Medicare Eligibility


Reaching Medicare eligibility can be confusing. Understanding when you become eligible for Medicare and what to do once you are eligible is essential for seniors. Below, you’ll learn everything you need to know about Medicare eligibility, requirements, and more.

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Who Qualifies For Medicare?

To qualify for Medicare, you must typically be at least 65 years old and a U.S. citizen or have legal residency in the U.S. for at least five years. Those younger than 65 and collecting Social Security Disability for at least 24 months are also eligible, as well as those diagnosed with End Stage Renal Disease (ESRD) requiring a kidney transplant or dialysis, or those diagnosed with amyotrophic lateral sclerosis (ALS).

Medicare Eligibility Age Chart

Medicare Eligibility Requirements for Under 65 Medicare Eligibility Requirements for 65+
You are a citizen of the U.S. or a legal resident for at least five years AND:
  • have been diagnosed with ALS or ESRD
  • OR
  • received Social Security Disability checks for at least 24 months
You are a citizen of the U.S. or a legal resident for at least five years AND:
  • paid Medicare taxes for at least 40 working quarters (10 years), so you qualify for premium-free Medicare Part A.
  • OR
  • paid Medicare taxes for fewer than 40 working quarters, so you will pay a monthly premium for Medicare Part A.

Medicare Disability Eligibility Requirements

Typically, you will automatically become enrolled in Medicare at the start of the 25th month that you collect Social Security Disability checks. However, certain circumstances do not require patients to wait for 24 months.

Those on disability because of ALS automatically start Medicare the same month that disability benefits begin. Medicare isn’t responsible for determining if you qualify for disability. Social Security oversees that decision, as they administer the SSDI checks.

If you become eligible for Medicare due to an end-stage renal disease (ESRD) diagnosis, you will need to enroll yourself in Medicare. You can do so by contacting your local Social Security Administration office.

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Premium-Free Medicare Part A Eligibility

Premium-Free Medicare Part A Eligibility Requirements
Many people believe Medicare is free, but in reality, only Medicare Part A hospital coverage doesn’t include a monthly premium if you or your spouse qualify. You or your spouse must have paid Medicare taxes for at least 40 quarters or ten years to be eligible. If not, you will need to buy into Medicare Part A according to how many quarters you have worked.

Your eligibility for premium-free Medicare Part A is found on your ssa.gov account. This will tell you how many eligible working quarters you have paid Medicare taxes – determining your Medicare Part A premium cost.

Medicare Part B Eligibility

If you do not meet the requirements for Medicare under 65, you will become eligible for Medicare Part B when you reach 65 years of age. Additionally, you must be a resident of the U.S. for at least five years to qualify for Original Medicare (Medicare Part A and Part B).

Unlike Medicare Part A, Medicare Part B involves a monthly premium for everyone who enrolls. This premium is dependent upon the adjusted gross income of the beneficiary.

Low-income earners may qualify for help paying their premium. Further, low-income earners could be eligible for Medicare and Medicaid.

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High-income earners, however, may pay more for Medicare Part B and Medicare Part D. This increase in premiums is known as the Income-Related Monthly Adjustment Amount (IRMAA) and is based on your income from two years prior to the current year.

Medicare Part D Eligibility

As of 2006, anyone who has Medicare Part A and Medicare Part B, regardless of health conditions, prescription drug usage, or income, is eligible for prescription drug coverage. The only Part D eligibility requirement is to reside in the service area for the plan in which you wish to enroll.

Medigap and Medicare Advantage Eligibility Requirements

Once you are eligible for Medicare Part A and Part B, you will automatically be eligible for Medigap and Medicare Advantage plans. Private insurance companies offer these plans to provide additional coverage to Original Medicare.

When enrolling in Medicare Advantage plans, you must do so during specific enrollment periods. Likewise, with a Medigap plan, you must apply during your Open Enrollment Period to avoid underwriting health questions.

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FAQs

How do I check my Medicare benefits?
You can check your Medicare benefits online by visiting MyMedicare.gov. Once you create an account, you’ll have full access to your personal information as it relates to Original Medicare benefits.
How long does it take for Medicare to kick in?
Your Medicare starts depending on when you sign up. Many people sign up during their Initial Enrollment Period. Generally, your Medicare coverage starts between one to three months after you enroll.
How long do Medicare benefits last?
When you’re over 65, your Medicare benefits last for as long as you pay your premiums. For enrollees under 65, Medicare coverage lasts as long as your disabling condition still meets Medicare’s requirements. If you return to work, you can keep your Medicare coverage for at least 8.5 years if their condition still qualifies you.
How can I lose my Medicare eligibility?
You can lose your Medicare benefits only if you’re eligible due to disability and you no longer receive SSDI. Yet, if you received Medicare because of your age, you can only lose coverage due to nonpayment of premiums.
Can I put Medicare on hold?
You can safely delay your coverage if you or your spouse have insurance through an employer with a sufficient number of employees. Otherwise, you’ll need to pay a penalty.
What if I don't want Medicare?
Medicare isn’t mandatory. But while you have the option of opting out of Medicare, it could result in a penalty fee if you decide to sign up for Medicare in the future.
Can you collect Medicare at 62?
You can only receive Medicare benefits before the age of 65 if you’ve received Social Security Disability Insurance (SSDI) for at least two years or have a diagnosis of ALS or ESRD.

How to Learn About Medicare Eligibility

If you have any questions or concerns regarding your eligibility, please contact a Medicare expert. You can reach a licensed agent to learn more about your coverage options by calling the phone number above or filling out our online rate form.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

2 thoughts on “Medicare Eligibility

  1. I will be turning 65 later this year. My wife still works and I have medical insurance thru her. What medicare coverage do I need? I also started collecting Social Security at 62. What will happen when I turn 65? Do I need to enroll in Medicare? Do I need a supplement or can my wife’s Medical Insurance cover that?
    Not as easy as I thought it would be…

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