Medicare Eligibility

While the Medicare program is most commonly known as a health care insurance program for seniors 65 and over, it also covers some people who are younger than 65 who qualify. If you are looking for information about whether you are eligible for Medicare or not, we can help you figure out what options you have and when you will qualify for Medicare benefits.

Eligibility requirements for people who are turning 65

Everyone is eligible for Medicare at the age of 65 if they meet the following requirements:

• They must be either a U.S. citizen or a permanent (legal) resident living in the country for at least five years.
• The beneficiary or the spouse must have worked and paid Medicare taxes for at least 40 quarters. This is equivalent to 10 years. 
• Or, if the beneficiary or spouse worked in a government position and paid Medicare payroll taxes during employment for at least 10 years.

If you are collecting Social Security or Railroad Retirement Board (RRB) retirement benefits at the time you turn 65, the Social Security Administration (SSA) automatically enrolls you in Medicare Part A (hospital insurance) and Part B (medical insurance). 

If the SSA automatically enrolls you in Original Medicare Parts A and B, you can change your coverage to a Medicare Advantage (Part C) plan during your Initial Enrollment Period. You can also opt-out of Medicare Part B during this enrollment period, but if you decide to enroll again later, you may pay a penalty unless you are dropping out to enroll in a primary health insurance plan offered by an employer.  

To qualify for premium-free Medicare Part A you must have paid Medicare withholding taxes for at least 40 quarters.

If you, or your spouse, hasn’t met this requirement but still wish to get Medicare Part A, you must pay a monthly premium based on the number of quarters you worked and paid taxes. You must also meet the citizenship or residency requirements.

Eligibility requirements for people who are under 65

The Medicare program allows people who are under 65 years old to enroll in Medicare if they fulfill any of the following qualifications:

• They have been getting Social Security disability benefits for at least 24 months. These don’t have to be consecutive months.
• The beneficiary has end-stage renal disease that requires being on dialysis or getting a kidney transplant. Eligibility also requires that the beneficiary or the spouse has paid Social Security taxes for an amount of time that is based on the age of the beneficiary.
• If the beneficiary has amyotrophic lateral sclerosis – Lou Gehrig’s disease – they can begin receiving Medicare benefits as soon as they are diagnosed. 
• They get Railroad Retirement Board disability benefits and fulfill other conditions.

Eligibility requirements for Medicare Advantage

Once you qualify for Original Medicare Parts A and B, you automatically qualify for Medicare Part C (Medicare Advantage). These types of plans are sold by private insurance companies as an alternative to Original Medicare. You must fulfill the following eligibility requirements before you can enroll in a Part C plan: 

• You must be a U.S. citizen, national, or living lawfully in the country.
• You must be currently enrolled in Original Medicare Parts A and B.
• You must be living in the service area covered by the insurance provider selling the Medicare Advantage plan.

Eligibility requirements for Medicare Supplement insurance

When you are enrolled in Original Medicare Part B and turn 65, you will enter a 6-month initial enrollment period during which you’ll be eligible to buy any Medigap, also known as Medicare Supplement, plan sold in your state. If you wait until this period ends to purchase a Medigap plan, you may be subject to medical underwriting and could be charged more or even refused coverage due to pre-existing conditions.