Medicare Eligibility

Understanding Medicare Eligibility Rules

Medicare eligibility is an essential part of the Social Security Administration retirement benefits program. It is absolutely necessary for many who have had health insurance coverage through their employer until reaching retirement age. Likewise, it is also a necessity for many who have been determined disabled due to some medical condition and can no longer work where health insurance is provided for them. The primary problem with Medicare is that the rules for eligibility are restricted only to these two groups of individuals. Others who are awarded government healthcare due to financial or disability eligibility are assigned to the Medicaid program. However, the majority of Americans who have worked a significant portion of their life will eventually be eligible for Medicare when they finally do retire. This means that understanding eligibility rules is important for everyone.

Age Qualification

Medicare was first established as a healthcare program for retirees who receive Social Security benefits based on age and Social Security tax payment credits. Individuals who have 40 tax credits over the course of their working careers become eligible for full benefits when they retire. Workers who retire at age 62 are not eligible for the most part unless they qualify through their spouse’s eligibility or are declared disabled and receive Social Security Disability Insurance for two years prior. It is not necessary for those years to be consecutive. Full benefits begin at age 65 with premium payments, and those who retire at age 67 receive full benefits without being required to pay premiums for Part A and Part B coverage.

Disability Qualification

It is possible to be eligible for Medicare if you have not reached retirement age, but this is based on disability status and the type of benefits received. Those who receive Medicaid for two years can add or switch to Medicare if they are also receiving Social Security Disability Insurance payments. Individuals who receive Supplemental Security Income must remain on Medicaid, which is a free needs-based program in most states. There are specific qualifiers as well for those who are diagnosed with ALS, medically termed as amyotrophic lateral sclerosis. The disease is better known as Lou Gehrig’s disease. Those who are diagnosed with kidney failure are also eligible for dialysis coverage. Retirees receiving Railroad Retirement benefits are also eligible for Medicare benefits immediately as well.

Premium Payment Requirements

Medicare is not a free program for all beneficiaries like Medicaid. Premium requirements apply for those who may qualify at an earlier age based on an itemized schedule for each part. There are three components of Medicare. They are Part A, Part B, and Part D, and there are some purchase requirements for certain recipients. Parts A and D are optional participation, but not Part B. Part A is is coverage for hospitalization. Retirees who have earned less than 30 credits pay the highest rate with those who have earned between 30-39 credits paying approximately half of the amount assigned to those with less than 30 credits. Retirees who have earned 40 credits or more do not pay hospitalization insurance. Part B covers doctors visits and other treatment visit needs, and it is a mandatory coverage that must be purchased by those who do not work until age 67 before claiming Social Security benefits. Retirees who claim over $91,000 income or $182,000 if married pay higher pro-rated premium amounts.

Disabled beneficiaries and retirees who receive Supplemental Security Income and have been covered by Medicaid for two years are also eligible for Medicare when they reach age 65. There is no benefit payment requirement for this group of retirees due to the fact that SSI payment amounts are in an exempt classification based on federal poverty income guidelines. Medicare will affect all workers if they live to retirement age, and it is good for all Americans to be versed on some level regarding how it will impact them when they do become eligible for government health coverage.