Medicare Eligibility Requirements

Few government programs have been revised, edited, and changed as many times as Medicare. Since its creation, several presidents and thousands of Congress members have passed hundreds of laws to patch over current law. In the process, they have created a system that is so deeply-woven and interconnected that to make sense of it is almost impossible. We’ll break through the basics of Medicare’s eligibility requirements below.

Age requirements
No requirement is as important as the age requirement, which is the single most disqualifying factor when it comes to receiving Medicare benefits. The age requirements are broken into several sections.

  • 65 or older & spouse – Those who are 65 years or older and with a spouse receiving Social Security are eligible for free Part A coverage through Medicare, the most basic form of insurance.
  • Under 65 but disabled – If you are under the age of 65 but currently receive disability benefits through the Social Security Disability Insurance fund then you are also qualified for part A coverage through Medicare. Those who do receive disability will have to remain on a waitlist for at least 2 years, which helps reduce the amount of Medicare funds that are spent on those who are not permanently disabled.
  • Kidney disease – As a special exception added by law after Medicare’s founding, those who have not yet reached the age of 65 years old but are currently facing kidney disease would qualify for Medicare. This benefit is outstanding, considering that Part A allows for several weeks of care in a hospital, which would absolutely stand to cost hundreds of thousands of dollars for anyone with renal disease.

Employment Requirements
Medicare is paid-for with taxes collected on payrolls, also known as FICA taxation. This form of taxation is used to determine your total retirement benefits in both Medicare and Social Security, so it is required that anyone who receives such care must have worked ample time in order to benefit. This is not necessarily a requirement of those who are disabled, however, as they may receive care even as minors with no work experience.

As a general rule of thumb, those who have worked or employed themselves for at least 10 years have sufficient credits to received Medicare. Keep in mind that for self-employed people, these 10 years must have been years in which your business was profitable, and in which self-employment taxation was paid. Unprofitable businesses would not register any FICA taxes for the year, and thus credits would not be earned. The IRS allows business owners to claim up to 3 years of losses at their company’s founding, and many are unprofitable beyond that time, so be sure to keep accurate logs of your FICA payments if you’re near the cutoff threshold.

Those who have not met these work-related criteria may meet other criteria that deal with immigration and legalization. If you have been a US citizen for at least five years, then you are automatically entered into the Medicare pool, and can draw from it with or without having worked sufficient time in which you paid sufficient FICA taxes.

Wealth and Income
Personal income and wealth are not disqualifiers for Medicare, though they are disqualifiers for Medicaid. Most who qualify for Medicare will not qualify for Medicaid, though everyone who qualifies for Medicaid would necessarily qualify for Medicare.

Near the end of retirement, many who outlive their nest eggs find that they slowly reach a point at which they have so little assets that they can then apply for and receive Medicaid benefits. It is being discussed future changes on income and wealth limits for Medicare, though there are no certainties about reform at the time of writing.

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