In most cases the eligibility age for Medicare is 65 years. Persons with certain medical conditions may however be registered at a younger age for coverage.
Medicare is the government-sponsored health insurance plan, which includes medical and hospital cover.
Most people who are covered by Medicare are 65 or older. According to the Kaiser Family Foundation, however, Medicare currently covers about 9.1 million people under the age of 65, many of whom have a chronic disability or medical condition. This is about 16 per cent of the population in Medicare.
This article explains how and when an individual is eligible for benefits from Medicare including factors related to age and health conditions.
When can a person enroll for Medicare?
A person usually meets medicare eligibility at age 65. Since 1965 Medicare has been available in the United States for people aged 65 and over. This is Medicare coverage which came into effect the same year.
Legislation has increased coverage over time for those with some medical conditions who have not yet reached age 65.
The Congressional Budget Office (CBO) has analyzed the feasibility of raising the limit of Medicare certification from 65 to 67 years and the potential cost savings. In 2013, the CBO released a report predicting that doing so would decrease the federal budget deficit by $19bn over seven years.
The current age for enrolment, however, remains 65 years.
Other qualifying factors for Medicare
Some people can qualify for Medicare coverage when they are younger than 65. This includes:
- people with certain disabilities
- people with end stage renal disease (ESRD)
- people with amyotrophic lateral sclerosis (ALS)
The following sections will discuss what these conditions mean for Medicare coverage in more detail.
If a doctor believes a person has a disability and is unable to function, they may be eligible for Medicare until they reach age 65. The doctor will have to fill out forms confirming the person has an illness.
In people with the following medical conditions they will report a disability:
- chronic heart failure
- liver disease
- multiple sclerosis
- sickle cell disease
People with these conditions may have a waiting period before they can start receiving Medicare Part A benefits after their doctor confirms their disability. They should ask their office of Social Security about exactly when they can apply for Medicare.
Most people who are already eligible to collect Social Security for their disability are not required to pay a Medicare Part A fee.
Typically, when a person requires dialysis or applies for a kidney transplant, it means they have ESRD.
Typically, a person with ESRD may obtain Medicare benefits around 3 months after dialysis at a health care facility, or nearly immediately if they qualify for dialysis at home.
When a person with an ESRD qualifies for Medicare, they do not have to pay Part A premiums. Medicare Part A includes services including a stay in a hospital (such as surgery), a stay in a skilled nursing facility or hospice, and home care.
If a individual has ALS, they’ll qualify for Part A of Medicare without raising the premiums. These will also usually qualify to obtain Medicare coverage without a waiting period.
What happens when a qualifying spouse is younger?
A individual is eligible for Medicare Part A if they have paid Medicare taxes for at least 40 quarters of the work, or their spouse.
This could become more complicated when 40 quarters didn’t work for an older adult with a younger partner but their spouse did.
If a younger spouse has been employed for 40 quarters, they will qualify their partner for Medicare coverage until they reach age 62 and the older non-working spouse reaches age 65.
If a person reaches 65 years of age, did not pay Medicare taxes for 40 quarters, and has a spouse under the age of 62 years, they may have to pay for their Medicare Part A benefits until their qualifying spouse reaches 62 years of age.
Preparing as the eligibility age nears
If a individual already receives benefits from the Social Security Administration, they are automatically enrolled by the Administration in sections A and B of Medicare.
A “Welcome to Medicare” packet will be given to the person 3 months before their 65th birthday, with instructions on how to sign up.
To receive Medicare a person doesn’t have to be retired. If a person does not currently receive benefits from the Social Security, they may apply for benefits from Medicare as early as 3 months before their 65th birthday.
For example, if a person turns 65 in April they can be in January of the same year for Medicare benefits.
Applying for Medicare benefits as early as possible can help the Office of Social Security process the paperwork in time for the 65th birthday of the individual.
People applying too late that face a 10 percent higher premium than those applying on time. This premium will apply for doubling the amount of time a person is eligible but has not applied.
A individual may apply for Medicare during their month of birth or up to 3 months after their month of birth, without having to pay Medicare coverage penalties.
Though, their benefits won’t start until the Medicare and Medicaid Services Centers review their application.
A individual can apply for Medicare benefits when he or she reaches age 65. The cost of these services depends on whether they or their partner has served for at least 40 quarters and paid taxes on Medicare.
Before this age, those with disabilities, ESRD, or ALS will qualify for Medicare benefits.