Most Americans know that they can qualify for Medicare at age 65, although a few exceptions allow younger individuals to qualify as well. However, Democrats in the Biden administration have introduced legislation that could lower the Medicare eligibility age to 60.
Many people wonder what Medicare at 60 would look like, including how much it would cost and the eligibility criteria. While this proposed change has not taken effect yet, it could affect your health insurance coverage if it does. Keep reading as we give you all the details on what Medicare at age 60 might look like.
Medicare At Age 60: What Does It Look Like?
Today, Medicare eligibility starts at age 65. There are exceptions for those who have received Social Security disability benefits for 24 months or those diagnosed with ALS or End-Stage Renal Disease (ESRD).
President Joe Biden expressed his desire to lower the eligibility age to 60 during his presidential campaign. This would provide additional healthcare options to those who retire early or are unemployed.
Congressional Legislation
The job market is often more challenging for older individuals, so they are usually left without group health insurance if they cannot find a job. Even though the Affordable Care Act (ACA) greatly expanded access to healthcare coverage, many think more can be done.
Congress has now introduced legislation that could make President Biden’s desire a reality. Representative Pramila Jayapal introduced this Medicare For All bill.
Proposed Changes
So, just what would Medicare coverage for 60-year-olds look like? Many aspects would likely look the same as today, with a lower eligibility age.
- Those with sufficient work credits would likely still receive Medicare Part A with no premium.
However, this premium-free coverage does raise some concerns. The hospital insurance trust fund is projected to become insolvent in a few years. Enrolling millions of uninsured Americans in the 60 to 65-year-old age group would cause the fund to run out of money even faster.
Medicare Part B would still include a premium, even for enrollees with sufficient work credits. Remember that Part B consists of a late enrollment penalty today for anyone not signing up during their initial enrollment period.
There is still some question about whether that penalty would apply under the new legislation. If it does, no one knows when the penalty will take effect. Would you then be required to sign up for Medicare at age 60, or would the penalty apply only if you waited past age 65? The answer to that question is not known at this point.
KEY TAKEAWAYS
- Congress introduced legislation allowing US citizens to enroll in Medicare at age 60 instead of 65, providing additional healthcare options for those who retire early or are unemployed.
- Under the new proposal, eligibility requirements and costs remain essentially unchanged. However, it would increase subsidies for low-income beneficiaries.
- Since Medigap rules are administered at the state level, it is unclear how federal Medicare changes might impact Medicap rules for eligibility and coverage.
Eligibility For Medicare At Age 60
Understanding what eligibility for Medicare might look like at age 60 helps to understand what eligibility looks like today. Today, you become eligible for Medicare at age 65, as long as you have been a U.S. citizen for at least five years.
If you already receive Social Security benefits, you will be automatically enrolled in coverage. Those not yet receiving retirement benefits will need to apply for coverage.
New Proposed Legislation
If the proposed Medicare legislation passes the House and Senate, here is what you can expect.
- You would become eligible for Medicare at age 60 instead of 65. The five-year U.S. citizenship rule would likely still apply.
- Since most people do not receive Social Security benefits at age 60, they would need to manually apply for Medicare coverage at that age.
The provisions that allow younger individuals to qualify for Medicare likely would not change.
- Younger individuals would still be able to receive Medicare after having been on Social Security disability benefits for at least 24 months.
- Similarly, younger people who are diagnosed with ALS or ESRD could still sign up for Medicare.
Remember that Medicare and Medicaid are two entirely separate insurance programs. Medicare is administered by the federal government and mostly provides coverage for older individuals. Medicaid, on the other hand, is primarily administered by state governments and is meant to provide health coverage for low-income individuals and families.
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Medicare Costs At Age 60
Medicare costs at age 60 may not be much different than they are today at age 65; for people with at least 40 work credits, Part A coverage would probably still be provided with no premium.
- If you do not qualify for premium-free Part A coverage, the monthly premium is currently either $278 or $505 per month, depending on how much work history you have.
Everyone pays a premium for Part B coverage.
- The premium for Part B coverage is currently $174.70 per month. This premium is adjusted on a sliding scale depending on your income. The more income you have, the higher your premium will be. You could pay $594 monthly for your Part B premium.
Part C plans, or Medicare Advantage plans, vary in cost. Each is administered by a private insurance company, so the details of each plan differ according to coverage, copay amounts, and deductibles. This is also true of Medicare Part D prescription drug plans.
Key Difference of New Proposal
One difference between the new Improving Medicare Coverage Act and the existing cost structure is that the act expands subsidies for low-income beneficiaries.
- Those with an income below 200% of the federal poverty level would be eligible for a Medicare Cost Assistance Program that would eliminate premiums for those people. This applies to both the Part A and Part B premiums, and it does not matter how many work credits you have.
Remember that premiums are not the only costs associated with Medicare coverage. Like most insurance plans, beneficiaries will also have many out-of-pocket expenses. You might be required to pay copayments and deductibles when you receive treatment from your provider.
- Just because Congress decides to implement a lower Medicare eligibility age does not mean that health coverage will be more affordable.
Healthcare costs have continued to rise in recent years, and this also applies to Medicare recipients.
Since its inception, Medicare has traditionally had low reimbursement rates for providers, so many providers do not support the lowering of the eligibility age.
TIP
The proposed legislative changes to Medicare to lower eligibility age to 60 have not gained much traction in the Senate or Congress. This change will unlikely be implemented, primarily because it would be cost-prohibitive.
Medigap At Age 60
Another big question about this new legislation is how Medicare Supplement plans will be handled. Today, Medigap plans exist to help Medicare beneficiaries with out-of-pocket expenses not covered by Medicare.
- Medicare coverage covers 80% of the cost of most services and procedures. Medigap plans can help pay for the 20% that is not covered.
Eligible individuals can enroll in a Medigap plan today during the Open Enrollment period. They can choose to have their plan begin at the same time as their Part B coverage. If they enroll during this period, their health will not affect their acceptance into a plan.
Medigap rules vary from state to state. Lawmakers have not clarified how the Medicare expansion would affect them. Today, state laws govern whether Medigap plans must be available for those under 65. There seems to be no consensus on whether that would change going forward.
- It might mean that even though you are eligible for Medicare at age 60, you might not have access to a Medigap plan until you turn 65.
Similarly, it is unknown whether guaranteed issue rights would apply to those in the 60–65 age group. Guaranteed issue rights mean you cannot be denied coverage due to an existing health condition, but the proposed new law is unclear on how that rule would apply to the new eligibility group.
The Bottom Line
Medicare has traditionally been available for those age 65 and older or those younger receiving Social Security disability benefits.
However, a recent congressional proposal could lower the eligibility age to 60. Many aspects of Medicare might still look very similar, like the requirement of work credits for premium-free Part A coverage.
However, many questions about Medigap and supplemental coverage for those in the new age group still exist. Unless the Democrats can gain support from conservative party members like Joe Manchin, the new proposal might never become law anyway.
Frequently Asked Questions
It is impossible to say whether the Medicare age will be lowered to 60. However, legislation has been introduced in Congress that would do that. This lowering of the eligibility age is something that Joe Biden pushed during his presidential campaign.
Now that he is president, Congress is attempting to get the age lowered through new legislation. Even though Democrats currently control the House of Representatives, they will have a more difficult time getting the legislation through the Senate. Many people do not support the legislation, and lowering the eligibility age to 60 could present real problems for the solvency of the Medicare program.
Medicare is funded through payroll taxes and premiums, so lowering the age of eligibility could put a financial strain on the program. There are also questions about how Medigap and the guaranteed issue rules would be affected by this new bill.
On the other side of the coin, there have also been talks in the past about raising the Medicare eligibility age to 67 to help Medicare remain solvent.
The earliest age at which most people can get Medicare is 65. However, there are a few exceptions.
- If you have been receiving Social Security disability benefits for 24 months, you will be enrolled in Medicare coverage regardless of your age.
- Similarly, younger individuals who have been diagnosed with Lou Gehrig’s disease (ALS) or end-stage renal disease (ESRD) can apply for Medicare benefits.
If the proposed Medicare expansion takes place, the general eligibility age would be lowered to 60. This means that you would become eligible for Medicare at age 60 instead of 65.
Since most people are not receiving Social Security retirement benefits at age 60, people in that age group would need to manually apply for Medicare upon becoming eligible.
There are a few differences between Medicare Part A and Part B. The biggest difference is in the coverage provided by each part. Medicare Part A is considered hospital insurance. It covers hospital stays and inpatient care. Part B, on the other hand, is medical insurance. Part B covers doctor’s office visits, outpatient care, and many preventive services. This includes things like the flu vaccine, pneumonia vaccine, hepatitis B vaccine, lab tests, and preventive screenings.
- The other difference is in the amount of the premium. If you have enough work credits, then you will not have to pay a premium for Part A coverage. Those without enough work credits can still receive Part A, but they will need to pay a monthly premium.
- Part B always includes a monthly premium. The amount that you pay for Part B coverage depends on your income. The more money you make, the more you will be required to pay. Part B coverage is also optional. You can choose whether or not to enroll in Part B, while enrollment in Part A is mandatory.
Medicare is available to people under 60, but only in a couple of circumstances. The most common way that you can receive Medicare under 60 is if you have been receiving Social Security disability benefits for at least 24 months.
You can also receive Medicare before age 60 if you have been diagnosed with ALS, or end-stage renal disease.
The proposed legislation that could lower the eligibility age to 60 would not affect these exceptions. Even though the legislation could lower the general eligibility age to 60, the ways to get Medicare before age 60 would remain the same. It is still yet to be determined whether the legislation will pass and take effect.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
