Question

While working on the online application for Medicare  I called Social Security.  They state that I am not eligible as I don’t have enough credits and won’t be eligible until my husband  turns 62 this coming October, then apply under him as he does have the credits.   They also said I couldn’t get Part B – Doctor Visits until open enrollment, Jan-March 2017, which wouldn’t be effective till July.

 

Answer

This is an interesting question as it’s the first time it’s come up for me for someone who has lived in the USA all their life. CMS gives the following information on their page which you can view by clicking here.

To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) [40] and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act Wikipedia (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.

Which begs the following Questions

I’m under 65, and I or my spouse is still working

My spouse has never worked. If they turn 65 before I do, can they get Medicare at 65? Or, do they have to wait until I turn 65 and have Medicare?

If you’re at least 62 and have worked at least 10 years in Medicare-covered employment, your spouse can get Part A and Part B at 65.

If you’ve worked at least 10 years in Medicare-covered employment but aren’t yet 62 when your spouse turns 65, they won’t be eligible for premium-free Part A until your 62nd birthday. In this case, your spouse should still apply for Part B at 65, so they can avoid paying a higher Part B premium.

However, if you’re still working and your spouse is covered under your group health plan, they could delay their Part B enrollment without paying higher premiums.

Next month, I’ll be 65. I’ve only worked for a few years and my spouse is 60. Can I enroll in Medicare?

Yes, you can enroll in Medicare. But if you’ve worked less than 10 years in Medicare-covered employment, you’ll have to pay a monthly premium for Part A. If you choose Part B, you’ll also have to pay the Part B premium.

Enroll in Part A and Part B or find out how much your Part A premium will be.

Does a spouse, age 62, get Medicare when their husband/wife aged 65 does?

Generally, no. You can’t get Medicare until you’re 65. However, you may qualify for Medicare coverage if you’re less than 65 if you have a disability or End-Stage Renal Disease (ESRD).  CMS.Gov

Bottom Line

How does paying the premium for Part A Hospital  compare to just continuing your premiums for Individual Medical Coverage?

Unfortunately,  our FREE Quote Engine doesn’t calculate over 65, coverage is  generally not available.   In reviewing the confidential file for this hypothetical person asking the question their husband and wife rate is $1,380 for Health Net  Gold HMO.   The rate for the under age 62 spouse only is $661, thus the premium would be $719 for the person who is 65.   $426 for Part A Hospital + $105 to $120 for Part B Doctor Visits – ZERO for a Medicare Advantage Plan that includes Part D Prescriptions still sounds like a good deal, especially since it doesn’t give you the Part B late enrollment penalty which includes having to wait till the next July to have it effective.  There is also a Part D Rx penalty if you don’t enroll when eligible.

Additional Research   reference materials.   View relevant pages.

Medicare Part A Hospital & B Doctor Visits Eligibility & Premium Calculator

Related Pages in   How to sign up for Medicare? » 65+ but less than 5 years in USA  Section

 

4 comments on “Age 65 but not enough credits

  1. hi Steve,
    My father and mother have had Covered CA Silver 94 PPO plan, with APTC since ACA went into effect. Their income is below FPL but through two years of consecutive appeals hearing, the Judge had ordered Covered CA that they are eligible for APTC since they are not eligible for non-MAGI Medi-Cal (since both my dad and mom are above 65, and have assets more than Medi-Cal limits, and they cannot spend down). Both my dad and mom have been legal permanent residents (green card) at the time of the appeals in 2016 and in 2015. They are eligible for Medicare but are not eligible for premium-free Medicare, and Covered CA did send them a letter stating that people who are not eligible for premium-free Medicare and who dont enroll in Medicare could be eligible for APTC. Just like last two years, again for 2017, Covered CA has told them that we are not eligible for APTC for 2017 coverage. My dad became a US citizen late 2016. But they continue to be ineligible for Medi-Cal, or premium-free Medicare. And without APTC, they cannot afford to get an affordable minimum qualified health plan. They have filed for an appeal, but if you can point us to any sections of the ACA, or Federal Code of Regulations or California regulations, or special rules/clarifications, or IRS notes that we can represent to the judge during our hearing, it would be really helpful. It is strange that while they would be eligible for APTC as non-citizen aliens (as decided by the Judge last 2 years), their becoming a citizen makes it worse for them.

  2. Steve,

    I have a few questions that I have numbered below for convenience.

    Regarding the sign up on the Social Security site, I understood from your email last week that I should sign up for:

    1. Medicare parts A and B.

    2. But should I also sign up for part D?

    3. What about Medigap?

    4. When do I sign up for part C (Advantage)?

    5. Once I sign up for Medicare can I start my coverage with the Blue Shield 65 Plus (HMO) plan effective April 1, 2016? If not, when will that coverage start?

    6. Once that coverage begins, do I pay for it until Bruce turns 62 in October?

    7. Also, have you heard from Blue Shield yet?

    Please try to answer today if you can so that I can try to sign up today.

    Thanks.

    • 1 That’s correct

      2 No, as you were getting the Blue Shield Medicare Advantage Plan. It includes Part D, Rx. Use the menu above to learn more about the Blue Shield and other plans.

      3 Medicare Advantage is pretty comprehensive and highly regulated. It’s my understanding an agent can go to jail if they sell you a Medi Gap plan in addition to a Medicare Advantage plan, as you don’t need the additional coverage.

      4 As soon as you get Part B, that should give you a new enrollment period into Medicare Advantage – Part C. OOPS!!! One has to check every rule, I don’t see that in Publication 11219 Understanding Medicare C & D Enrollment periods. It’s if you get Part B during the general enrollment period then you get a Medicare Advantage enrollment period. So, if you get your Part A & B NOW, then you can apply by the end of March for a April 1 start date. This MUST be done by the 31st as your 65th birthday was in December. We have your Blue Shield application, just give us your Medicare #.

      5 Yes. Sign up TODAY and get us the number. At least some PROOF that you’ve signed up and will be effective in April!

      6 The Blue Shield Medicare Advantage plan has no premium, other than the optional dental. Use the menu above to get the details and disclosures.

      You will always pay for Part B Medicare – Doctor Visits.

      It’s my understanding that once your husband turns 62 then you won’t have to pay the Part A premium of $426/month. Everything I have on buying Part A is on the page above or in the links to Medicare, Social Security and CMS websites.

      7 I just reemailed them and they agreed that you can pay for Part A or wait till your husband turns 62. If there are Part B late enrollment penalties, Blue Shield doesn’t do that. Social Security assesses them. The late enrollment penalty calculator also shows Part A premium and when one is eligible.

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