Medicare is available to everyone who meets the eligibility requirements, regardless of if you’ve worked during your lifetime or not. However, if you have not worked and therefore not paid Social Security taxes, you’ll likely pay much more for Medicare Part A than someone who has.
Today, we’ll discuss who is eligible to enroll in Medicare, your costs for Medicare if you’ve never worked, and some alternative options.
Medicare Eligibility Requirements
To enroll in Medicare, you must meet specific eligibility requirements set by the Centers for Medicare and Medicaid Services (CMS). Individuals must:
- Be 65 or older, and
- Be a U.S. citizen or permanent legal resident for five consecutive years
You can also qualify for Medicare under the age of 65 if you have been on disability for two years or have been diagnosed with either End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS).
Premium-Free Part A Requirements
Once you’ve determined that you’re eligible for Medicare, you must then find out if you qualify for premium-free Part A. Medicare Part A is premium-free for most individuals. As long as you have worked and paid Social Security taxes for at least ten years (or 40 quarters), you’ll receive Part A premium-free.
You will have to pay a monthly premium for Part A if you’ve not met that requirement. The premium is based on how many quarters you did pay taxes. If you’ve worked anywhere between 30 and 39 quarters, you will pay a premium of $274 per month. Anything less than 30 quarters will cause your premium to be the full $499. (These are premiums based on 2022 and are subject to change yearly.)
Fortunately, these numbers also apply if you have never worked but are married to someone who has. However, you must have been married for a minimum of one year, and then your Part A premium will be based on your spouse’s work history.
In addition, divorced or widowed spouses may also be eligible to use the work history of their ex-partner. For example, you can receive premium-free Part A based on their work history if:
- You are divorced and now single but were married for at least ten years.
- You are widowed and now single but were married for at least nine months before your spouse passed away.
For every other Medicare plan, including Medicare Part B, Medicare Supplements, Medicare Advantage Plans, Part D prescription drug plans, etc., your working history has no impact on the premium amounts.
Alternatives to Medicare
Those who find themselves paying the full amount for Part A – $499 – may want to look at healthcare options outside of Medicare. Don’t forget; you’ve still got to account for paying for Part B (currently $170.10 per month) and any other supplemental coverage. Those options could easily add up to several hundred dollars, making them unaffordable for many.
One alternative for individuals who are eligible for Medicare but do not qualify for premium-free Part A is to purchase a plan through the Affordable Care Act (ACA) Marketplace. In that instance, they can also qualify for premium tax credits based on their income. This is a viable short- or long-term alternative for those who cannot afford to pay the full Part A premium. Individuals who enjoy premium-free Part A can still elect to enroll in an ACA plan but will not be eligible for premium subsidies.
Another alternative is to find out if you are eligible for Medicaid, a financial assistance program available for certain groups of people. Depending on your income level, you could qualify for partial or more extensive assistance to help with your healthcare costs.
Medicare also offers four different Medicare Savings Programs, which help with Medicare costs like your premiums, deductibles, or coinsurance amounts. Your eligibility is determined by your income level and is reassessed each year.
If you have questions about your Medicare eligibility, speak with one of our licensed Medicare advisors. We can help check your eligibility status and determine your Medicare costs.