Are You Eligible for Medicare?

Many people assume if they lived and worked in the United States, they automatically qualify for premium-free Medicare when they turn 65. But depending on your employment history, that may not be the case.

Verify Your Medicare Eligibility

If you are not sure if you are Medicare eligible, you should contact the Social Security Administration at Medicare by calling 1-800-MEDICARE (1-800-633-4227; TTY users, 1-877-486-2048). Medicare representatives are available 24 hours a day, seven days a week. You can also verify your eligibility for Medicare benefits on the Medicare.gov website. When considering retirement, it is critical to consult with your employer’s benefits advisor or group health plan administrator.

Medicare Part A and B

Let’s start with a basic understanding of Medicare. Original Medicare has two parts. Medicare Part A covers inpatient care in a hospital, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers most outpatient services.

In general, most of us qualify for premium-free Part A Medicare benefits and we pay a modest premium for Part B. Medicare is typically available to you if you:

• are 65 years old
• have been a legal resident of the United States for at least 5 years
• you paid Federal Insurance Contributions Act (FICA) taxes for 40 quarters (approximately 10 years) through your job or through self-employment taxes

FICA and Social Security Taxes

FICA helps fund both Social Security and Medicare programs which provide benefits for retirees, the disabled, and children. FICA taxes are paid equally by workers and their employers. If your employer did not deduct these taxes from your paycheck or you did not work the minimum required number of years, you may not be eligible for Social Security retirement benefits or Medicare.

If you worked part-time or you worked in a position where FICA was not withheld from your paycheck, you may not have accumulated the required 40 quarters of employment necessary to claim Medicare benefits. However, you may be entitled to claim spousal benefits if you meet the following criteria:

• You are currently married and your spouse is eligible for Social Security benefits (either retirement or disability). You must be married for at least one year before you apply.
• You are divorced and your former spouse is eligible for Social Security benefits (either retirement or disability). You must have been married for at least 10 years and you must now be single.
• You are widowed and married for at least nine months before your spouse died. You must be single.

Purchasing Medicare Part A

If you or your spouse have not been paying FICA taxes for at least 10 years, you are still eligible to buy Medicare Part A coverage, but you will pay a premium based on your work history. If you paid into Medicare for less than 30 quarters (7.5 years), your premium in 2018 will be $422 per month. If you paid into Medicare for 30-39 quarters (7.5 to less than 10 years), your premium in 2018 will be $232 per month. Note that if you do buy into Medicare Part A, you must also enroll in Medicare Part B.

Public Service Employees

If you are a public service employee working for a city, municipality, state or other civilian government agency that is exempt from FICA and therefore Medicare, you may be eligible for:

• an employee pension plan
• a retiree health plan that is not based on Medicare enrollment*

* If you have accumulated sufficient credits to qualify for premium-free Medicare Part A, your employer may require you to enroll in Medicare before they will offer you a Medicare-based retiree health insurance option.

Failure to enroll in Medicare when eligible may result in the loss of employer retiree health insurance benefits and result in Medicare enrollment restrictions and penalties. Some employers may require a letter from Social Security documenting your ineligibility for premium-free Medicare Part A before they will allow you to enroll in a non-Medicare based retiree health insurance plan.

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