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What If I Haven't Worked Long Enough to Qualify for Medicare?

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En español l Q. I haven’t worked long enough to qualify for Medicare. What are my options?

A. Medicare is a big umbrella, covering several different aspects of health care. So strictly speaking, not having worked long enough to “qualify” means only that you can’t receive benefits for Medicare Part A (hospital insurance) without paying premiums for them. But you most likely qualify for Medicare Part B (which covers doctors’ services, outpatient care and medical equipment) and for Part D (prescription drug coverage) because these have nothing to do with how long you’ve worked.

Normally, you need to have earned about 40 “credits” or “quarters” by paying Social Security and Medicare payroll taxes while working — equal to about 10 years of work — in order to get Part A services without paying premiums. The premiums have already been covered by your payroll taxes. 

However, if you don't have enough credits you may qualify for premium-free Part A services on the work record of your spouse, provided that you are 65 or older and your spouse is at least 62. In some circumstances, you may qualify on the work record of a spouse who is dead or divorced. Following the overthrow of the Defense of Marriage Act, people in a same-sex marriage can also qualify on their spouse’s work record if they live in a state that accepts same-sex marriage or recognizes the laws of other states that do.

Otherwise, if you’re 65 or older, you can buy into Medicare by paying monthly premiums for Part A hospital insurance. You can also join Part B and pay the same premiums as other people. In both cases, you must be a U.S. citizen or a legal resident (green card holder) who has lived in the United States continuously for at least five years.

The amount you pay for the Part A premium in 2014 is $234 a month (if you have 30 to 39 work credits) or $426 a month (if you have fewer than 30 work credits). These amounts usually change a little each year. If you continue working until you’ve earned 40 credits (about 10 years' work in total), you’ll no longer be required to pay Part A premiums.

If you buy Part A, you must also enroll in Part B. But you can enroll in Part B without having Part A. You can get Part D prescription drug coverage if you’re enrolled in Part A or Part B.  To join a private Medicare Advantage plan or to buy Medigap supplemental insurance, you must have Part A and Part B.

It’s important to know that if you don’t enroll in Part B when you’re supposed to, you risk having to pay a permanent late penalty when you finally sign up, even if you haven’t worked long enough to qualify for Part A without paying a premium for it. (Related article: “Can You Be Penalized for Not Enrolling in Medicare?”)

Patricia Barry is a senior editor for AARP Integrated Media and the author of “Medicare For Dummies” (Wiley/AARP, October 2013)

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