How Do I Qualify for Medicare?

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 10/20/2018

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If you’re new to the health-care program, you may have questions about how to qualify for Medicare and when to sign up. There may be certain citizenship, residency, or age requirements that affect whether you qualify for Medicare. Here’s how it works.

How to qualify for Medicare

In general, you may qualify for Original Medicare, Part A and Part B, if you’re 65 or older and either a United States citizen or a permanent resident of at least five continuous years.

If you’re under 65 and disabled, you may also qualify for Medicare if you’ve received Social Security Administration (SSA) disability benefits, or certain Railroad Retirement Board (RRB) disability benefits for at least two years. You may qualify for Medicare without the two-year waiting period if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

How to qualify for Medicare because of disability or ESRD

After you’ve received disability benefits for two years, you’ll typically continue to qualify for Medicare as long as you meet Social Security’s definition of disabled. But you could lose your eligibility if:

  • Your health gets better so that you no longer meet the SSA definition of disability.
  • You choose to go back to work.

Similarly, if you qualify for Medicare solely because of ESRD, your benefits end:

  • One year after the month you end dialysis.
  • 36 months after the month you get a kidney transplant.

Your Medicare benefits can start again in certain situations.

Qualifying for premium-free Medicare

You may qualify for Medicare Part A without a premium if you or your spouse worked at least 10 years (40 quarters) under Medicare-covered employment and paid taxes. If you haven’t worked enough quarters to get premium-free Part A, you may have to pay for coverage.

Remember, your work history affects whether you pay a premium for Part A, not whether you qualify for Medicare. And when it comes to Part B, most people pay a premium, regardless of how long they worked.

Qualifying for Medicare if you’re a permanent resident

As mentioned, you may qualify for Medicare coverage if you’re a lawfully admitted permanent resident who has lived in the U.S. for at least five continuous years. This means that if there was a break during your stay when you lived outside of the country, those years don’t count towards the qualifying five-year period. Once you meet the residency requirements and have lived in the U.S. for five straight years, you may be eligible to apply for Medicare the following month.

Learn more about how to qualify for Medicare if you’re a green card holder.

How incarceration affects whether you qualify for Medicare

According to the Centers for Medicare & Medicaid (CMS), you’re “incarcerated” if:

  • You’re in police custody and either in prison or jail, or
  • You’re in a mental health institution because you committed a crime.

Incarceration doesn’t affect your eligibility, whether you qualified for Medicare while you were incarcerated or before you went to prison. However, you may not be able to use your Medicare benefits, since the prison usually provides health services.  You’ll need to keep paying your Part A (if applicable) and Part B premiums while you’re incarcerated, or you could lose your coverage.

If you’re about to qualify for Medicare, it’s never too soon to start thinking about your options. I can tell you more if you like. To get started, use the links below to set up a phone appointment or have me email you plan options that may interest you. You can also easily browse from home: simply click the Compare Plans button to view plan options in your zip code.

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