Summary:
If you’re getting ready to retire on the early side — say, at 62 — you may be wondering whether you can qualify for Medicare once you stop receiving your employer’s health insurance. The answer: probably not.
Almost everyone will have to wait until they turn 65 before they qualify for Medicare coverage, says Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation. The exception is if you have a specific disability.
One reason for the common confusion? You can start receiving Social Security benefits as early as age 62. But the rules for enrolling in Medicare differ from those for Social Security.
What’s more, even if your spouse is old enough to qualify for Medicare, you can’t start receiving it until you’re 65. That’s because, unlike the health insurance plans offered by many employers, Medicare isn’t a group plan. It’s an individual one.
The reverse is also true: “You can’t enroll in Medicare and also cover your spouse if they don’t qualify on their own,” says Donovan.
eHealth is here to make Medicare easy. Use our PlanPrescriber tool to find plans that fit your budget and cover your doctors.
Here are answers to some other common questions about qualifying for Medicare.
If my spouse is 65 and I’m 62, how will that affect my spouse’s Medicare costs?
Your spouse’s costs will depend on the type of Medicare plan they choose — Original Medicare from the government or Medicare Advantage from a private insurer. And it will depend on the number of years you’ve both worked.
Here’s the lowdown: At the age of 65, your spouse will qualify for traditional Medicare, also called Original Medicare. That includes Medicare Part A, which covers hospital costs, and Medicare Part B, which covers doctor visits, among other things. If they need additional benefits, like coverage for prescription drugs, vision, hearing, or dental care, they must buy either additional Medicare Supplement plans or enroll in a Medicare Advantage plan (Medicare Part C) that bundles those benefits in one policy.
Chances are that your spouse will have to pay a monthly premium for Part B (because almost everyone does). But they probably won’t have to pay for Part A. The reason: If your spouse has worked for at least 10 years (40 quarters), they’ve paid taxes to Medicare, so they won’t have to pay a premium for Part A.
And if your spouse hasn’t worked for at least 10 years? They can still qualify for premium-free Part A if you’ve worked for that amount of time and have paid taxes to Medicare. (The tax is automatically deducted from your paycheck, and people who are self-employed pay it too.)
If, on the other hand, neither you nor your spouse has worked for at least 10 years, you both may need to pay a premium for Part A. That cost can be as much as $499 a month. Part B is at least $170.10.
Will I get my spouse’s Medicare if I retire at age 62?
No. Even if your spouse has Medicare when you retire at 62, you aren’t eligible for it until you turn 65 (unless you qualify by disability).
If you retire before age 65, you may be able to continue to get health insurance through your employer, or you can purchase coverage from a private insurance company in the meantime. (eHealth can help you find a plan to fit your needs. Get started.)
How do you qualify for Medicare early if you have a disability?
If you have a disability, you may be eligible for Medicare if you’re younger than 65 and:
- You have been collecting Social Security disability benefits for at least 24 months. In this case, you’ll likely be automatically signed up for Medicare coverage starting in month 25.
- You have end-stage renal disease (ESRD). You won’t be automatically signed up for Medicare, though. You’ll still need to contact Social Security or visit their website to enroll.
- You have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. If you have ALS, you’ll be automatically signed up for Medicare the same month your Social Security disability benefits start.
Will I be enrolled in Medicare automatically?
Not necessarily — and that’s something that confuses a lot of people, says Donovan.
You will be automatically enrolled in Medicare if:
- You’re already receiving Social Security retirement benefits when you turn 65.
- You’re younger than 65 and have been receiving Social Security disability benefits for 24 months. Then you’ll be enrolled in Medicare starting in month 25.
- You’re younger than 65 and have ALS (Lou Gehrig’s disease). You’re automatically signed up for Medicare the same month your Social Security disability benefits start
You will typically have to sign up for Medicare yourself if:
- You aren’t receiving Social Security retirement benefits when you turn 65.
- You’re under 65 and have end-stage renal disease, a type of kidney failure.
- You live in Puerto Rico. You may be automatically enrolled in Medicare Part A when you turn 65, but you’ll need to sign up for Part B.
If you don’t sign up for Medicare when you become eligible, you may have to pay a late enrollment penalty. Learn more about the late enrollment penalties.
Does the eligibility age change for different types of Medicare coverage?
No. Unless you have a disability, you must turn 65 to sign up for Medicare Part A and Part B. And if you want to sign up for a Medicare Advantage plan or a Medicare Supplement insurance plan, then you need to first have Part A and Part B.
Can I enroll earlier in Medicare if I’m a widow or widower?
No, your Medicare eligibility doesn’t change if your spouse dies.
If I enroll earlier than age 65, is my Medicare coverage reduced?
No. Only people with a disability can sign up before age 65, and there’s no penalty for doing so. This is another way Medicare differs from Social Security benefits.
If you qualify for Medicare at a younger age, you receive Original Medicare benefits (Parts A and B). If you need prescription drug or other coverage, contact your State Health Insurance Assistance Program (SHIP) about buying a Medicare Supplement insurance plan.
How do I get full Medicare benefits?
You’re entitled to full Medicare Part A and Part B benefits as soon as you’re eligible for Medicare.
If you’re interested in benefits beyond Original Medicare, you may want to consider:
- Medicare Advantage: Also known as Medicare Part C, these plans give you another way to get your Medicare Part A and Part B coverage. Plus, they often include extra benefits, like prescription drug coverage.
- Medicare Supplement Insurance: This private insurance plan works alongside your Medicare Part A and Part B coverage. It’s also called Medigap.
- Medicare Part D: This stand-alone prescription drug plan helps you cover the cost of prescription medications.
Finding the Medicare plan that’s right for your needs doesn’t have to be overwhelming — eHealth is here to help. Get started now.
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