Medicare Eligibility

Tamera Jackson by Tamera Jackson | Licensed since 2007

This article was updated on: 05/28/2019

Medicare eligibility: Understanding who is eligible for Medicare

Medicare coverage is not available to everyone. To receive benefits under this federal insurance program, you have to meet Medicare eligibility requirements.

What does it mean to be eligible for Medicare?

Some people might confuse two types of Medicare eligibility: eligibility for Medicare, and eligibility for premium-free Medicare Part A. How you qualify for Medicare is described below. How you qualify for premium-free Part A is described later on.

Age 65 or older: who is eligible for Medicare? 

If you are age 65 or older, you are generally eligible to receive Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) if you are a United States citizen or a permanent legal resident who has lived in the U.S. for at least five years in a row.

Younger than age 65:  who is eligible for Medicare? 

As long as you meet the citizenship/legal residence requirements described above, you may be eligible for Medicare when you are younger than age 65 if one of the following circumstances applies to you:

  • You have been receiving Social Security disability benefits for at least 24 months in a row
  • You have Lou Gehrig’s disease (amyotrophic lateral sclerosis)
  • You have permanent kidney failure requiring regular dialysis or a kidney transplant. This condition is called end-stage renal disease (ESRD).

Read more details about enrollment in Medicare when you’re under 65.

Who is eligible for premium-free Medicare Part A?

There’s a monthly premium for Medicare Part A. You generally don’t have to pay a Part A premium if either of these applies to you:

  • You or your spouse worked long enough (40 quarters or 10 years) while paying Medicare taxes
  • You or your spouse had Medicare-covered government employment or retiree who has paid Medicare payroll taxes while working but has not paid into Social Security.

Normally, you pay a monthly premium for Medicare Part B, no matter how many years you’ve worked. Read more about the Part A and Part B premiums.

How do you receive your Medicare benefits when you meet Medicare eligibility requirements at age 65?

If you meet Medicare eligibility requirements and you have received Social Security benefits for at least four months prior to turning age 65, you will typically get Medicare Part A and Part B automatically the first day of the month you turn age 65.

If you’re not enrolled in Original Medicare (Part A and Part B) automatically, you may need to file an application with the Social Security Administration.  You can enroll in Medicare Part A and Part B during the period that begins three months before your 65th birthday month, includes your birthday month and ends three months after your birthday month.

Note: You have a choice if you want to keep or refuse enrollment in Medicare Part B. If you refuse it, you don’t lose your Medicare Part B eligibility.  However, you may have to wait for a valid enrollment period before you can enroll. You may also have to pay a late enrollment penalty for as long as you have Medicare Part B coverage.

How do you receive your Medicare benefits when you meet Medicare eligibility requirements for people younger than age 65?

  • If you receive Social Security benefits for 24 months, usually you will automatically be enrolled in Medicare Part A and Part B at the beginning of the 25th month.
  • If you have Lou Gehrig’s disease, usually you will automatically be enrolled in Medicare Part A and Part B as soon as you receive the first month of Social Security disability benefits.
  • If you have ESRD, you might be eligible for Medicare but you must apply for Medicare benefits by visiting your local Social Security office or contacting Social Security (1-800-772-1213 (TTY users 1-800-325-0778) from 7AM – 7PM Monday – Friday, all U.S. time zones. Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. (This waiting period will start even if you haven’t signed up for Medicare yet.)

Are you unsure whether you meet Medicare eligibility requirements? Contact me. I will be happy to help you.

  • You can use the links below to reach me or have me send you customized information through an email.

If you wish to learn more about some of the Medicare plans where you live, use the Compare Plans button on this page.

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