A person becomes eligible for Medicare when they reach 65 years of age. Other insurance options are available for people who retire at the age of 62. Younger people can qualify if they meet specific requirements.
Medicare is a federal health insurance plan for people in the United States who have reached the age of 65. It began in 1965, with changes since then allowing more people to become eligible. In 2019, more than 60 million people in the U.S. received Medicare.
In this article, we discuss age limits on Medicare, the exceptions that may allow people of other ages to qualify, and other health plan options.
Medicare is a federal insurance plan that covers people aged 65 or older. Part A covers hospital costs, while Part B covers medical costs. Part D provides coverage for outpatient prescription drugs. Part C, also called Medicare Advantage, covers a combination of benefits from parts A, B, and D.
Currently, people must be 65 or older to be eligible for Medicare.
However, younger people may qualify if they meet certain conditions, including:
- receiving Social Security Disability Insurance (SSDI)
- having a specific illness, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
- becoming eligible through family relationships
A person can use the Medicare Eligibility & Premium Calculator as a first step in finding out whether they qualify for Medicare.
Eligibility by disability
People under 65 who have a disability and have received SSDI for at least 24 months can qualify for Medicare.
The enrollment is automatic after a person receives their 25th SSDI check.
When a person has a disability, their eligibility for SSDI depends on Social Security. When they qualify for SSDI, this may make them eligible for Medicare.
Eligibility due to specific illness
Younger people may qualify if they have ESRD or ALS.
End stage renal disease
If a person is living with ESRD, they may also qualify for Medicare before they reach 65. They must:
- have received a diagnosis of kidney failure
- be getting dialysis or have had a kidney transplant
- be eligible to get SSDI benefits
Amyotrophic lateral sclerosis
If a person has ALS and gets SSDI, there is no waiting period. Medicare begins automatically in the first month that their SSDI benefits start.
Eligibility through family relationship
An individual may qualify for Medicare before age 65 if a qualified person paid Medicare taxes for a certain period. The qualified person can be the person themselves or their parent or spouse.
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Other health plans form part of Medicare, each of which has special rules and exceptions. These may denote where the plan is available and what it covers.
Medicare Cost Plans
Medicare Cost Plans are available only in certain parts of the U.S. Some plans provide services for Part A and Part B, whereas others provide only Part B. Generally, a person can join when the plan has open enrollment. They can leave to go back to Original Medicare at any time.
Some plans offer prescription coverage. Unlike Medicare Advantage Plans, people can join Medicare Part D if their Cost Plan does not include drug coverage. A union health plan or employer sponsors Medicare Cost Plans. People can contact their employer or union representative for information about their plan.
Demonstration or pilot programs
Medicare developed demonstration or pilot programs as research to test improvements. They are usually only available for a short time. To qualify, a person must live in a specific area, belong to a specific group of people, or both. To check whether a demonstration or pilot program is available, a person can call Medicare at 1-800-MEDICARE (633-4227).
Another option is the Programs of All-Inclusive Care for the Elderly (PACE), which is a combination of benefits from Medicare and Medicaid. It helps older adults meet their health care needs in the community so that they do not have to enter a care facility. Not all states offer PACE.
A person must have Medicare, Medicaid, or both to join. They must also:
- be 55 years of age or older
- live in an area that offers PACE
- be certified by the state to need nursing home care
- be able to live safely in the community with help
A healthcare team manages this program, deciding on the care and services. These may include adult day care, home care, meal delivery, nutritional counseling, and social services. The premiums depend on a person’s financial ability. To find out whether a person qualifies, contact the local Medicaid office.
Medicare is a federal insurance plan that covers people aged 65 or older.
A person may qualify for Medicare when they are younger if they get SSDI, have ESRD or ALS, or are eligible through family relationships.
Medicare offers Medicare Cost Plans through employers or union groups.
Medicare and Medicaid work together to provide PACE. This program helps older adults remain in the community rather than going to nursing homes. It can include benefits that Medicare does not usually cover, and a healthcare team manages it.