Qualifying for Medicare

A good solid health insurance plan is important today. With the ever-rising cost of care, even a short stay in the hospital can be extremely costly, and can wipe out years of savings. For retirees and others who are over age 65, this can oftentimes be devastating. This is why is it important to understand how you can qualify for Medicare coverage. Having coverage from Medicare can help to ease the cost burden of a wide variety of different health care expenses.

If You Are Age 65 or Older

For the most part, people who qualify for Medicare are age 65 or older. If you fall into this age category, you will qualify for Medicare if:

  • You are a United States citizen or a permanent legal resident, and
  • You or your spouse has a long enough work record that you are eligible for either Social Security retirement income benefits or Railroad Retirement income benefits (meaning that you or your spouse has earned 40 credits from approximately 10 years of work – even if you are not actually receiving these benefits yet), or
  • You or your spouse is an employee of the U.S. government or is a retiree who has not been paying into the Social Security system, however, has or had been paying into the Medicare system while you were working.

It is also possible to qualify for Medicare coverage based upon the working record of your spouse, provided that he or she is age 62 or over, and that you are age 65 or over. In addition, you could also qualify for Medicare based upon the working record of either a deceased spouse or a divorced spouse.

In addition, based upon the June 2013 ruling by the Supreme Court on the Defense of Marriage Act, it is also now possible to qualify for Medicare benefits based on a same-sex spouse’s working record, provided that you reside in the state where you were wed, or you live in another state that also recognizes same-sex marriages (or if you are civilian or military employees of the federal government).

If You Are Age 65 or Younger

While most people believe that you must be age 65 in order to qualify for Medicare, there are certain instances in which you may be eligible for Medicare benefits when you are under this age. These circumstances include the following:

  • You have a qualifying disability and you have been entitled to Social Security disability benefits for at least 24 months (these 24 months are not required to be consecutive), or
  • You are receiving a disability pension from the Railroad Retirement Board (along with certain other conditions), or
  • You have been diagnosed with ALS (also referred to as Lou Gehrig’s disease), or
  • You have been diagnosed with permanent kidney failure and you either need a kidney transfer or regular kidney dialysis. (In order to meet this condition, you or your spouse will have to had paid into the Social Security system for a certain amount of time, based upon your current age).

If You Don’t Qualify for Medicare

For those who do not actually qualify for Medicare, there is still a way to obtain Medicare benefits when you turn age 65, as long as you are either a United States citizen or you have been a legal resident of the U.S. for at least five years.

In this case, you can obtain Medicare coverage by doing the following:

  • You can pay Medicare Part A premiums. In 2014, the maximum Medicare Part A premium is $426 per month for those who possess less than 30 work credits. Should you keep working until you accumulate 40 work credits, you will no longer be required to pay Medicare Part A premiums.
  • You can also obtain Medicare Part B by paying your required Part B monthly premium.
  • You may opt to obtain a Medicare Part D prescription drug plan. With this plan, you will be required to pay the amount of premium for the particular plan that you choose.

It is important to note that you are able to enroll in Medicare Part B without being required to obtain Part A coverage. However, if you enroll in Medicare Part A, you will be required to also obtain Medicare Part B. You can purchase a Medicare Part D plan whether you have Medicare Part A or Part B.

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