Medicare Eligibility

Not everyone is eligible for Medicare. As we will find out together on this page, there are certain conditions an individual can meet before they can be considered eligible for Medicare.

Medicare Eligibility Age

Contrary to popular belief, the retirement age does not count for Medicare eligibility. Anyone who is 65 years old qualifies for Medicare, whether they are still working or not when they turn 65.

What are the requirements for Medicare eligibility?

For people aged 65 or older.

Any U.S. citizen or a permanent legal resident who has been in the country for not less than five years will be eligible for Medicare, provided:

–           they are receiving Railroad Retirement or Social Security benefits; or

–           they have worked for the number of years required for such benefits without receiving them.

Likewise, U. S. citizens, or permanent legal residents who have lived in the country for at least five years, will qualify for full Medicare benefits if they (or their spouses) are government retirees or employees.  However, such government employees or retirees must have paid Medicare payroll taxes during service.

For people below the age of 65.

American citizens who are younger than 65 will be eligible for full Medicare benefits if:

They are permanently disabled.

Permanently disabled Americans who have been entitled to or receiving Social Security disability benefits for not less than 24 months, not necessarily consecutive, are eligible for Medicare. Such individuals are automatically enrolled in Medicare Parts A and B on the 25th month of their disability benefits.

They are receiving a disability pension.

Americans below age 65 who have been receiving beneficiaries of disability pension from the Railroad Retirement Board and meet other important requirements are eligible for Medicare.

They have Lou Gehrig’s disease.

People under age 65 but living with Lou Gehrig’s disease or amyotrophic lateral sclerosis (ALS) are eligible for Medicare Parts A and B. Such potential beneficiaries are automatically enrolled on the first day of the month they start receiving disability benefits – the enrollment is immediate.

They have permanent kidney failure.

Americans with end-stage renal diseases (ESRD), which needs regular dialysis or kidney transplant, are eligible for Medicare. However, they (or their spouse) must be eligible for, or already getting, the Railroad Retirement Board or Social Security benefits or worked under the Railroad Retirement Board, Social Security, or the government.

They are also qualified if they are a spouse or dependent of an eligible beneficiary for Railroad Retirement or Social Security benefits.

Now, let’s discuss eligibility for each Medicare Parts

Medicare Eligibility By Parts

Who is eligible for Medicare Part A?

If anyone (or their spouse) has worked legally for at least ten years in the United States and is aged 65, they are eligible for Medicare Part A. Such potential beneficiaries must have paid taxes towards their Part A hospital benefits, which exempts them from paying premiums on eligibility.

Americans age 65, but yet to meet the 10-year working period requirement, can buy Medicare Part A for around $400 every month. The premium may be lower if they have worked over 30 but less than 40 quarters.

Enrollment is automatic after the 65th birthday, provided the potential beneficiary is enrolled in Social Security home benefits.

Who is eligible for Medicare Part B?

Americans age 65 are eligible for Medicare Part B. However, Part B is not free – it attracts a monthly premium. If the potential beneficiary still has active health insurance through their employer, they can maintain that and postpone their Part B enrollment.

Who is eligible for Medicare Part C?

Medicare Part C or Medicare Advantage program is open to Americans who want their benefits to come through a private insurance company rather than Original Medicare. This may come with Part D coverage as an add-on in some cases.

The prerequisite for Medicare Part C is an existing enrollment in both Parts A and B and being a resident in the plan’s service area.

NB – Enrolling in Medicare Advantage does not exempt beneficiaries from Medicare Part B premiums. The enrollment in Medicare Parts A and B must be maintained to keep the Medicare Advantage plan active.

Who is eligible for Medicare Part D?

Anyone who is actively enrolled in either Medicare Part A or Part B is automatically eligible for Part D, provided they live in the plan’s service area.  Unlike Medicare Part A, Part D is not compulsory. However, it is best to enroll if there is no drug coverage in place to prevent paying expensive medication costs out of your pocket.

Enrolling in Medicare Part D or having a creditable substitute coverage will also exempt you from the late enrollments that come with future enrollment.

When can an eligible beneficiary enroll in Medicare?

Eligible beneficiaries are automatically enrolled at age 65 or enroll manually within the 7-month Initial Enrollment Period. For details, visit our Medicare Enrollment page.

What is the right age to apply for Medicare?

Anyone who meets every other requirement but age can apply for Medicare when they are age 64. The enrollment period is three months before their 65th birthday month.

Is Medicare enrollment compulsory?

While it is not compulsory to sign up for Medicare at age 65, there will be penalties for delaying enrollment if the potentially eligible beneficiary does not have creditable health coverage.

NB – An enrollment into Social Security income benefits automatically enrolls you into Medicare Part A.

Have any more questions on Medicare eligibility?

Ask the experts

Are you struggling to determine your eligibility for Medicare? Or you have questions on Medicare eligibility that need adequate answers? Contact us today via phone or email. Our experts are always willing and ready to discuss your Medicare needs and concerns. We are here to help.