Medicare eligibility requirements if they are the dependent parent of a fully insured deceased child.

Medicare Qualifications for Those Who Do Not Qualify for No-Cost Part A Coverage

If a person does not meet Medicare eligibility for no-cost Medicare Part A, they may purchase the coverage for a monthly premium. In addition, if a person meets Medicare qualifications for Part A Medicare at no cost, they are eligible to enroll in Medicare Part B. However, they may be required to pay a monthly premium for the Part B coverage.

Medicare Part D coverage is available to anyone who meets Medicare qualifications for Parts A and B. The coverage is available even if a person does not qualify for no-cost Medicare Part A medical coverage. Part D coverage is optional, and beneficiaries are not required to enroll even if they are receiving Part A or Part B.

What are the Medicare eligibility rules for age?

Medicare eligibility age requirements specify that an individual must be 65 years of age or older to qualify for Part A premiums at no cost. Those younger than 65 years of age are exempt from the age rules. However, to qualify, they must meet one of the following criteria:

  • Be entitled to Social Security Disability Insurance (SSDI) for 24 months
  • Currently receive retirement benefits from the Railroad Retirement Board
  • Have earned at least 40 work credits
  • Have permanent kidney failure

Medicare Income Limits

Medicare is an age-based program and as such, Medicare eligibility does not depend as much on income as Medicaid does. However, there are instances where Medicare income limits apply. The income limits affect how much a beneficiary pays for their Part B coverage.

The insurance plan pays 75 percent of the medical services portion of a Part B premium. The beneficiary pays the rest. Individuals with higher incomes may be required to pay higher premiums for their Part B coverage. The amount equals either 35, 50, 65 or 80 percent of the premium based on the beneficiary’s income.

Beneficiaries with higher income also pay an additional amount for their Medicare Part D prescription drug coverage. The amount is a charge on top of the monthly premium. The below outlines the income Medicare income limits for those who must pay an additional amount towards their coverage.

Modified Adjusted Gross Income (MAGI) Part B Part D
Individuals $85,000 or less Standard premium = $134.00 Plan Premium
Married Couples $170,000 or less Standard premium = $134.00 Plan Premium
Individuals above $85,000 Standard premium + $53.50 Plan Premium + $13.00
Married Couples above $170,000 up to $214,000 Standard premium +$53.50 Plan Premium +$13.00
Individuals above $107,000 up to $133,500 Standard premium +$133.90 Plan premium + $33.60
Married Couples above $214,000 up to $267,000 Standard premium +$133.90 Plan premium + $33.60
Individuals $133,500 up to $160,000 Standard premium + $214.30 Plan premium + $54.20
Married Couples above $267,000 up to $320,000 Standard premium + $214.30 Plan premium + $54.20
Individuals above $160,000 Standard premium + $294.60 Plan premium + $74.80
Married Couples above $320,000 Standard premium + $294.60 Plan premium + $74.80

 

Medicare Eligibility for the Disabled

Per Medicare eligibility requirements, a person younger than 65 years of age with a disability automatically qualifies for Part A and Part B. For a beneficiary to meet Medicare qualifications under this rule, the recipient must be receiving Social Security or Railroad Retirement Board disability benefits for 24 months. Beneficiaries with a disability are eligible for the optional Medicare prescription drug coverage (Part D).

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)

Those individuals with amyotrophic lateral sclerosis (ALS) are exempt from the 24-month waiting period for Medicare benefits. These beneficiaries automatically qualify for no-cost Medicare Part A and Part B coverage. The coverage begins the date of their entitlement to disability.

End-Stage Renal Disease

Individuals meet Medicare qualifications if they have kidney failure, require dialysis and have had a kidney transplant. Beneficiaries qualify if:

  • They have enough work credits (40 credits).
  • The already receive Social Security or Railroad Retirement Benefits Board disability.
  • They are the spouse or child of a person who meets the above criteria.

begins the first month the individual begins dialysis treatment. Coverage continues for 12 months after the beneficiary stops dialysis treatments. Or, coverage ends 36 months after the month of the individual’s kidney transplant. Their Medicare eligibility may be extended if the recipient gets a new transplant within 12 months after discontinuing dialysis. They may also have their coverage extended if they restart dialysis or get another kidney transplant within 36 months after the first transplant.

In most cases, an individual will not be required to pay a monthly premium for their Medicare Part A coverage. However, the beneficiary may be required to pay a monthly premium for their Part B coverage.

Related Article: Program of All Inclusive Care for the Elderly (PACE)

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