Healthcare Educators


Are You Eligible for Medicare if You Never Worked

by | Aug 30, 2022

Many people qualify for Medicare based on their work history and payment of payroll taxes. Medicare, however, is available to anyone who meets the eligibility requirements, regardless of their work history. If you have not worked and therefore not paid Social Security taxes, you will most likely have to pay a premium for Medicare Part A.

For all other Medicare plans including Part B, Part D drug plans, Medicare Advantage and Medicare Supplement plans, your work history has no impact on the premium amounts you pay. Paying a premium for Part A will not impact what you pay for other coverage.

Medicare Eligibility Requirements

To enroll in Medicare, you must meet specific eligibility requirements. You must be 65 years of age or older and be a U.S. citizen or permanent legal resident for five consecutive years,

You can also qualify for Medicare under the age of 65 if you have been on disability for two years or have been diagnosed with either End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS).

Part A Premiums

If you meet the eligibility requirements, and you have worked and paid Social Security taxes for at least ten years (or 40 quarters), you’ll receive Part A premium-free.

If you have not met that requirement, you will have to pay a monthly premium for Part A. The premium is based on how many quarters you did pay taxes. If you’ve worked anywhere between 30 and 39 quarters, you will pay a premium of $274 per month. Anything less than 30 quarters will cause your premium to be the full $499. (These are 2022 premiums which are subject to change yearly.)

Eligibility Based on Spousal Coverage

If you haven’t worked enough in your lifetime to earn the necessary 40 credits, it may be possible to qualify for premium free Medicare Part A benefits based on your spouse’s work history and Medicare eligibility.

You may qualify if:

  • You are at least 65 years old
  • Married – If you are currently married for at least one year, and your spouse must be eligible for Social Security benefits under disability or retirement.
  • Divorced – Individuals who are now single but were married to their former spouse for 10 or more years
  • Widowed – You were married at least nine months before your spouse died and you are currently single.

Enrolling in Part A

If you must pay a premium for Part A you do not automatically get Medicare when you turn 65. You must:

To keep premium Part A, you must continue to pay your monthly premiums and stay enrolled in Part B.

What If You Can’t Afford the Premiums

If you are living on a fixed income you may struggle to pay the costs associated with your health insurance, especially if you have to pay the Part A premium plus the Part B premium ($170.10 in 2022). There are some options for you to consider:

  • If you have to pay for Part A and you cannot afford it, you can choose to get coverage through the ACA Insurance Marketplace instead of Medicare. Before making this decision, check to see if Marketplace coverage meets your needs and fits your budget. You may qualify for a premium tax credit or premium subsidy based on your income.
    If you sign up for coverage through the Marketplace instead of Medicare, and later change your mind, you might have to wait for a Special Enrollment Period to sign up for Medicare and you could be facing late enrollment penalties. These penalties can be costly and they continue to increase the longer you delay signing up.
  • Medicare offers four different Medicare Savings Programs, which help cover out of pocket costs for Parts A and B, like premiums, deductibles, or coinsurance amounts. Your eligibility is determined by your income level and is reassessed each year.

Do you need help understanding the eligibility rules and your options? Contact us today. Our knowledgeable and experienced team is here to help you make the right decision.