September 17th 2024
By Ari Parker
You are not automatically eligible for Medicare when you turn 55—but you may be eligible if you have certain disabilities or conditions. Click to learn more.
Medicare is the government’s health insurance solution for retired people who cannot take part in employer coverage. While many people consider a 50 or 55-year-old person a “senior citizen,” you are not automatically eligible for Medicare when you turn 55. That said, if you have certain disabilities or health conditions, you may be eligible for Medicare at age 55.
In this guide, we’ll share detailed information about Medicare eligibility. We’ll also share information about your health insurance options as a retiree before you turn 65.
Most people become eligible for Medicare due to age and are eligible at 65 years old.
Some people are eligible for Medicare before they turn 65 due to certain health conditions.
If you’re retired and not yet eligible for Medicare, you can use COBRA or the Health Insurance Marketplace to obtain health insurance.
Most people become eligible for Medicare due to age. All Americans are eligible for Medicare at age 65. Some people are able to get Medicare at age 55 or even earlier due to having certain conditions. You’re eligible if you have:
A disability
End-Stage Renal Disease (permanent kidney failure)
ALS (also called Lou Gehrig’s disease)
If you have questions about your eligibility, give us a call at 855-900-2427. We’re happy to help you understand your eligibility and enroll when the time is right!
Unless you have a disability or qualifying medical condition, you are not eligible for Medicare at 55—you’ll need to wait until you turn 65. That said, some people retire before they turn 65. So, what are your health insurance options if you retire before 65?
COBRA is an act that allows workers and their families to continue using the health benefits from their group health plan for limited periods when certain circumstances arise:
Voluntary or involuntary job loss
Reduction of working hours
Transition between jobs
Death, divorce, and other life events
With COBRA, employers must provide a temporary extension of coverage in certain situations. Retirees may choose to use COBRA to extend their coverage from their employer until they become eligible for Medicare. In this situation, COBRA and Medicare work together to provide retirees with health insurance.
If you retire at 55 (or any other time before 65) and lose your employer-linked health insurance, you can use the Health Insurance Marketplace to obtain health insurance. While Open Enrollment via the Marketplace is usually between November 1st and January 15th, you’ll be eligible for a Special Enrollment Period because you lost your previous coverage. When you fill out your application, you’ll figure out if you’re eligible for a private plan with premium tax credits and lower out-of-pocket costs. You’ll also find out if you’re eligible for Medicaid in your state.
If you retire before 65 and have retiree health insurance coverage, you can enroll in a Marketplace plan, but you’ll need to wait for Open Enrollment. You also won’t be eligible for premium tax credits and other savings due to your income. This may be different if you are eligible for retiree health insurance coverage but are not actually enrolled.
COBRA isn’t always the most affordable option, and many people wonder if they can switch from COBRA to a Marketplace plan. The answer depends on your situation.
1. Your COBRA coverage runs out outside of the Marketplace Open Enrollment Period.
You qualify for a Special Enrollment Period and can enroll in a Marketplace plan when your coverage ends.
2. You choose to end your COBRA coverage outside of Marketplace Open Enrollment.
You don’t qualify for a Special Enrollment Period, so you will need to wait for Open Enrollment to purchase a Marketplace plan.
3. Your COBRA coverage ends (voluntarily or involuntarily) during Marketplace Open Enrollment.
You can enroll in a Marketplace plan.
If you retire at 55 and are not yet eligible for Medicare, you’ll most likely use COBRA or a Marketplace plan to maintain continuous health insurance coverage until you turn 65. Whether you enroll in COBRA or a Marketplace plan, you can cancel your coverage once your Medicare coverage starts.
Whether you’re 55 or just around the corner from turning 65, you can always prepare for Medicare enrollment early. Our Medicare Explained Guide will help you understand the most important factors of Medicare. If you ever have any questions about Medicare, we’re here to help! Give us a call at 855-900-2427 to get help understanding and comparing your options. Not ready for a call? Schedule a time to chat.
