Medicare Eligibility

Free Plan Comparison
Compare Quotes From
Top Companies and Save

In the United States, Medicare is a federal health insurance program for people aged 65 or older and suffering from End-Stage Renal Disease. With the exception of a few individual Medicare benefits, this plan has no dollar limit as long as services are medically necessary. The purpose of this article is to explain the eligibility, requirements, and enrollment of Medicare.

Eligibility for Medicare Based on Age and Disease

When you turn 65 or within three months of turning 65, you are eligible to enroll in Medicare. There are different requirements for people under or over 65 years of age.

Medicare Eligibility If You Are Under 65

Medicare is available to people under 65 if they meet the following criteria:

  • Social Security disability benefits have been paid to you for at least 24 months, and/or
  • Dialysis or a kidney transplant are required if you have End-Stage Renal Disease.

It is not necessary to receive Social Security Disability Insurance (SSDI) benefits consecutively. In the Social Security Administration (SSA), disability benefits are counted as one month each.

Medicare qualifies you for coverage if you have previously received these types of disability benefits:

  • If more than 60 months have passed since the worker was terminated, or
  • Disabled widows, disabled widowers, or childhood disability benefits must be terminated within 84 months.

You will automatically be counted in the 24 months if your previous disability benefits include the same or are directly related to your current disability impairment.

Eligibility for Medicare at 65 and older

You must fall into the following categories if you are 65 years of age or older to qualify for full Medicare coverage:

  • You must either be a US citizen or a permanent resident for five years in order to qualify.
  • If you've worked for at least ten full years without collecting Social Security or railroad retirement benefits, or
  • Your spouse and you pay Medicare payroll taxes while employed, but you did not pay Social Security taxes.

If you pay Medicare payroll taxes for ten years, Medicare Part A, which covers hospital services, will be free. In addition to Medicare Part B, which covers outpatient care, and Medicare Part D, which covers prescription drugs, you won't need to earn work credits to qualify.

Amyotrophic Lateral Sclerosis (ALS) and Lou Gehrig's Disease Special Rule

A person with Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's disease is eligible for Medicare Part A. The first month they receive disability benefits from Social Security or Railroad Retirement Board, they are covered under Part A. There is no waiting period.

Benefits for disabled children under a special rule

Child disability benefits are only available to individuals with ALS at 18 years of age, according to the Social Security Administration (SSA). In the absence of ALS, people with child disability benefits are only eligible for Medicare Part A at the age of 20.

Eligibility for Medicare Supplement Plans

You must pay copayments, coinsurance, and deductibles before you can claim Medicare Part A and Part B benefits. In order to cover these gaps in coverage, you may want to consider a Medicare Supplement Plan, also known as Medigap.

Medigap insurance is also offered by private insurers, just like Medicare Advantage.

Medicare Advantage Plans: Who Is Eligible?

ESRD is not covered by regular Medicare Advantage, but you may be eligible for a Medicare Special Needs Plan (SNP). SNPs are Advantage plans designed to meet the specific needs of a particular condition or financial situation. If you purchased your Medicare Advantage plan before developing ESRD, you can keep it.

To know more about Medicare Supplement Plans, click here.

Medicare Enrollment

There is a Social Security office locator on the agency's website if you wish to enroll in Medicare. Medicare Part A and Part B will be enrolled for you by the Social Security Administration. 

The Social Security Administration (SSA) estimates that enrolling online takes less than 10 minutes. MySocial Security accounts must be created.Creating an account requires preparing identity questions for verification, your mobile phone number, your credit card, and W-2s.

Review Medicare’s checklist here.

If you are automatically eligible for Medicare, you will receive your Medicare card two to three months before your 65th birthday. After applying for Medicare, you'll usually receive your card in three weeks to one month.

If you don't plan to retire right away, you can also apply for Medicare. There are certain times of the year when enrollment will be available, however.

Medicare Initial Enrollment Periods

Initial enrollment may be opened three months before or three months after your 65th birthday. You will be covered as soon as you turn 65 if you enroll three months before your birthday. If you enroll three months later, the same rule applies. 

Medicare Special Enrollment Periods

Special Enrollment Periods are available if you missed the Initial Enrollment Period. The following are examples of Medicare Special Enrollment Qualifying Events:

  • If you move outside the coverage area of your current Medicare Advantage plan,
  • In the event that you are leaving your employer's health plan,
  • You will no longer be able to receive Medicare Advantage services from your current provider

The bottom line

For US citizens 65 and older, as well as those with End-Stage Renal Disease (ESRD) and Lou Gehrig's disease or ALS, Medicare is available. It takes around 10 minutes to enroll online with minimal requirements. A Medicare Supplement Plan can also help with copayments, coinsurance, and deductibles.