Many people choose to retire at 62 because this is when Social Security benefits can start. Unfortunately, Social Security benefits are not tied to your eligibility for Medicare benefits. They are separate programs.
As a general rule, eligibility for Medicare begins at 65, and many employees continue on their employer’s medical plan at retirement until they reach this age. But, there are certain situations in which you might be eligible for Medicare benefits before the age of 65.
When you are under 65, you can become eligible to receive Medicare benefits if:
You have been collecting Social Security Disability Insurance (SSDI) or certain disability benefits from the Railroad Retirement Board (RRB) for at least 24 months;
A doctor has diagnosed you with Amyotrophic Lateral Sclerosis (ALS), and you are receiving SSDI; or
A doctor has diagnosed you with End-Stage Renal Disease (ESRD).
The good news is that you won’t have to do anything to enroll in Medicare if you have an eligible disability. It will happen automatically.
At the start of your 25th month of disability, your enrollment in Medicare Part A and Part B should be seamless, and you’ll receive a card in the mail shortly. Part B premiums will be deducted from your disability checks.
This isn’t coverage that you should decline unless you have an alternative. In most cases, an employment-based plan is considered secondary once you are eligible for Medicare.
If you’ve been diagnosed with ALS, also known as Lou Gehrig’s disease, and are under 65, you don’t have to wait 24 months for Medicare eligibility. You will be able to enroll as soon as you begin collecting SSDI or RRB checks.
When you submit your disability paperwork to either of these agencies, be sure to specify that you were diagnosed with ALS. There will be a five-month waiting period before you begin collecting benefits. But your Medicare eligibility will begin at the same time as your payments, and you should receive your card automatically.
If you have been diagnosed with ESRD that requires a kidney transplant or dialysis and are under 65, you will be eligible for Medicare immediately provided you, a spouse, or parent have enough work history to qualify for SSDI or RRB benefits.
To enroll in Medicare, call or go to a Social Security Administration (SSA) office, and speak to them about the “ESRD Medicare” program. You’ll want to do this even if you qualify through RRB benefits.
If you begin a program of home dialysis, your Medicare eligibility takes effect at the start of the first month of that program. The physician must indicate that you’re expected to finish the program and will continue with home dialysis once it’s over.
If you are receiving dialysis at an outpatient or inpatient center, your Medicare eligibility takes effect at the beginning of the fourth month of the program.
If you are meant to get a kidney transplant, your Medicare eligibility takes effect at the beginning of the month of in which you’ve been admitted to a Medicare-approved facility for the transplant. The program requires that the transplant take place within two months after your coverage begins.
Sometimes, even children can qualify for Medicare coverage. The child must be related to someone, by birth or adoption, that has received sufficient Medicare credits through work.
A child under 20 years old can only qualify for Medicare if they have ESRD and either needs a kidney transplant or dialysis. A child over the age of 20 must be disabled and have been receiving SSDI for at least two years before being eligible for Medicare coverage.
Too many people mistakenly believe that early Medicare coverage based on a serious condition only allows you to get treatment for that condition, and nothing else. This isn’t the case.
If you qualify for Medicare before 65, you’ll have full coverage just as you would if you were 65 or over. In other words, you’ll have Part A and Part B coverage, which covers medical services and hospital bills. Part D coverage, which could be free depending on your income level, pays for prescription drugs.
Other options are Part C coverage, which is called Medicare Advantage, and supplemental insurance, both of which might be limited in these circumstances.
Medicare supplement plans, sometimes called “Medigap” coverage, are private insurance plans that help pay for some of the healthcare costs that Medicare doesn’t cover. This can include out-of-pocket costs such as deductibles, coinsurance, and copayments.
Federal law doesn’t require that insurers sell Medicare supplement plans to people under 65. However, if you have Medicare eligibility, you may be able to find this coverage in some states.
If you are under 65 and have been eligible for Medicare because of a coverage disability, you can keep your Medicare coverage if you return to work but continue to be medically disabled.
If you do go back to work, you won’t have to pay your Part A premium for the first 8 1/2 years. After that, if you haven’t reached 65, you’ll have to pay the premium for Part A coverage.
It’s a common misconception that Medicare eligibility is tied to your eligibility for Social Security. This isn’t the case. There are only a few ways to get Medicare before the age of 65.
If you need health insurance coverage after retirement, but before you are eligible for Medicare, there are many affordable plan options available. There are also many choices in supplemental policies to give you the coverage that Medicare lacks.