Medicare is open to those who meet the specific program criteria, including citizenship or legal residency status and age or qualifying medical condition. Similarly, your Social Security record influences your premium costs, and you may be eligible for premium-free coverage.
Here are some things to understand about the program requirements:
Citizenship and Residency Requirements
U.S. citizens can automatically qualify for Medicare contingent on age, disability, or medical condition. Legal permanent residents (green card holders) who have lived in the U.S. for at least five continuous years may also generally be able to partake in Medicare.
Qualifying Based on Age or Disability
The primary age-based eligibility criterion for Medicare is turning 65. You are generally able to enroll in Medicare when you turn 65, regardless of your employment status or health condition. The age requirement is consistent across all parts of Medicare (A, B, C, and D).
In some cases, younger individuals can qualify to enroll in Medicare based on a qualifying disability. Generally, you must have a qualifying disability that prevents you from engaging in substantial gainful activity and is expected to last for at least 12 months or result in death.
Certain disabilities, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), can result in immediate Medicare eligibility. You must receive Social Security Disability Insurance (SSDI) benefits for a specific period (usually 24 months).
Qualifying For Premium-Free Medicare Part A
To qualify for premium-free Medicare Part A, you must meet the Social Security work requirements to be “fully insured.” Fully insured means you have accumulated enough work credits through your employment history. The number of credits you need to qualify for premium-free Medicare Part A depends on your age.
Work credits are earned through your employment or self-employment activities and the payment of Social Security taxes. You can earn up to four work credits annually. Medicare considers you fully insured once you have 40 work credits (the equivalent of 10 years of work).
Even if you don’t meet the work credit requirements for premium-free Part A, you may still be able to enroll by paying a monthly premium.
Requirements to Maintain Medicare Enrollment
You could lose your Medicare coverage if you do not pay your premiums. If this happens, you’ll need to re-enroll during a future enrollment period, which may result in gaps in your healthcare coverage.
If you’re facing financial difficulties and are struggling to pay your Medicare premiums, it’s important to communicate with the appropriate authorities or your insurance provider. Some individuals may qualify for assistance programs that can help cover Medicare premiums and other healthcare costs.
Even if you’re eligible for Medicare, you might need to wait for specific enrollment periods to take advantage of the program’s offerings. These enrollment periods are designed to ensure an organized and efficient process for individuals seeking coverage.