Who Is Eligible for Medicare?

Medicare is usually available to US citizens (and long-term residents) who are 65 and older, people under 65 who qualify for Social Security Disability Insurance, and people with ALS (Lou Gehrig's disease) or End-Stage Renal Disease (ESRD). However, eligibility requirements do vary depending on which type of coverage you choose. Keep reading to learn more.

Who Is Eligible for Medicare Coverage?

The normal eligibility age for Medicare is 65, but if you have ALS, ESRD, or receive Social Security Disability Insurance benefits, you may be eligible at a younger age.

There are three main groups of people who qualify for Medicare coverage:

  • US citizens who are at least 65 years old (and permanent residents who’ve lived here continuously for five years)
  • People with disabilities who are receiving Social Security disability benefits
  • People who have ALS (Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD)

If you have more general questions about Medicare, visit our About Medicare page to learn the basics.

 

Medicare Eligibility for People over Age 65

If you’re age 65 and older, you qualify for Medicare under the following conditions:

  • You qualify for Social Security retirement benefits, or you already receive Social Security retirement benefits.

If you don’t qualify for Social Security retirement benefits, you are still eligible for Medicare under the following conditions:

  • You are a US citizen.
  • You are a permanent resident of the US and have lived here continuously for at least five years.

 

Medicare Eligibility for People under Age 65

If you’re younger than 65, you still qualify for Medicare under the following conditions:

  • You have a disability, and you have received Social Security Disability Insurance for at least 24 months.
  • You have ALS, and your Social Security Disability Insurance has gone into effect.

If you have End-Stage Renal Disease, your Medicare eligibility depends on a variety of conditions, including when you apply for Medicare and what kind of treatment you need.

If you have more questions about your eligibility for Medicare, check here.

 

Eligibility Breakdown: Part A through D

Original Medicare Eligibility—Parts A and B

Medicare Parts A and B are considered Original Medicare. Eligibility requirements are similar for both, but costs differ. Once again, the normal Medicare age for eligibility is 65, but there are exceptions.

Part A Medicare Eligibility | Hospital Insurance

To be eligible for Part A Medicare you must be a US citizen or a permanent resident who has lived in the US continuously for at least five years.

You also have to meet one of the following conditions:

  • Be 65 or older
  • Have a disability that qualifies for Social Security Disability Insurance
  • Have End-Stage Renal Disease

Will you have to pay for Medicare Part A?

Medicare part A is usually free for people over age 65 if they or their spouses have been employed in the US for at least 40 employment quarters (about 10 years).

If you don’t meet the work requirement, you can still get Medicare Part A, but you’ll need to pay a premium.

When are you eligible for Medicare Part A?

  • You are eligible for Part A coverage once you turn 65. If you’re automatically enrolled, your card will arrive approximately three months before your birthday. If you aren’t automatically enrolled, your Initial Enrollment Period begins three months before you turn 65.
  • If you’re under 65 but qualify for Social Security Disability Insurance (SSDI), you become eligible for Medicare Part A once you’ve received SSDI benefits for 24 months. You are normally automatically enrolled and can expect your card about three months before your 25th month of SSDI benefits.
  • If you have ALS (Lou Gehrig’s disease), you are eligible for Medicare Part A the same month that your SSDI benefits begin.

 

Part B Medicare Eligibility | Medical Insurance

Eligibility requirements for Part B Medicare coverage are the same as the eligibility requirements for Part A:

  • You are a US citizen who is 65 or older.
  • You are a permanent US resident who is 65 or older and has lived in the US continuously for five years.
  • You qualify for Social Security Disability Insurance benefits.
  • You have End-Stage Renal Disease.

Will you have to pay for Medicare Part B?

Yes. Medicare Part B is not free. However, your premium is usually lower if you’ve met the work requirements (working at least 40 quarters, or about 10 years).

 

Part C Medicare Eligibility | Medicare Advantage Plans

Medicare Advantage Plans are offered by private insurance companies that contract with Medicare. These plans bundle Part A and B Medicare coverage with additional coverage.

In order to qualify for a Medicare Advantage Plan, you must meet the following conditions:

  • Be recently eligible for Part A and B coverage or already be enrolled in Part A and B coverage
  • Live in an area covered by your plan

If you have End-Stage Renal Disease, you cannot qualify for a Medicare Advantage Plan.

 

Part D Medicare Eligibility | Prescription Drug Coverage

Part D Medicare coverage is offered by private insurance companies. It can add prescription drug coverage to Original Medicare Plans (Part A and B) or to a Medicare Advantage Plan (Part C).

In order to qualify for Part D Medicare, you must be eligible for Part A and B Medicare coverage.

 

How to Enroll in Medicare

Your enrollment process will depend on your work history and what type of Medicare coverage you choose.

 

How to Enroll in Original Medicare (Parts A and B)

If you already qualify for Social Security retirement benefits four months before you turn 65, you will likely be automatically enrolled in Original Medicare as your 65th birthday approaches. In that case, you’ll get your Medicare card about three months before you turn 65.

If you aren’t automatically enrolled, you’ll need to sign up for Medicare during designated enrollment periods. Your Initial Enrollment Period begins three months before the month you turn 65. That period lasts seven months.

There are three ways to sign up for Medicare Part A and B:

Visit our Medicare Enrollment page for more details about Medicare enrollment.

 

How to Sign Up for Medicare Advantage and Prescription Drug Coverage

Medicare Advantage and Prescription Drug Plans can give you more coverage and insurance benefits. This coverage is offered through private insurance companies that work with Medicare. If you want Part C or Part D Medicare, you’ll need to contact your chosen insurance company directly or speak with a Medicare agent.

 

Find the Right Medicare Coverage

Finding the best coverage for your needs can be difficult when there are so many rules and so many options. If you need help finding a plan, contact a Medicare agent who can help you navigate your options.

Get help from an agent in your area

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