Eligibility for Premium-Free Part A for Individuals Under 65 and Medicare-Eligible

By Brian Krantz - April 8, 2023

Medicare is primarily associated with people aged 65 and older, but it also provides healthcare coverage for certain individuals under 65. In this article, we will explore the eligibility requirements for premium-free Medicare Part A for those under 65 and Medicare-eligible, and discuss the impact of returning to work on Medicare coverage.

Eligibility for Premium-Free Part A for Individuals Under 65:

Individuals under 65 can be eligible for premium-free Medicare Part A if they meet one of the following criteria:

Disability Benefits: If you have been receiving Social Security disability benefits or certain Railroad Retirement Board (RRB) disability benefits for at least 24 months, you may qualify for premium-free Medicare Part A. The 24-month waiting period starts from the first month you receive disability benefits.

End-Stage Renal Disease (ESRD): Individuals with ESRD, a severe form of kidney failure requiring dialysis or a kidney transplant, may also qualify for premium-free Medicare Part A. Eligibility depends on factors such as work history, receipt of Social Security or RRB benefits, or being the spouse or dependent child of someone who meets these requirements.

Amyotrophic Lateral Sclerosis (ALS): If you have been diagnosed with ALS, also known as Lou Gehrig’s disease, you may be eligible for premium-free Medicare Part A. In this case, there is no waiting period, and Medicare coverage begins the same month your disability benefits start.

Returning to Work and Medicare Coverage: If you return to work, you can keep your Medicare coverage indefinitely as long as you remain medically disabled. For the first 8.5 years of being back at work, you will not have to pay the Part A premium. After that, you will have to pay the Part A premium yourself. If at that point your income is too low to afford the Part A premium, you may be eligible for the Qualified Disabled and Working Individuals (QDWI) program. QDWI pays the Part A premium if you meet its eligibility requirements.

Eligibility for premium-free Medicare Part A for individuals under 65 depends on specific circumstances, such as receiving disability benefits, having ESRD, or being diagnosed with ALS. Additionally, returning to work can have implications on Medicare coverage and Part A premiums. If you need assistance navigating your Medicare coverage or have questions about enrollment, consider reaching out to the local Medicare advisors at Plan Medicare for expert guidance and support.

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