Am I Eligible for Medicare?

Today’s Elder Care Matters Q&A provides information about Medicare Eligibility

Question: When will I be eligible for Medicare?

Answer: At age 65, most individuals are eligible for Medicare coverage. The Medicare program is funded by taxes withdrawn from workers’ paychecks so most individuals receive Part A coverage free of charge. As of 2015, 84% of Medicare beneficiaries were 65 and older, and the rest were covered as a result of a disability. If you have a disability, you may be eligible for Medicare benefits even if you are younger than 65. The following is a breakdown of eligibility guidelines as outlined by Investopedia:

Eligibility at Age 65

• You receive full benefits at retirement age if you (or your spouse) have earned at least 40 credits.
• Each $1,260 earned = one credit. You can only earn a maximum of 4 credits per year. To receive the 40 credits, you need at least 10 years of work in which you earned at least $5,040 each year.
• If you are considering working past 65, it is advised to speak with a Medicare expert about the different choices available to you.

Eligibility for Spouses

• If your spouse had the required 40 credits and you’ve been married at least one year, you qualify for benefits.
• Same-sex couples qualify for spousal benefits if they live in the state where they were married or in another state that recognizes same-sex marriages, or if they are a civilian or military employees of the federal government. Investopedia advises that all same-sex couples should apply regardless, as the exact guidelines are vague.
• If you are divorced you may be eligible for spousal benefits if you were married for at least 10 years and are currently single.

Eligibility for Disability Benefits

• There are no published list of qualified disabilities and caseworkers evaluate each case individually.
• There is no difference in coverage between disability benefits and retiree benefits.
• You must first receive Social Security Disability for at least 24 months in order to qualify for Medicare.
• End stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS) are exceptions to the 24 month wait period rule. For individuals with ESRD, they can usually begin receiving benefits three months after a course of regular dialysis or a kidney transplant. For individuals with ALS, they can enroll in Part A and Part B Medicare as soon as they begin collecting Social Security Disability benefits.
• For those receiving Medicare disability benefits and returning to work, there is a nine-month trial work period. Beneficiaries can work and still receive full benefits during this time. The nine months do not have to be consecutive, and the trial period continues until you have worked for nine months within a 60-month period.
• When the nine month trial period ends, there is an extended period of eligibility. You qualify for the extended period for the next 36 months if you are not earning “substantial” benefits (over $1,130 per month or $1,820 if you are blind).
• Expenses such as transportation to work, mental health counseling, prescription drugs, and other expenses may qualify to be deducted from your monthly income, which may allow you to continue to qualify for benefits while earning more money.
• If you still qualify as disabled after the nine month trial, you can still receive free Medicare Part A benefits and pay the premium for Part B for at least 93 months after the trial period ends.

Medicare.gov has a eligibility and premium calculator that can help you see if you qualify for benefits.

Today’s Answer was provided by Brian Andrew Tully, JD, CELA, CSA, CLTC, Founding Partner of Tully Law, PC in Melville, New York.  Attorney Tully is a Partner Member in the National ElderCare Matters Alliance.

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If you need help in planning for and/or dealing with this issue or with any Elder Care / Senior Care matter, you can find the professional help you need in one of the following 21Mobile Friendly” Elder Care / Senior Care Directories. These Elder Care / Senior Care – specific Directories are sponsored by the National ElderCare Matters Alliance, an organization of thousands of America’s TOP Elder Care / Senior Care Professsionals who help families plan for and deal with a wide range of Elder Care Matters.

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