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Am I Eligible for Medicare?

Updated: Jun 21, 2022

As we enter our senior years, many of us begin thinking about the transition to Medicare from employer-based insurance plans. We may wonder when we will qualify and if the taxes we have been paying through our working lives will cover our Medicare insurance. As Medicare agents, it’s our job to help kupuna understand their Medicare options and that includes understanding Medicare eligibility and the costs associated with these options. Today we are going to talk about Medicare Part A (the free part of Original Medicare) that covers your hospital insurance and Medicare Part B that covers your medical insurance.

Am I eligible for Medicare?

The vast majority of U.S. citizens or legal permanent residents aged 65 years or older qualify for Medicare. In addition to this, people under the age of 65 who have disabilities* or End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) typically qualify. Medicare Part A is free for those who fit into these categories as long as they worked or had a spouse who worked and paid Medicare taxes for at least 10 years or they worked or had a spouse who had Medicare-covered government employment. Note that Medicare Part B always carries a monthly premium, which is most often deducted from a person’s Social Security benefits, Railroad Retirement, or Civil Service Retirement check.

To confirm your Medicare eligibility along with your expected premium, use the eligibility tool.

*What kind of disabilities qualify for Medicare under the age of 65?

  1. You are receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB).

  2. You are eligible to receive Social Security or Railroad benefits but you still need to file for them.

Note that people who have had disability benefits from Social Security for 24 months or certain disability benefits from the RRB for 24 months, will automatically be enrolled in Medicare Part A and Part B. Those who qualify will get a red, white, and blue Medicare card in the mail before their 25th month of disability or the first month of receiving benefits if they have Lou Gehrig's disease.

What if I didn’t pay Medicare taxes?

If neither you nor your spouse paid Medicare taxes while you worked (and neither you nor your spouse worked for a Medicare-covered government job) or you didn’t pay the taxes for the 10 years required but you are 65 years or older then you may be able to access Medicare Part A by purchasing it. This is true if you are a U.S. citizen or permanent resident (green card holder) and have lived here for at least five consecutive years. If you need to pay for Medicare Part A then you will receive a bill for the premium.

Who is not eligible for Medicare?

Because of the way that people qualify for Medicare, most new immigrants or recent Green Card holders will not qualify for Medicare Insurance. Seniors who fall into these categories may need to purchase temporary health insurance that provides medical coverage for non-U.S. citizens.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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