You may have more options for coverage than you think
by Paul Lorrah, Medicaid Plus, P.C.
Q. I haven’t worked long enough to qualify for Medicare. What are my options?
Medicare is a big umbrella, covering several different aspects of health care. So strictly speaking, not having worked long enough to “qualify” means only that you can’t receive benefits for Medicare Part A (hospital insurance) without paying premiums for them. But you most likely qualify for Medicare Part B (which covers doctors’ services, outpatient care and medical equipment) and for Part D (prescription drug coverage) because these have nothing to do with how long you’ve worked.
Normally, you need to have earned about 40 “credits” or “quarters” by paying Social Security and Medicare payroll taxes while working — equal to about 10 years of work — in order to get Part A services without paying premiums. The premiums have already been covered by your payroll taxes.
However, if you don't have enough credits you may qualify for premium-free Part A services on the work record of your spouse, provided that you are 65 or older and your spouse is at least 62. In some circumstances, you may qualify on the work record of a spouse who is dead or divorced.
Otherwise, if you’re 65 or older, you can buy into Medicare by paying monthly premiums for Part A hospital insurance. You can also join Part B and pay the same premiums as other people. In both cases, you must be a U.S. citizen or a legal resident (green card holder) who has lived in the United States continuously for at least five years.
The amount you pay for the Part A premium in 2020 is $252 a month (if you have 30 to 39 work credits) or $458 a month (if you have fewer than 30 work credits). These amounts usually change a little each year. If you continue working until you’ve earned 40 credits (about 10 years' work in total), you’ll no longer be required to pay Part A premiums.
If you buy Part A, you must also enroll in Part B. But you can enroll in Part B without having Part A. You can get Part D prescription drug coverage if you’re enrolled in Part A or Part B.
To join a private Medicare Advantage plan or to buy Medigap supplemental insurance, you must have Part A and Part B.
It’s important to know that if you don’t enroll in Part B when you’re supposed to, you risk having to pay a permanent late penalty when you finally sign up, even if you haven’t worked long enough to qualify for Part A without paying a premium for it.
You qualify for full Medicare benefits at age 65 or older if:
- You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years; and
- You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits — usually having earned 40 credits from about 10 years of work — even if you are not yet receiving these benefits; or
- You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
Younger than 65? You still may be eligibleYou qualify for full Medicare benefits under age 65 if:
- You have been entitled to Social Security disability benefits for at least 24 months that need not be consecutive, or
- You receive a disability pension from the Railroad Retirement Board and meet certain conditions, or
- You have Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, which qualifies you immediately; or
- You have permanent kidney failure requiring regular dialysis or a kidney transplant — and you or your spouse has paid Social Security taxes for a specified length of time depending on your age.
Other ways to get coverage If you do not qualify on your own or your spouse's work record but are a U.S. citizen or have been a legal resident for at least five years, you still can get full Medicare benefits at age 65 or older. You just have to buy into them by:
- Paying premiums for Part A, the hospital insurance. If you have fewer than 30 work credits, you pay the maximum premium, $458 in 2020. If you have 30 to 39 credits, you pay less, $252 a month in 2019. If you continue working until you gain 40 credits, you will no longer pay these premiums.
- Paying the same monthly premiums for Part B, which covers doctor visits and other outpatient services, as other enrollees pay. In 2020, the amount is $144.60 for individuals with a yearly income of $87,000 or less or those filing a joint tax return with $174,000 in income or less. Rates are higher for people with higher incomes.
- Paying the same monthly premium for Part D prescription drug coverage as others enrolled in the drug plan you choose.
You can get Part D if you're enrolled in either A or B.
You cannot enroll in a Medicare Advantage plan, such as health maintenance organization or a preferred provider organization, or buy a Medigap supplemental insurance policy unless you’re enrolled in both A and B.
Most people receive statements from Social Security saying whether they're yet eligible on their work records. If you don't get these statements or are still not sure if you qualify, call Social Security at 800-772-1213.