Jane Dotson
If you are aged 55 and looking for medical insurance, you may be eligible for Medicare if you have certain disabilities or health conditions. However, for most people, Medicare is only available from the age of 65. If you are not eligible for Medicare, you may want to consider COBRA, which allows you to continue using the health benefits from your previous employer for a limited time. Alternatively, you could apply for a Marketplace health insurance plan, although this can be expensive, especially if you are over 55.
Eligibility for medical insurance at age 55
| Characteristics | Values |
|---|---|
| Medicare | Not eligible unless you have a disability or qualifying medical condition, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) |
| Medicaid | Eligibility depends on the state; in most states, individuals under 65 are eligible if their income does not exceed 138% of the poverty level |
| COBRA | Allows workers and their families to continue using the health benefits from their group health plan for a limited period after retirement |
| Marketplace/exchange plan | Available to anyone who is self-employed or does not have retiree insurance or Medicare; lower costs are available based on household size and income |
| Employer-sponsored health coverage | If you continue working until you are eligible for Medicare, you can use your employer-sponsored health coverage |
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What You'll Learn
Medicare eligibility at 55
Medicare is the US government's health insurance program for people aged 65 and over. While this is the standard eligibility age, there are some exceptions that allow for earlier enrollment.
Am I eligible for Medicare at 55?
If you are 55 and have certain disabilities or health conditions, you may be eligible for Medicare. These include:
- Receiving Social Security disability benefits for at least 24 months.
- Receiving a disability pension from the Railroad Retirement Board.
- Being diagnosed with Lou Gehrig's disease (Amyotrophic Lateral Sclerosis or ALS).
- Needing regular dialysis or a kidney transplant due to permanent kidney failure.
If you retire at 55 and are not yet eligible for Medicare, you can maintain continuous health insurance coverage through the following options:
- COBRA: This allows you to continue using your previous employer's health benefits for a limited time.
- Health Insurance Marketplace: You can purchase a Marketplace plan during the Open Enrollment Period. Losing your employer-linked health insurance qualifies you for a Special Enrollment Period.
- Medicaid: This is a state-based health insurance program with no age restrictions.
- Private health insurance plans.
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Marketplace health insurance plans
If you are 55 years old and have retired or lost your job-based health insurance, you can use the Health Insurance Marketplace to buy a plan. The Marketplace is also a good option if you don't have coverage through a job and don't qualify for Medicare or Medicaid.
The yearly period for enrolling in a Marketplace health insurance plan is from November 1 to January 15. You can apply with a Special Enrollment Period any time from 60 days before and 60 days after your separation date. Losing health coverage, moving, getting married, having a baby, adopting a child, or having a household income below a certain amount are all qualifying life events for a Special Enrollment Period.
Marketplace plans are a better option than short-term plans, which almost always have worse coverage and are not eligible for discounts. Short-term plans can also deny coverage or charge higher rates based on your health history and may have no limit on how much you pay for medical care in a year. On the other hand, Marketplace plans limit your yearly medical costs and can provide government discounts (premium tax credits or subsidies) if you have a low to average income.
Blue Cross Blue Shield (BCBS) is one well-rated and widely available option for Marketplace coverage. You can find and compare Marketplace plans and prices on HealthCare.gov or your state health exchange.
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COBRA health insurance
If you are 55 years old and lose your job-based health insurance, you can use COBRA insurance to extend your coverage until you become eligible for Medicare at age 65. COBRA, or the Consolidated Omnibus Budget Reconciliation Act, is a federal law that allows employees and their families to continue their employer-provided health insurance for a limited time after leaving their job or experiencing certain life events that would otherwise end their coverage. These life events include voluntary or involuntary job loss, reduction in hours worked, transition between jobs, death, divorce, and other life events.
COBRA insurance is considered expensive, as individuals are required to pay the full cost of their health insurance premium, which was previously subsidised by their employer, plus an administrative fee of up to 2%. Monthly premiums typically range from $400 to $700 per individual, depending on the plan and coverage. However, COBRA can be a good option for those who need continuous health coverage, as it ensures no gaps in coverage.
It is important to note that COBRA coverage is not always the most affordable option, and there may be other alternatives available such as the Health Insurance Marketplace. Individuals can compare the cost of COBRA with Marketplace plans and decide which option suits their needs. If you choose to end your COBRA coverage, you will generally need to wait for the next Open Enrollment period to purchase a Marketplace plan, unless you experience certain life changes that qualify you for a Special Enrollment Period.
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Special Enrollment Period
In the United States, Medicare is the government's health insurance program for retired individuals who cannot take advantage of employer coverage. While eligibility for Medicare is typically linked to age, with most Americans becoming eligible at 65, it is also available to those under 65 with certain disabilities or health conditions. Therefore, if you are 55 years old and have a qualifying disability or health condition, you may be eligible for Medicare.
If you are 55 and do not have a disability or health condition that qualifies you for Medicare, you may need to explore alternative insurance options. One option is to use COBRA, a provision that allows workers and their families to continue utilising their previous group health plan for a limited period after retirement. Another option is to purchase insurance through the Health Insurance Marketplace, where you may find plans with lower monthly premiums and out-of-pocket costs depending on your household size and income.
Now, moving on to Special Enrollment Periods (SEPs), these are periods outside of the yearly Open Enrollment when you can sign up for or change your health insurance plan. SEPs are typically triggered by specific life events or changes in your circumstances. Here are some scenarios that may qualify you for a Special Enrollment Period:
- Loss of qualifying health coverage: If you or anyone in your household has lost or expects to lose health coverage within the past 60 days or the next 60 days, you may qualify for an SEP. This includes losing coverage through an employer or a family member's employer, or losing Medicaid or Children's Health Insurance Program (CHIP) coverage in the past 90 days.
- Gaining a new dependent: If you gain a new dependent due to a child support or court order, you may qualify for an SEP. Coverage can start from the effective date of the court order, even if you enrol up to 60 days afterward.
- Marriage, having or adopting a baby: Life events such as getting married, having a baby, or adopting a child can qualify you for an SEP.
- Moving: Relocating to a different state or territory may trigger an SEP, especially if your previous coverage does not meet the new location's minimum requirements.
- Income changes: If your household income drops below a certain level, you may qualify for an SEP and be eligible for lower-cost coverage.
- Serious medical condition or natural disaster: Facing a serious medical issue, natural disaster, or other emergency that prevented you from enrolling in health insurance during the Open Enrollment Period may qualify you for an SEP.
It is important to note that Special Enrollment Periods are not limited to the scenarios mentioned above, and there may be other complex situations that qualify. Additionally, specific rules and requirements may vary based on your state and the insurance provider. Therefore, it is always advisable to refer to official government websites or consult with a qualified insurance agent or broker for the most accurate and up-to-date information regarding Special Enrollment Periods.
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Health insurance costs at 55
If you are 55 and have retired, you may be eligible for Medicare, the government's health insurance program for retired people, provided that you have certain disabilities or health conditions. However, if you are not eligible for Medicare, you can use COBRA or the Health Insurance Marketplace to obtain health insurance until you turn 65. COBRA is an act that allows workers and their families to continue using the health benefits from their group health plan for a limited period after retirement. On the other hand, the Health Insurance Marketplace offers plans with varying premiums and out-of-pocket costs. For example, Bronze plans typically have the lowest monthly premiums but the highest deductibles, whereas Gold and Platinum plans have higher premiums but lower out-of-pocket costs.
The cost of health insurance in the marketplace differs based on age, income level, plan type, and metal tier. The average monthly health insurance cost for a single 21-year-old is $445, $467 for a single 27-year-old, and $505 for a single 30-year-old. As you age, your health insurance premiums will increase. This is because older people are more likely to develop health conditions and require frequent and costly medical care.
If you are 55 and still working, you can also take advantage of employer-sponsored health insurance policies, which are usually cheaper than marketplace plans. The cost of employer-sponsored health insurance depends on the size of your employer. The average deductible at a small company is $2,543, while the average deductible at a large company is $1,493.
It is important to note that health insurance costs can vary due to economic factors such as inflation and the current market environment. Therefore, it is recommended to compare quotes from multiple health insurance companies to find the most affordable plan for your needs.
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Frequently asked questions
No, you are not eligible for Medicare at 55 unless you have a disability or qualifying medical condition. Most people become eligible for Medicare at 65 due to age.
You can use COBRA or the Health Insurance Marketplace to obtain health insurance. COBRA allows workers and their families to continue using the health benefits from their group health plan for limited periods when certain circumstances arise. With COBRA, employers must provide a temporary extension of coverage in certain situations.
Getting coverage from the Affordable Care Act is usually the best option for health insurance for 55-year-olds. Many retirees also choose to get a part-time job that offers health coverage.
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