Medicare enrollment and the Affordable Care Act

Frank – Texas: I turn 65 in November of this year, and I understand that I need to sign up for Medicare then. However, for 40 years, I worked as a volunteer missionary (no salary, but expenses provided), so that means my paid work history is minimal. I’ve been working now for six years and plan to continue. I should be eligible for Social Security and Medicare coverage when I’m 69. (Even then, I plan to continue working.) What are my health insurance options after I reach 65? At the moment, I’m on an Affordable Care Act (ACA) plan. Do I need to enroll in Medicare at 65, even if I receive little or no coverage? Or will the coverage be so minimal that I should stick with my high-premium ACA package — and is that even possible after 65?

Phil Moeller: Frank, you qualify for an exception to the general rule that people without group employer health coverage must sign up for Medicare when they turn 65. Because you have not worked the required quarters (40) at jobs where Social Security payroll taxes were deducted from your wages, you do not qualify for premium-free Part A Medicare, which covers hospital expenses. The premiums for this coverage may exceed $400 each month. However, people 65 and older who do not qualify for premium-free Part A may continue to get their health coverage through an Affordable Care Act state insurance exchange. When you amass enough quarters of work, you will have to get Medicare. You did not mention whether you were married, but if you are, you would qualify for premium-free Part A if your spouse had enough quarters of Social Security coverage. This rule also applies to divorced spouses, by the way, assuming the couple was married at least 10 years and the spouse wishing to qualify for premium-free Part A has not remarried.