Just about everyone will agree that dealing with Medicare can lead to a whole lot of confusion. One of the first confusing points is figuring out who is eligible to get or enroll in Medicare. Here are three relevant queries submitted to me recently.
I am 52 years old with serious health problems. How can I get Medicare?
The original Medicare legislation, passed into law in 1965, provided coverage for those 65 years and older. Over time, eligibility has expanded to include those under age 65 with certain disabilities and medical conditions. As a result, some individuals with health issues believe they can get Medicare before age 65. However, not all health issues lead to Medicare eligibility.
The criteria for getting Medicare under age 65 are very specific.
- Those who qualify for Social Security Disability Insurance (SSDI) will be enrolled in Medicare automatically as of the 25th month of receiving benefits.
- If the disability is due to ALS (Amyotrophic Lateral Sclerosis or Lou Gehrig’s disease), Medicare starts the first month of SSDI benefits. There is no waiting period.
- Those diagnosed with end-stage renal disease (ESRD) generally will qualify for Medicare three months after beginning a course of regular dialysis. In some situations, this could be as early as the first month of dialysis. Enrollment is not automatic; these individuals must apply.
It’s possible that this 52-year old woman will likely have to wait until age 65 to get Medicare.
I applied for Social Security retirement benefits six months ago at age 62. I heard that those receiving retirement benefits automatically get Medicare. How come I haven’t received my Medicare card?
Part of this question is true. Those who are receiving Social Security retirement benefits are enrolled automatically in Medicare. However, one important fact is missing. They must be eligible for Medicare, which means they are 65 years or older. As detailed in the first question, only those who qualify for Medicare because of SSDI, ALS or ESRD can get Medicare coverage before age 65.
I am turning 65 and will apply for Medicare Part A and Part B and a medical plan. My 59-year-old spouse has not worked. I know that my wife can get Medicare on my record so can I enroll her in that same medical plan now?
To get premium-free Part A, hospital insurance, an individual must have worked and paid taxes for 10 years (40 quarters) or have a spouse who did. This 59-year old spouse will have to wait until age 65 to enroll in Medicare.
Upon further discussion, this man knew his wife would not be eligible for Medicare until then; he just wants to put her on his Medicare medical plan, as she was with his employer’s plan before he retired. But that won’t work.
A medical plan to go with Part A and Part B is generally either Medicare supplement insurance (a Medigap policy) or a Medicare Advantage plan. This additional coverage helps to cover Medicare’s out-of-pocket costs. And that coverage is a one-person plan. Medicare does not cover dependents.
Remember: Unless you have serious medical issues that qualify you for early enrollment, you will have to wait until age 65 and your Initial Enrollment Period to begin the Medicare process. Then, the coverage you choose will be just for you.