Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment, and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

• You have received Social Security or Railroad Retirement
• Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.

Medicare options

Medicare beneficiaries can choose from several options to access Medicare coverage. The first choice is between Medicare Advantage plans, where coverage is provided via private health insurance companies, or Original Medicare, where benefits are provided directly by the federal government. Medicare beneficiaries also have options around Medigap policies (which cover out-of-pocket costs under Original Medicare) and Medicare Part D (coverage for prescription drugs).

Original Medicare includes Medicare Parts A and B. Medicare Part A (also called hospital insurance) helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center. Medicare Part B (also called medical insurance) helps pay for outpatient care like a visit to a doctor (or nurse practitioner or physician assistant) and preventive healthcare service, such as most vaccinations).

Medicare Advantage includes all the basic coverage of Medicare Parts A and B, and these plans generally include additional benefits — such as integrated Part D prescription drug coverage and extras like dental and vision — for a single monthly premium.

There are pros and cons to Original Medicare and Medicare Advantage plans, and the right solution is different for each person.

Medicare enrollment periods

Medicare Advantage enrollment is available when a person is initially eligible for Medicare, but there’s also an annual enrollment window each fall (October 15 – December 7) when Medicare beneficiaries can select a different Medicare Advantage plan or switch between Medicare Advantage and Original Medicare. There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.