Myth vs. Fact: I’m in poor health, I can’t qualify for Medicare

There are many misconceptions concerning the qualifications needed for Medicare. Many people believe if they are in poor health, they won’t receive benefits. That is simply not the case.

People do not have to be sick or have underlying health conditions to qualify for Medicare coverage. That being said, the reverse applies. If you are ill or have health conditions, you can still be eligible for Medicare.

More than any other factor, Medicare eligibility is determined by the length of employment.

Medicare Eligibility for Ages 65 & Older

Medicare has provided health insurance for the elderly and disabled for more than 55 years. It is not automatic to qualify for this program. Here’s what you need to know about Medicare eligibility requirements.

Are you 65 or older?

Full Medicare benefit are available to you if:

  • You are a United States Citizen: If you have lived in the United States for at least five years and have US citizenship or a permanent legal resident card, and
  • Social Security or railroad retirement benefits are being paid to you, or you have worked long enough to be eligible for those benefits but are not yet receiving them.
  • During your work life, you or your spouse paid into Medicare but not Social Security. or

Are you younger than 65? You may still be eligible

Under age 65, you are eligible for full Medicare benefits if:

  • If you have been entitled to disability benefits from Social Security for at least 24 months (even if they are not consecutive); or
  • Having received a disability pension from the Railroad Retirement Board and meeting specific criteria; or
  • You have Lou Gehrig’s disease (ALS), also known as amyotrophic lateral sclerosis, which automatically qualifies you; or
  • If you are permanently disabled by kidney failure (needing regular dialysis or a kidney transplant), and you have paid Social Security taxes for a specific period of time, or your spouse has paid Social Security taxes for a determined period.

What Medicare benefits are available for the disabled?

In addition to those who qualify based on their age, those who qualify based on their disability are also covered by Medicare. Individuals eligible for Medicare can take advantage of the full range of benefits.

This policy covers hospitals, nursing homes, home health services, physician practices, and community-based health care. It is not necessary that health care services be related to a disability for them to be covered.

Getting Medicare in other ways

At 65 or older, US citizens and legal residents who do not qualify on their own or through their spouse’s work record can get fully funded Medicare. The only requirement is that you buy into Medicare.

A dedicated insurance expert can help you determine eligibility for Medicare, whether or not you’re 65 or older, or even healthy or sick. Guided Solutions can help. Contact one of our insurance experts today.


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