The eligibility age for Medicare is 65 years, in most circumstances. However, people with certain medical conditions may be eligible for coverage at a younger age.
Medicare is the government sponsored health insurance program that includes hospital and medical coverage.
Most people with Medicare coverage are 65 years or older. However, according to the Kaiser Family Foundation, Medicare currently covers around 9.1 million people under the age of 65, many of whom have an ongoing disability or medical condition. This is approximately 16% of the Medicare population.
This article explains how and when a person becomes eligible for Medicare benefits, including considerations that relate to age and health conditions.
A person usually reaches eligibility for Medicare at 65 years of age. Medicare has been eligible for people aged 65 and over in the United States since 1965. This is the same year Medicare coverage went into effect.
Over time, legislation has increased coverage for those with certain medical conditions who have not yet reached the age of 65 years.
The Congressional Budget Office (CBO) have studied the feasibility and potential cost savings of increasing the age of Medicare qualification from 65 to 67 years. In 2013, the CBO issued a report that estimated that doing so would decrease the federal budget deficit by $19 billion over 7 years.
However, the current enrollment age remains 65 years.
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 determines that a person has a disability and is not able to work, they may qualify for Medicare before reaching 65 years of age. The doctor will need to fill out forms that confirm that the person has a disability.
They may confirm a disability in people with the following medical conditions:
- chronic heart failure
- liver disease
- multiple sclerosis
- sickle cell disease
People with these conditions may have a waiting period after their doctor confirms their disability before they can start receiving Medicare Part A benefits. They should ask their Social Security office about when exactly they can qualify for Medicare.
Most people who are already enrolled to collect Social Security for their disability do not have to pay a premium for Medicare Part A.
When a person requires dialysis or qualifies for a kidney transplant, it usually means that they have ESRD.
A person with ESRD can usually receive Medicare benefits about 3 months after undergoing dialysis at a healthcare facility, or almost immediately if they qualify for at-home dialysis.
A person with ESRD does not have to pay Part A premiums when they qualify for Medicare. Medicare Part A covers treatments that require a hospital stay (such as surgery), a stay at a skilled nursing facility or hospice, and home healthcare.
If a person has ALS, they will qualify for Medicare Part A without having to pay premiums. Also, they will usually qualify without a waiting period to receive Medicare benefits.
A person is eligible for Medicare Part A if they or their spouse have paid Medicare taxes for at least 40 quarters of work.
This might become more challenging when an older adult with a younger spouse did not work 40 quarters but their spouse did.
If a younger spouse worked for 40 quarters, they can qualify their partner for Medicare coverage once they reach 62 years of age and the older, nonworking spouse reaches 65 years of age.
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.
If a person already receives benefits from the Social Security Administration, the Administration will automatically enroll them in Medicare parts A and B.
The person will receive a “Welcome to Medicare” packet 3 months before their 65th birthday, with instructions on how to sign up.
A person does not have to be retired to receive Medicare. If a person is not currently receiving Social Security benefits, they can apply for Medicare benefits as early as 3 months before their 65th birthday.
For example, if a person turns 65 years of age in April, they can apply for Medicare benefits in January of the same year.
Applying for Medicare benefits as early as possible may help the Social Security office process the paperwork in time for the person’s 65th birthday.
People who apply too late may face a premium 10% higher than that of those who apply on time. This premium would apply for double the time a person has been eligible but did not apply.
A person can apply for Medicare during their birth month or up to 3 months after their birth month without having to pay penalties for Medicare coverage.
However, their benefits will not begin until the Centers for Medicare and Medicaid Services process their request.
A person can qualify for Medicare benefits when they reach 65 years of age. The cost of these benefits depends on whether or not they or their spouse have worked at least 40 quarters and paid Medicare taxes.
Those with disabilities, ESRD, or ALS may qualify for Medicare benefits before this age.