Medicare Eligibility For People Under 62
There are a few exceptions for Medicare age limits that can allow people younger than 65 and under age 62 to enroll in Medicare.
- If you have ALS , you are immediately eligible for Medicare regardless of your age as soon as your Social Security or Railroad Retirement Board disability benefits begin.
- You may also qualify for Medicare if you have kidney failure that requires dialysis or a kidney transplant, which is known as end-stage renal disease .
- You may also qualify for Medicare at age 62 or any age before 65 if you receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.
If you qualify for Medicare under the age of 65 because of a disability, you might also qualify for a Medicare Advantage Special Needs Plan.
How Do Sources Of Supplemental Coverage And Prescription Drug Coverage Differ For Medicare Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries
Most Medicare beneficiaries, including those under age 65 with disabilities, have public or private supplemental insurance to help cover Medicares cost-sharing requirements.9 A much larger share of beneficiaries under age 65 with disabilities than older beneficiaries rely on Medicaid to supplement Medicare because of their relatively low incomes .10 Medicaid helps with Medicare premiums and cost-sharing requirements, and covers services needed by many people with disabilities that are not covered by Medicare, particularly long-term services and supports.
Figure 3: Supplemental Coverage Among Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older in 2012
Just over 1 in 5 beneficiaries under age 65 has no supplemental coverage, compared with 12% of those age 65 or older. Lack of supplemental coverage among Medicare beneficiaries is associated with higher rates of access problems, but rates of access problems are higher among younger beneficiaries with disabilities who lack supplemental coverage than among older beneficiaries, including not seeing a doctor for a health problem when they think they should and having trouble getting needed health care .12 Regardless of whether or not they have supplemental coverage, however, a larger share of younger beneficiaries with disabilities than older beneficiaries experience access and cost-related burdens .
Prescription drug coverage
Who’s Eligible For Medigap
If youre enrolled in both Medicare Part A and Part B, and dont have Medicare Advantage or Medicaid benefits, then youre eligible to apply for a Medigap policy. These plans are standardized, and are designed to cover some or all of the out-of-pocket costs that are incurred when you have a Medicare-covered claim .
You have a federal right to buy a Medigap plan during the six months beginning when youre at least 65 years old and have enrolled in Part B. This is known as your Medigap open enrollment period. After this time runs out, you will have only limited chances to purchase one down the road.
Some states allow people of any age or health status to purchase Medigap coverage at any time without medical underwriting, but most dont. In many states, Medigap plans may not be available for people who have Medicare before age 65. There are 33 states that require Medigap plans to be guaranteed issue in at least some circumstances when an applicant is under age 65, but the rules vary from one state to another you can click on a state on this map to see details about state-based Medigap rules.
If youre enrolling in Medicare due to your age, the primary factor that will affect your ability to purchase a Medigap policy regardless of your health will be whether you enroll during your Medigap Open Enrollment Period.
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Can I Get Medicare Early If I Retire Early
If you retire earlier than age 65, you will not be eligible for Medicare. Although Medicare is often thought of as insurance for retired people, the Medicare age requirement is still 65. Some people continue to work past age 65 and have insurance coverage through their employer. Many people retire before they turn 65 and must purchase health insurance or are covered on their spouses insurance plan. Although you may be eligible for social security retirement benefits if you retire early, it does not change your age requirement for Medicare health insurance coverage.
Review Your Medicare Choices Each Year
Whether you enroll in original Medicare or a Medicare Advantage plan, you generally do not need to renew coverage every year. That being said, plans are sometimes discontinued or their benefits and costs may change to the point that the plan no longer meets your needs. Its not unusual for pharmacy and provider networks to change, for costs to increase, or the list of covered prescription drugs to vary. Thats why its a good idea to review your plan each year and compare it against your current health care needs.
Your health insurer is required to send you an Annual Notice of Change by September 30 each year. The notice outlines any changes in coverage and costs expected to begin the following January. If you decide to change your health care plan after reviewing those updates, you can do so during Medicares open enrollment period. The period runs from October 15 to December 7. During this time, you can switch from original Medicare to Medicare Advantage or vice versa. You can switch from one Medicare Advantage plan to another or from one Medicare Part D plan to another. You can also enroll in Medicare Part D if you have not done so already, although late enrollment penalties may apply.
If you find that the new health care plan is not meeting your needs, you can reverse some plan decisions January 1 to March 31 of the following year. Guidance for the renewal process is offered through the U.S. governments phone line at 1-800-MEDICARE or through your local SHIP.
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Am I Eligible For Medicare Part A
Generally, youre eligible for Medicare Part A if youre 65 years old and have been a legal resident of the U.S. for at least five years. In fact, the government will automatically enroll you in Medicare Part A at no cost when you reach 65 as long as youre already collecting Social Security or Railroad Retirement benefits.
If youre already receiving Social Security or Railroad Retirement benefits, all you need to do is check your mail for your Medicare card, which should automatically arrive in the mail about three months prior to your 65th birthday . The card will arrive with the option to opt-out of Part B , but opting out of Part B is only a good idea if youre still working and have employer-sponsored coverage that provides the same or better coverage, or if your spouse is still working and you have coverage under their plan.
If youre not already receiving Social Security or Railroad Retirement benefits, youll need to enroll in Medicare during a seven-month open enrollment window that includes the three months before the month you turn 65, the month you turn 65, and the three following months. If you enroll before the month you turn 65, your benefits will start the month you turn 65 . If you enroll in the three months after you turn 65, your coverage could have a delayed effective date.
In addition to turning 65, people can become eligible for Medicare due to a disability , or due to end-stage renal disease or amyotrophic lateral sclerosis .
Before You Make Your Decision
There are advantages and disadvantages to taking your benefit before your full retirement age. The advantage is that you collect benefits for a longer period of time. The disadvantage is your benefit will be reduced. Each person’s situation is different. It is important to remember:
- If you delay your benefits until after full retirement age, you will be eligible for delayed retirement credits that would increase your monthly benefit.
- That there are other things to consider when making the decision about when to begin receiving your retirement benefits.
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How Much Is Medicare Part A 2020
In 2020, the Medicare Part A premium can be as high as $458 per month. Lets say Geralds wife, Jessica, reaches age 62 and has worked for the required number of years to qualify for premium-free Part A once she turns 65. Because Jessica is now 62 years old and has met the working requirement, Gerald may now receive premium-free Part A.
If I Retire At Age 62 Will I Be Eligible For Medicare
En español | Nobody can become eligible for Medicare before age 65, unless he or she qualifies at an earlier age on the basis of receiving Social Security disability benefits.
If you retire at any time before 65, you may be able to get health insurance from any of the following sources:
- Your spouses current employer, if youre married and the employer provides health care that covers you
- Your former employer, if youre eligible for retiree health benefits
- COBRA coverage, which extends your former employers coverage for a certain period of time usually 18 months but requires you to pay the full premiums, including what your employer used to pay toward them
- Private insurance purchased through marketplaces set up under the Affordable Care Act
- Private insurance purchased on the open market.
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How Do I Know If I Am Automatically Enrolled In Medicare
Medicare will enroll you in Part B automatically. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If you’re not getting disability benefits and Medicare when you turn 65, you’ll need to call or visit your local Social Security office, or call Social Security at 1-800-772-1213.
Who Qualifies For Premium
For members who are interested in premium-free Medicare Part A coverage, those who are age 65 will qualify if they meet the following:
- Already receive retirement benefits from Social Security or Railroad Retirement Board
- Eligible to receive Social Security or Railroad benefits but havenât filed for them
- A member or their spouse were Medicare-covered employed through the government
And for members who are under 65 the eligibility requirements are:
- Received Social Security or Railroad Retirement Board disability for 24 months
- Person who has End-Stage Renal Disease and meets determined requirements
In addition, you must also pay the Part B premium each month. The standard premium is $170.10 in 2022.
Please keep in mind that individuals with a higher income may have to pay more for their Part B premium. Be aware that if you donât sign up for Medicare Part B when you first become eligible, you may have to pay a 10% penalty for each full 12-month period you could have had Part B but didnât sign up .
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How Social Security Helps Pay For Medicare
In addition to automatically enrolling you in Medicare, if you are receiving Social Security or Railroad Retirement Board benefits, your Medicare Part B premium will be automatically deducted from your monthly benefit payment.
If you are not receiving Social Security or Railroad Retirement Board benefits yet, you will get a bill called a Notice of Medicare Premium Payment Due . Bills can be paid for by check or money order, a credit or debit card, or through online bill pay services.
In conclusion, as youre starting to think about Medicare and retirement, do some research and make sure you understand how your Social Security benefits can or will play a role.
How Do Beneficiaries Out
Although total Medicare per capita spending is higher for Medicare beneficiaries under age 65 with disabilities than for older beneficiaries, younger beneficiaries in traditional Medicare spend significantly less out of pocket, on average. This is likely due to the fact that a greater share of younger beneficiaries with disabilities than older beneficiaries have Medicaid coverage , as well as Part D Low-Income Subsidies , that help cover their premiums and cost sharing. Overall, out-of-pocket spending by younger beneficiaries with disabilities is 40% less than that of older beneficiaries . Younger beneficiaries have lower average out-of-pocket spending than older beneficiaries for insurance premiums and for medical and long-term care services combined .
On average, in 2012 beneficiaries in traditional Medicare with disabilities spent the largest share of their total non-premium out-of-pocket costs on medical providers , followed by prescription drugs and long-term care facility costs . These services also were the top three in terms of out-of-pocket costs for older beneficiaries, but in a different order: older beneficiaries spent the largest share of their out-of-pocket costs on facility costs , followed by medical providers and prescription drugs .
Access to care and cost-related problems
Figure 6: Selected Measures of Access to Health Care for Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older
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How Do You Receive Your Medicare Benefits When You Meet Medicare Eligibility Requirements For People Younger Than Age 65
- If you receive Social Security benefits for 24 months, usually you will automatically be enrolled in Medicare Part A and Part B at the beginning of the 25th month.
- If you have Lou Gehrigs disease, usually you will automatically be enrolled in Medicare Part A and Part B as soon as you receive the first month of Social Security disability benefits.
- If you have ESRD, you might be eligible for Medicare but you must apply for Medicare benefits by visiting your local Social Security office or contacting Social Security from 7AM 7PM Monday Friday, all U.S. time zones. Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments.
Are you unsure whether you meet Medicare eligibility requirements? Contact me. I will be happy to help you.
- You can use the links below to reach me or have me send you customized information through an email.
If you wish to learn more about some of the Medicare plans where you live, use the Compare Plans button on this page.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Who Is Eligible To Receive Medicare Benefits
Two groups of people are eligible for Medicare benefits: adults aged 65 and older, and people under age 65 with certain disabilities. The program was created in the 1960s to provide health insurance for senior citizens. Older Americans had trouble finding affordable coverage, which spurred the government to create a program specifically for this portion of the population. Its an entitlement program in that the federal government finances it to some degree, but its also supported and financed directly by the very people who use it. Youre eligible for Medicare because you pay for it, in one way or another.
To receive Medicare benefits, you must first:
- Be a U.S. citizen or legal resident of at least five continuous years, and
- Be entitled to receive Social Security benefits.
That means that every U.S. citizen can enroll in Medicare starting at age 65 . When we say Medicare, were referring to original Medicare. This comprises Parts A and B. Part A covers hospital care while Part B covers medical care. There are four parts to the program Part C is a private portion known as Medicare Advantage, and Part D is drug coverage. Please note that throughout this article, we use Medicare as shorthand to refer to Parts A and B specifically.
To qualify for Medicare based on ESRD, you first need to meet the following qualifications:
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How Social Security Determines You Have A Higher Premium
We use the most recent federal tax return the IRS provides to us. If you must pay higher premiums, we use a sliding scale to calculate the adjustments, based on your modified adjusted gross income . Your MAGI is your total adjusted gross income and tax-exempt interest income.
If you file your taxes as married, filing jointly and your MAGI is greater than $182,000, youll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $91,000, youll pay higher premiums. See the chart below, Modified Adjusted Gross Income , for an idea of what you can expect to pay.
If you must pay higher premiums, well send you a letter with your premium amount and the reason for our determination. If you have both Medicare Part B and Medicare prescription drug coverage, youll pay higher premiums for each. If you have only one Medicare Part B or Medicare prescription drug coverage youll pay an income-related monthly adjustment amount only on the benefit you have. If you decide to enroll in the other program later in the same year, well apply an adjustment automatically to the other program when you enroll. You must already be paying an income-related monthly adjustment amount. In this case, we wont send you another letter explaining how we made this determination.
Remember, if your income isnt greater than the limits described above, this law does not apply to you.
If Your Income Has Gone Down
If your income has gone down and the change makes a difference in the income level we consider, contact us to explain that you have new information. We may make a new decision about your income-related monthly adjustment amount for the following reasons:
- You married, divorced, or became widowed.
- You or your spouse stopped working or reduced your work hours.
- You or your spouse lost income-producing property because of a disaster or other event beyond your control.
- You or your spouse experienced a scheduled cessation, termination, or reorganization of an employers pension plan.
- You or your spouse received a settlement from an employer or former employer because of the employers closure, bankruptcy, or reorganization.
If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a federal income tax return for the year in question, you need to show us your signed copy of the return. Use Form Medicare Income-Related Monthly Adjustment Amount Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.
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