Eligibility for Medicare: Can I Qualify Before I'm 65?

Question:

I was just denied Social Security disability insurance (SSDI) benefits because I didn't have enough work credits. I was mainly applying to qualify early for Medicare (I'm 60), because I have high medical costs due to kidney disease and other conditions. Now I'm worried I won't qualify for Medicare even when I turn 65. What can I do?

Answer: You can qualify for Medicare before age 65 in several situations

You have some options to get Medicare coverage. There are several parts to Medicare, with different rules for qualifying for each.

Part A, Hospital Insurance, is the Medicare coverage that's premium-free for those who are fully insured with Social Security. Individuals over 65 who aren't insured with Social Security can pay a premium to get Part A.

Anyone over 65 can get Part B, Medical Insurance (mainly for doctors' visits), simply by paying a premium (about $165 per month).

And anyone who is entitled to Medicare Part A or enrolled in Part B can get Part D prescription drug coverage by paying a monthly premium.

Here are the various ways to qualify for Medicare Part A.

Premium Free Medicare Part A for People 65 or Older

If you are 65 or older, you'll qualify for free Medicare Part A if you OR your spouse worked for long enough at a:

• job covered by Social Security
• a railroad, or
• a federal, state, or local government in a Medicare-covered job.

Generally, you need 40 work credits (each representing one calendar quarter of work) to be fully insured by Social Security. That represents about ten years' worth of work.

To qualify for Part A based on your spouse's work record (or your ex-spouse's work record), your spouse must be at least 62. Do you have a spouse who will have enough work credits by the time you turn 65? Check with Social Security to see if your spouse (or ex-spouse) will have enough credits.

Again, anyone who is 65 or older or receives Social Security disability benefits (and is beyond the waiting period) can get Part B by paying the Part B premium.

Paid-Premium Medicare Part A for People 65 or Older

People over 65 who don't qualify through one of the above methods can get Part A by paying a premium. Note though, if you want to get Part A by paying a premium, you also have to pay for Part B. On the other hand, you can just get Part B if you want, by paying the Part B premium.

How much are you looking at having to pay for Part A if you're not fully insured for Social Security? If you, or your spouse, has 30 to 39 work credits (instead of the 40 required to be fully insured by Social Security), the monthly premium for Part A is currently $278 per month.

If you or your spouse has fewer than 30 credits, the monthly premium would be $506 per month (in 2021). If you have income below a certain level, however, you can get help paying your premiums through one of the Medicare Savings Programs.

Medicare Coverage for People Younger Than 65

Unfortunately, there are limited ways to get Medicare if you're under 65. Here are the two groups of people who can get Medicare coverage before they reach 65:

• people with disabilities who are receiving SSDI, or
• people who have end-stage kidney/renal disease (ESRD).

If you don't fit into those categories and your income and assets are low (and you may not need to count the money you spend on your medical expenses), you might want to look into applying for Medicaid, especially if your state has opted for Medicaid expansion.

SSDI Recipients

You can qualify for Medicare if you're approved for disability benefits from Social Security or the Railroad Retirement Board. However, there is a 24-month waiting period after you become entitled to disability benefits before you can get Medicare (except for those who suffer from ALS).

ESRD Patients

You can get Medicare if you have end-stage kidney/renal disease (ESRD). Medicare coverage will start as soon as you begin dialysis.

You or your spouse does need to be at least "currently insured" for Social Security (or entitled to an annuity from the Railroad Retirement Board) to get Medicare for ESRD. You're currently insured if you or your spouse earned six credits in the three years before turning 65 (or if your spouse earned six credits in the three years before dying). You can also get Medicare if you have ESRD and you are dependent on a parent who is fully or currently insured for Social Security or railroad benefits.

Ways to Get More Credits to Qualify for Medicare or Social Security

If you're close to the number of credits you need (at age 60, you need 38 credits to qualify for disability benefits; at age 62 or older, you need 40 credits to qualify for disability or retirement benefits), you might consider going back to work on a very part-time basis.

You need to earn only $1,640 to get one credit (in 2023), and you can earn four credits per year. Getting to 40 credits (or 30, even), can save you thousands of dollars in Medicare Part A costs over the years. Or, if your spouse is close to being fully insured for Social Security, he or she might be able to earn a few more work credits.

Lastly, you can always appeal a Social Security denial. If you can get approved for disability benefits, you'll automatically be eligible for Medicare two years later or when you turn 65, whichever is earlier.

_{Updated February 1, 2023}