Who is Eligible for Medicare?
Written by True Tamplin, BSc, CEPF®
Updated on March 30, 2021
Not everyone is eligible for Medicare.
If you want to collect benefits under this federal insurance program, you will have to meet certain eligibility requirements.
And what does Medicare eligibility mean?
Many people confuse being eligible for Medicare with being eligible for Medicare Part A, which are two separate things.
In general, Medicare is offered to people who are at least 65 years old, or are disabled.
If you are at least age 65, you are usually able to receive Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
You have to be a citizen of the U.S. or else a permanent legal resident who has lived here for at least five years in a row.
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Medicare Benefits Requirements
If you are under age 65, then you can still receive Medicare benefits if you fall into one of the following categories:
- You have been collecting Social Security Disability Benefits for at least the past 2 years, uninterrupted
- You have Lou Gehrig’s Disease
- You have end stage Renal Disease, which means that you either have permanent kidney failure that requires regular dialysis or will require a kidney transplant
If you or your spouse are 65 or older and did not pay Medicare taxes during your working years, you may be able to buy Part A if you are a U.S. citizen or permanent resident.
If you are eligible for Medicare Part A, then you won’t have pay a monthly premium if you fall into one of these two categories:
- Either you or your spouse has worked at least 40 quarters and paid Medicare taxes for the duration, or you are receiving benefits from either Social Security or the Railroad Retirement Board
- You or your spouse paid Medicare taxes on your earnings but did not pay into Social Security
If you meet all of the other eligibility requirements for Medicare and you have collected Social Security benefits for at least the previous four months before turning age 65, then you will generally receive Medicare benefits (Parts A and B) during the first month of the year that you turn 65.
If you’re not automatically enrolled in Medicare Parts A and B, then you’ll probably have to file an application with the Social Security Administration.
You can enroll in both programs during the seven months surrounding your 65th birthday, three months before and three months after plus of course the actual month of your birthday.
If you are younger than 65 and meet all other Medicare eligibility requirements, then you can qualify for benefits under the following circumstances:
- If you have collected Social Security retirement benefits for at least 24 consecutive months, then you will automatically be enrolled in Parts A and B in the 25th month.
- If you have Lou Gehrig’s Disease, then you’ll be automatically enrolled in both Parts A and B during the first month that you collect a Social Security disability benefit.
- If you have end stage renal disease, then you’ll have to apply directly for Medicare by contacting the Social Security Administration directly, either by phone or in person at one of their locations. Medicare coverage generally starts on the first day of the fourth month in which you receive dialysis treatments.
Everyone who receives Medicare coverage is eligible for prescription drug coverage, regardless of income, age, health status or prescription drug use.