Jane Dotson
If you're over 65 and wondering how to get free medical insurance, you may be eligible for Medicare, which is available to people aged 65 or older. You may even be able to get Medicare before you turn 65 if you have a disability, End-Stage Renal Disease (ESRD), or ALS. To get free Medicare Part A (Hospital Insurance), you must be entitled to receive it based on your own earnings or those of a spouse, parent, or child. You must also have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. If you're not eligible for free Medicare, you can purchase health insurance coverage in the Marketplace, and you may be eligible for premium tax credits if your income is at least 100% of the federal poverty level.
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What You'll Learn
Medicare Part A and Part B
Part A coverage begins the month the individual turns 65, provided they file an application for Part A or for Social Security or RRB benefits within six months of turning 65. If the application is filed more than six months after turning 65, Part A coverage will be retroactive for six months. For an individual whose 65th birthday is on the first day of the month, Part A coverage begins on the first day of the month preceding their birth month. For example, if an individual's birthday is on December 1, Part A begins on November 1. People who must pay a premium for Part A do not automatically get Medicare when they turn 65. They must file an application to enroll by contacting the Social Security Administration.
Part B is medical insurance that helps cover two types of services: medically necessary services and preventive services. Medically necessary services are services or supplies that meet accepted standards of medical practice to diagnose or treat a medical condition. Preventive services are healthcare to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best. You pay nothing for most preventive services if you get the services from a healthcare provider who accepts the assignment. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin. If you already have Part A, you can add Part B during specific enrollment periods. If you are covered by an active employer group health plan (either yours or your spouse's) since turning 65, and it ended within the last eight months, you can enroll in Part B without any penalty. This is considered a "Special Enrollment Period."
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Eligibility for premium-free Medicare
Medicare is health insurance for people aged 65 or older. To be eligible for premium-free Medicare Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. The worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits.
QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during an individual's working years. Most individuals pay the full FICA tax, so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A. However, certain Federal, State, and local government employees only pay the Part A portion of the FICA tax. Therefore, the QCs they earn can only be used to meet the requirements for premium-free Part A and not for monthly Social Security benefits.
An individual receiving monthly Social Security or RRB benefits at least four months before turning 65 does not need to file a separate application to become entitled to premium-free Part A. Their Part A coverage begins the month they turn 65, provided they file an application for Part A or Social Security/RRB benefits within six months of turning 65. If the application is filed more than six months after turning 65, Part A coverage will be retroactive for six months. For individuals whose 65th birthday is on the first day of the month, Part A coverage begins on the first day of the preceding month.
If you are still working when you turn 65, you may not have to pay a premium for Part A. In this case, you can choose to sign up when you turn 65 or anytime later. If you have group health insurance available to everyone at your company, you can wait until you stop working or lose your health insurance to sign up for Part B without paying a late enrollment penalty.
If you are an annuitant with Medicare, Medicare must pay benefits first, and your FEHB plan will pay benefits as the secondary carrier.
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Job-based health insurance
If you are over 65 and still working, you may be able to get free medical insurance through your employer. This is known as job-based health insurance or group health insurance. Here is some information on how job-based health insurance works and what you need to know:
Eligibility for Job-Based Health Insurance:
To be eligible for job-based health insurance, you typically need to be an employee of the company offering the insurance. In some cases, the insurance may be available to everyone at the company, while in other cases, it may only be available to certain groups or categories of employees. It is important to check with your employer to understand the specific eligibility requirements for their health insurance plan.
Understanding the Cost of Job-Based Health Insurance:
The cost of job-based health insurance can vary depending on the plan offered by your employer. In most cases, your employer will pay a portion of the monthly premium, while you will be responsible for the remaining cost. To determine if the job-based health plan is considered "affordable," you need to calculate if your share of the monthly premium for the lowest-cost plan offered is less than a certain percentage of your household income. As of 2025, if your share is less than 9.02% of your household income, the plan is considered affordable.
Enrolling in Job-Based Health Insurance:
If you are offered job-based health insurance, you will need to decide whether to enroll in the plan. It is important to review the details of the plan, including the monthly premium, deductible, copayments, and coinsurance. You may also want to compare the job-based plan with other options, such as a Marketplace plan, to find the most suitable and affordable coverage for your needs.
Coordinating Job-Based Insurance with Medicare:
If you are over 65 and eligible for Medicare, you should coordinate your job-based insurance with Medicare Parts A and B. Ask your employer if you need to sign up for both parts when you turn 65. If you don't sign up for Medicare, your job-based insurance may not cover all your medical costs. Additionally, if you have retiree coverage from a previous job, it may require you to have both Medicare Parts A and B to continue paying for your health services.
Avoiding Gaps in Coverage:
When transitioning from job-based insurance to Medicare or making any changes to your health insurance coverage, it is crucial to avoid gaps in coverage. Ensure that you enroll in Medicare about a month before your current coverage ends to prevent any interruptions in your health insurance protection.
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Special Enrollment Period
Medicare is health insurance for people aged 65 or older. Some people get Medicare automatically, while others have to sign up. If you are 65 or older and still working, you may not need to apply for Medicare medical insurance (Part B) at age 65. You may qualify for a Special Enrollment Period (SEP) that will let you sign up for Part B during any month you remain covered under the group health plan and your, or your spouse's, current employment continues.
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days. If you lose health coverage through your employer or the employer of a family member, you may qualify for a Special Enrollment Period. If you lose Medicaid or Children's Health Insurance Program (CHIP) coverage in the past 90 days, you may also qualify for a Special Enrollment Period.
You may qualify for a Special Enrollment Period if you move to the United States from a foreign country or United States territory. Moving only for medical treatment or staying somewhere for vacation does not qualify you for a Special Enrollment Period. If someone on your Marketplace plan dies, causing you to lose your current health plan, you will qualify for a Special Enrollment Period.
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Medicaid and Marketplace plans
If you are 65 or older and do not qualify for premium-free Medicare, you can purchase health insurance coverage in the Marketplace. If your income is at least 100% of the federal poverty level ($15,060 for an individual in 2025), you will be eligible for premium tax credits to make the coverage in the Marketplace more affordable.
Medicare Part A Hospital Insurance and Part B Medical Insurance are available to most people at no cost when they turn 65. However, some people have to pay a premium for this coverage. To be eligible for premium-free Part A, you must be entitled to receive Medicare based on your own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A based on age, disability, or End-Stage Renal Disease (ESRD). If you are enrolled in Medicare Part A, you no longer qualify for savings on your Marketplace plan.
If you are enrolled in Medicare and have limited income and resources, you may qualify for Medicaid to help pay for your premiums and out-of-pocket medical expenses. Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare. In total, 12 million people are enrolled in both Medicaid and Medicare.
To determine whether you are eligible for Medicaid, you must consider the eligibility requirements in your state, which may include age, income, and disability.
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Frequently asked questions
In the US, individuals over 65 are usually eligible for Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance). Most people get Part A for free if they or their spouse have worked and paid taxes for a specified number of quarters.
If you don't qualify for free Part A, you can choose to pay a premium for it.
Everyone is charged a premium for Part B. You can choose to sign up for it if you need it.
You should sign up for Medicare when you turn 65 to avoid a late enrollment penalty and gaps in coverage.
If you have insurance through your employer, you should ask them if you need to sign up for Medicare Part A and Part B when you turn 65. If you don't sign up, your job-based insurance might not cover certain costs.
