Medicare Eligibility

Medicare Eligibility

Medicare is a federal health insurance program for Americans aged 65 and older. It also covers some younger people under certain circumstances. Signing up for Medicare is easy. But first, you must be eligible to receive benefits. Performing a Medicare eligibility check is the first step you should take before trying to enroll.

Who is eligible for Medicare?

When determining Medicare eligibility, it’s important to understand that Original Medicare has two parts:

• Part A (Hospital Insurance): Part A covers the cost of inpatient hospital care, skilled nursing facility care, hospice, and related costs.
• Part B (Medical Insurance). Part B covers outpatient care like doctor visits as well as the costs associated with home health care and durable medical equipment.

To qualify for Medicare Parts A and B the following criteria must be met. 

Citizenship 

• You must be a United States citizen OR 
• You must be a permanent resident of the United States for at least 5 consecutive years.  

Age 

Most people are eligible for Medicare when they reach the age of 65. If you are under 65, you may qualify for benefits if you have certain disabilities that prevent you from working.

What disabilities qualify for Medicare under 65?

If you are over 18 and under age 65, you may qualify for Medicare benefits if you:

• Have received Social Security disability benefits (SSDI) for at least 2 years, OR 
• Have been diagnosed with Lou Gehrig’s Disease, also called Amyotrophic Lateral Sclerosis (ALS), AND
  • Are starting to get Social Security disability. Usually, you can get Medicare the 6th month after Social Security found that your disability started, OR 
• Have been diagnosed with End-Stage Renal Disease, sometimes called ESRD, AND
  • Have been on dialysis for 3 months OR 
  • Have had a kidney transplant. 

Who is not eligible for Medicare?

You are not eligible for Medicare if:

• You are in the U.S. on a visa.
• You are not a U.S. citizen or permanent legal resident (even if you’re married to one).

Generally, Medicare is available for people aged 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

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

To find out if you are eligible and your expected premium, go to the Medicare.gov eligibility tool.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

• You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
• You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Prescription Drug Coverage

Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage. For more information, you may wish to visit the Prescription Drug Coverage site.

If you are receiving Social Security benefits before turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday or your 25th month of disability. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday.

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