Medicare is a federal health insurance plan primarily for Americans who are 65 years of age or older. However, certain younger people with a qualifying disability or who have End Stage Renal Disease (ESRD) or ALS may qualify as well.
To qualify for Medicare as an older adult, you’ll need to meet certain requirements. These criteria are based on things like your citizenship status and work history. Keep reading to learn more about the requirements for getting Medicare.
You may be able to get Original Medicare at age 65 or older if you meet all of the following requirements:
- You are a U.S. citizen or permanent legal resident living in the U.S. for at least five continuous years.
- You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement Benefits. This means that you have worked and paid Medicare taxes for at least 40 calendar quarters (10 years), although they do not have to have been continuous.
- You or your spouse have a government job that is Medicare-covered.
Individuals who are U.S. citizens or permanent residents for at least five years but have not worked at least 40 quarters may still be able to get Medicare Part A by purchasing it. The current Medicare Part A premiums are $274 per month if you have worked between 30 and 39 quarters or $471 per month if you have worked for fewer than 30 quarters. You may still qualify even if you have not paid Social Security taxes but have paid Medicare taxes.
If you are not sure if you qualify for Medicare, you can use the Eligibility & Premium Calculator on the Medicare.gov website. This tool can also help you determine your premiums for Part A (if any) as well as for Part B.
How to Pay for Medicare
Like any health coverage plan, you are required to pay your premium in order to maintain coverage. Do you receive Social Security retirement benefits? If so, your Medicare Part B premium is automatically deducted from your monthly check once you are enrolled. Otherwise, you will be responsible for paying your premiums. You can pay by check, credit card or automatic debit from a checking account.
If you have a Medicare Advantage plan, you would pay your premium directly to the insurance provider.
Payment Assistance Options
If you cannot afford the costs of Original Medicare, you may be able to get help with payments through Medicare Savings Programs (MSP) or Medicaid.
There are four kinds of MSPs:
- Qualified Medicare Beneficiary Program: You may be able to qualify for this if your monthly individual income is $1,094 or less or $1,472 for a married couple. It helps pay for premiums for Part A and Part B as well as copays and other out-of-pocket costs.
- Specified Low-Income Medicare Beneficiary Program: The monthly income limits for this program are $1,308 for an individual or $1,762 for a married couple. It helps cover the cost of the Part B premium if you have Part A.
- Qualifying Individual Program: This program helps pay for Part B premiums for people with Part A if you earn $1,469 per month as an individual or $1,980 for a married couple.
- Qualified Disabled and Working Individuals Program: This is for a person who is both disabled and working. Monthly income limits are $4,379 for an individual and $5,892 for a married couple.
