You qualify for Medicare if you are 65 or older, a U.S. citizen or a permanent legal resident who’s been in the United States for at least five years, have worked 10 years and paid Medicare taxes. You may also qualify if you are younger than 65 but are disabled or have certain medical conditions.
Medicare is best known as a federal health insurance program for people 65 and older. But not everyone will automatically qualify for Medicare benefits when they turn 65.
There are several requirements you have to meet. These include how many years you have paid into the Medicare program, citizenship and immigration status.
Medicare Eligibility at 65 and Older
The year you turn 65, you can apply for Medicare starting three months before your birth month until three months after. You generally have to meet three eligibility requirements to qualify for full Medicare benefits when you turn 65.
The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived at least five years in the United States.
- You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means you’ve worked for at least 10 years. You must also be eligible for Social Security benefits even if you are not yet receiving them.
- You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.
Paying Medicare payroll taxes for 10 full years means you won’t have to pay premiums for Medicare Part A, which covers hospital care.
You don’t need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, or Medicare Part D, which covers prescription drugs. But everyone has to pay premiums for both.
Other Ways to Get Medicare Coverage at Age 65
If you don’t qualify for premium-free Medicare Part A coverage, you may still be eligible to buy coverage.
You still have to be a U.S. citizen or a permanent resident for at least five years.
- You can pay premiums for Medicare Part A hospital insurance. These vary on how long you have worked and paid into Medicare. If you continue working until you’ve totaled 10 years of paying into the system, you won’t have to pay premiums anymore.
- You can pay monthly premiums for Medicare Part B medical services insurance. You’ll pay the same premiums as anyone else enrolled in Part B.
- You can pay monthly premiums for Medicare Part D prescription drug coverage. This is the same as anyone else would pay depending on the plan you choose.
Medicare Eligibility If You Are Under 65
People younger than 65 may qualify for Medicare if they have certain costly medical conditions or disabilities.
- You have been receiving Social Security disability benefits for at least 24 months. These do not need to be consecutive months.
- You have end-stage renal disease requiring dialysis or a kidney transplant. You qualify if you or your spouse has paid Social Security taxes for a specified period of time based on your age.
- You have amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. You qualify for Medicare immediately upon diagnosis.
- You receive a disability pension from the Railroad Retirement Board and meet certain other criteria.
Who Is Eligible for Medicare Advantage Plans
You’ll automatically qualify for Medicare Advantage (Part C) once you qualify for Part A and Part B coverage. Advantage plans are sold by private companies to cover some of the out-of-pocket costs Medicare does not cover.
Medicare Advantage Eligibility Requirements
- You must be a U.S. citizen, U.S. national or lawfully present in the United States.
- You must be enrolled in Medicare Parts A and B.
- You have to live in the Medicare Advantage plan provider’s service area.
- You must not have end-stage renal disease (ESRD).
While regular Medicare Advantage does not cover ESRD, you may qualify for a Medicare Special Needs Plan. SNPs are special types of Advantage plans specifically designed for a particular condition or financial situation.
You can keep your Medicare Advantage plan if you purchased it before developing ESRD. And you can buy an Advantage plan after being medically determined to no longer have ESRD — usually from a successful kidney transplant.
Medicare Supplement Plan Eligibility
Medicare supplemental insurance, often called Medigap because it fills in the out-of-pocket coverage gaps in Medicare Parts A and B, is purchased from private insurers.
Medigap helps cover copayments, coinsurance and deductibles from Medicare Part A and Part B.
- You must be 65 or older.
- You have been diagnosed with Lou Gehrig’s disease.
- You have been receiving Social Security or Railroad Board disability payments for 24 months.
- You must have been diagnosed with end-stage renal disease, requiring regular dialysis or a kidney transplant.
You cannot enroll in a Medicare Advantage plan and a Medigap plan at the same time. You have to choose one or the other.
When to Enroll in Medigap
You may only purchase Medicare Supplement Insurance during your open enrollment period. This is a six-month period immediately following your 65th birthday and only after you have enrolled in Medicare Part B.
The enrollment period cannot be changed or repeated. Once the enrollment period ends, you may no longer be able to enroll in a Medigap policy. If you are able, it may cost you more.
Medigap insurers are not allowed to charge you more for a policy if you have pre-existing conditions and cannot ask you about your family medical history.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2019, November 15). Original Medicare (Part and B) Eligibility and Enrollment. Retrieved from https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol
- U.S. Centers for Medicare & Medicaid Services. (2019, September). Understanding Medicare Advantage Plans. Retrieved from https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
- U.S. Department of Health and Human Services. (2014, September 11). Who Is Eligible for Medicare? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Eligibility & Premium Calculator. Retrieved from https://www.medicare.gov/eligibilitypremiumcalc/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
- U.S. Centers for Medicare & Medicaid Services. (n.d.). When Can I Buy Medigap? Retrieved from https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap