According to the U.S. Census Bureau, the average retirement age for men in this country is 65 and for women 63. While you may not qualify for your full amount of Social Security retirement benefits at 65, you do qualify for Medicare at 65 years of age. 

But because life isn’t one size fits all, not everyone has the same health care insurance needs at age 65. Some people have retired and are automatically enrolled in Medicare, some are still working and have great coverage through their employers, others are self-employed and don’t have any coverage.

What Healthcare for Retirees do You Qualify for at Age 65? 

Since 1965, Medicare has been mainly recognized as health care insurance for retirees – even though it also covers those who are younger and have certain qualifying disabilities. While most people qualify for Medicare at the age of 65, you must still meet the following eligibility criteria:

You qualify for Medicare benefits at age 65 or older if: 

  • You are a citizen of the United States, or you’re a permanent legal resident who’s lived in this country for at least five years. 
  • You are currently receiving retirement benefits from the Social Security Administration or the Railroad Retirement Board. Or you have worked long enough (at least 40 quarters) to qualify for these benefits but aren’t receiving them yet. 
  • You or your legal partner is a current or former government employee who paid into the Medicare system while employed. 

If you meet the qualification requirements above, and your income is below a certain amount, you qualify for premium-free Medicare Part A benefits. You can also enroll in Medicare Part B or a Medicare Advantage (Part C) plan as an alternative to Medicare Parts A and B. Enrollees pay a monthly premium for Medicare Part B. You can also enroll in a Medicare Part D (prescription drug) plan, which carries its own monthly premium. 

Qualifying for Medicare health insurance at 65

You will qualify for Medicare benefits at the age of 65 even if you or your legal partner haven’t met Medicare’s work record requirements of 40 quarters (or approximately 10 years) of paying Medicare payroll taxes. In this instance, you or your spouse may be able to purchase Medicare Part A health care insurance by doing the following: 

1. Pay Medicare Part A monthly premiums 

Medicare Part A covers inpatient hospital care. Most people who qualify for Medicare also qualify for premium-free Part A coverage. However, if you don’t meet the requirements, you can pay a monthly premium which is based on the amount of time you have worked and covered your Medicare taxes, and the number of work credits you have. 

The longer you work and pay Medicare taxes, the more work credits you earn. Work credits are based on your income; in 2022 one work credit “costs” $1,510.00 in earnings. You can get up to four work credits per year, and Medicare considers full qualification to be 40 quarters or approximately 10 years of employment and tax-paying. 

If you have under 30 work credits, you must pay the maximum Part A premium. This amount is $499.00 per month in 2022. If you have between 30 and 39 work credits, you pay $274.00 per month in 2022. 

If you enroll in Medicare and pay your monthly Part A premium, but you continue working and gaining work credits, you no longer have to pay your monthly premium when you reach 40 work credits (or quarters). 

2. Pay Medicare Part B monthly premiums

Medicare Part B covers outpatient medical care like doctor’s visits and other medical services. If you are 65 or older you can enroll in Medicare Part B. In 2022, the Part B monthly premium is $170.10 for enrollees who do not exceed a yearly income of $91,000.00 as individual taxpayers; or $182,000.00 for joint filers. If you make more than that, you pay a higher monthly premium for Part B coverage. 

You can purchase prescription drug coverage from a stand-alone Medicare Part D provider if you are enrolled in either Part A or Part B. 

However, you don’t qualify for a Medicare Advantage (Part C) plan or Medicare Supplement insurance (Medigap) unless you enroll in both Medicare Part A and Part B.