Can you get Medicare at 63 years old?: Eligibility Rules and Early Coverage Options

While Medicare is generally for individuals aged 65 and older, a small percentage of Americans qualify for coverage earlier due to specific medical conditions or disabilities. This means you cannot simply opt to receive Medicare at age 63, but it does leave a few key exceptions for those who need it sooner.

Quick Summary

Eligibility for Medicare before age 65 requires qualifying conditions like End-Stage Renal Disease (ESRD), ALS, or receiving Social Security Disability benefits for 24 months. For those without an exception, health insurance options before turning 65 include Marketplace plans, COBRA, and Medicaid.

Key Points

• Age Restriction: You cannot get Medicare at 63 based on age alone; eligibility typically begins at 65.

• Disability Exceptions: Early eligibility is possible if you have received Social Security Disability Insurance (SSDI) for 24 months, or have ALS or ESRD.

• Pre-65 Options: For those not qualifying early, alternatives include ACA Marketplace plans, COBRA, and Medicaid.

• Avoid Penalties: Missing your Initial Enrollment Period at age 65 can lead to a lifetime late enrollment penalty for Medicare Part B.

• Plan Ahead: At 63, you should plan for your interim health insurance and research your options for a smooth transition to Medicare at age 65.

Medicare Eligibility at a Glance: The 65-and-Over Rule

Most people know Medicare as the federal health insurance program for people aged 65 and older. This is the standard rule, and for the vast majority of the population, eligibility is tied directly to turning 65. However, specific criteria must be met to receive premium-free Part A. An individual must be 65 or older and be eligible for Social Security or Railroad Retirement benefits based on their or a spouse's work history. For those who did not pay Medicare taxes for a sufficient duration, a monthly premium for Part A is required.

Early Enrollment Exceptions: How to Qualify Before 65

Although turning 63 does not automatically grant you access to Medicare, certain conditions can make you eligible early. The most common exceptions are:

• Disability: If you have received Social Security Disability Insurance (SSDI) benefits for 24 months, you will automatically be enrolled in Medicare Parts A and B. The 24-month waiting period begins after you are determined to be disabled, not from the date you applied for SSDI.
• Amyotrophic Lateral Sclerosis (ALS): Individuals diagnosed with ALS, also known as Lou Gehrig's disease, are automatically enrolled in Medicare Parts A and B the same month their SSDI benefits begin, without the 24-month waiting period.
• End-Stage Renal Disease (ESRD): People with permanent kidney failure requiring regular dialysis or a transplant can become eligible for Medicare after a waiting period. Eligibility for ESRD is not tied to SSDI, but does require that the individual, or their spouse, have worked the required amount of time under Social Security.

Comparing Health Insurance Options Before Medicare

For those who do not meet the early eligibility criteria, it is essential to have a plan for health coverage until age 65. The following table provides a comparison of common options for a 63-year-old:

Feature	Affordable Care Act (ACA) Marketplace Plan	COBRA	Medicaid	Employer-Sponsored Retirement Plan
Eligibility	Income-based subsidies may lower costs.	Available after leaving a job with 20+ employees.	Low-income individuals, rules vary by state.	Offered by some employers to retirees.
Cost	Varies based on income, location, and plan.	High, often paying the full premium plus an administrative fee.	Minimal or no cost for qualified individuals.	Varies by employer; can be expensive.
Duration	Renewable annually during Open Enrollment.	Limited to 18-36 months.	Continuous as long as eligibility is maintained.	As defined by the employer's plan.
Pros	Subsidies can make it affordable; comprehensive plans.	Continues existing coverage temporarily.	Often no out-of-pocket costs; comprehensive.	Familiar coverage with potential employer subsidies.
Cons	Not all providers participate; may not qualify for subsidies.	Very expensive; temporary coverage.	Income and asset limits can be restrictive.	Not universally available; can be costly.

Navigating the Enrollment Periods

It is crucial to understand Medicare's enrollment periods to avoid late enrollment penalties, which can increase your Part B premium for life.

Initial Enrollment Period (IEP)

Your IEP is your first opportunity to sign up for Medicare based on age and lasts seven months. It includes the three months before your 65th birthday month, your birthday month, and the three months after.

General Enrollment Period (GEP)

If you miss your IEP, you can sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. However, coverage does not begin until July 1, potentially creating a significant gap in coverage.

Special Enrollment Period (SEP)

For those delaying Medicare enrollment past 65 because they have group health coverage through current employment, a Special Enrollment Period (SEP) allows enrollment without penalty. The SEP lasts for eight months, beginning the month after your employment or group coverage ends, whichever comes first.

The Bridge to Medicare: Interim Health Coverage

If you are 63 and not eligible for early Medicare, securing health coverage for the next two years is paramount to avoid gaps and penalties. Options include:

• Employer Coverage: If you or your spouse are still working, staying on your employer's plan is often the most straightforward solution. Be sure to check with your human resources department about continuing coverage.
• COBRA: This allows you to temporarily continue your health coverage from a former employer, but premiums are high. It's a useful short-term bridge, but is typically not a long-term solution.
• ACA Marketplace: Healthcare.gov offers a variety of plans, and depending on your income, you may qualify for subsidies to lower your premium. This is a popular option for those who retire before Medicare eligibility.
• Medicaid: If your income and assets are low, you might qualify for Medicaid, a state-run program. Eligibility varies significantly by state.

What to Do at 63

At 63, you cannot get Medicare based on age alone, so your immediate focus should be on securing reliable interim health insurance. Simultaneously, it's wise to begin your research and planning for your eventual Medicare enrollment at age 65.

Step-by-step preparation:

1. Assess Your Current Coverage: Review your current health plan (employer, COBRA, Marketplace) to understand your costs, coverage, and what will happen as you approach age 65.
2. Explore Options: Research the different types of health insurance available to you for the next two years. Compare costs and benefits to find the best fit for your situation.
3. Investigate Early Eligibility: If you have a disability or qualifying medical condition, determine if you are eligible for an early enrollment exception.
4. Start Medicare Research: Even though you are not yet eligible, begin learning about Original Medicare (Parts A and B), Medicare Advantage (Part C), Medigap policies, and Medicare Part D prescription drug plans. This will prevent you from being overwhelmed when your Initial Enrollment Period begins.
5. Plan Your Transition: Map out your healthcare coverage plan leading up to your 65th birthday to ensure a smooth transition and avoid any gaps in coverage or late enrollment penalties.

Conclusion

In summary, the answer to the question "can you get Medicare at 63 years old?" is no, unless you meet specific disability or medical criteria. Without these exceptions, the standard eligibility age is 65. The years between 63 and 65 require careful planning to secure health insurance through alternatives like the ACA Marketplace, COBRA, or an employer-sponsored plan. By researching your options and planning ahead, you can ensure a seamless transition to Medicare when the time comes, without facing coverage gaps or expensive penalties.

To ensure you have the most up-to-date and accurate information, you can always visit the official Medicare.gov website, which provides comprehensive resources on enrollment, eligibility, and plan options.

Frequently Asked Questions

Can I get Medicare at 63 if I retire early?

No, retiring early does not make you eligible for Medicare before age 65. The standard eligibility age for Medicare is 65, unless you qualify under a specific disability or medical condition.

What if I have a disability? Can I get Medicare at 63?

Yes, if you have a disability and have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months, you will automatically be enrolled in Medicare Parts A and B. For ALS, enrollment starts immediately with SSDI benefits.

What are my health insurance options between age 63 and 65?

You have several options, including purchasing a plan through the ACA Marketplace (where you may qualify for subsidies), electing for COBRA coverage from a former employer, or enrolling in Medicaid if you have a low income.

What is the Initial Enrollment Period for Medicare?

The Initial Enrollment Period (IEP) is a seven-month window around your 65th birthday. It begins three months before your birthday month, includes your birthday month, and ends three months after.

Can I keep my COBRA coverage when I turn 65?

Generally, if you have COBRA and become eligible for Medicare, your COBRA coverage may end. It is crucial to enroll in Medicare during your Initial Enrollment Period to avoid late penalties and a gap in coverage.

Will I have to pay a penalty if I don't sign up for Medicare at 65?

Yes, if you do not sign up for Medicare Part B when first eligible and do not qualify for a Special Enrollment Period, you may have to pay a late enrollment penalty for as long as you have Part B coverage.

What is a Medicare Special Enrollment Period (SEP)?

An SEP allows you to enroll in Medicare past age 65 without penalty if you have group health coverage based on current employment. The SEP lasts for eight months after your employment or coverage ends.

Can I get a Marketplace plan if I am eligible for Medicare?

Once you become eligible for premium-free Medicare Part A, you cannot receive subsidies for a Marketplace plan. It is generally against the law for someone to sell you a Marketplace plan if they know you have Medicare.