Medicare Eligibility

It’s important to know when you become eligible for Medicare and what to do once you qualify. Below you’ll learn everything you need to know about Medicare eligibility, requirement, guidelines, and more.

Who Qualifies for Medicare?

There are three basic criteria that an individual must meet before they can become eligible for Medicare. First, you must be at least 65 or older. Second, you need to be a U.S. citizen or have been a legal resident for five years. Last, you or your spouse must pay at least ten years (40 quarters) of Medicare taxes. This also makes you eligible for Premium-free Part A. However, not everyone needs to be 65 to get Medicare. Medicare is available for people younger than 65 who have certain health conditions and disabilities.

People living with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS) are eligible upon diagnosis. ALS patients get automatic enrollment, whereas ESRD patients must enroll themselves. Those with either disease don’t need to meet the ten-year Medicare tax requirement for premium-free Part A.

Additionally, individuals on Social Security disability, regardless of age, for at least two years are also able to enroll. Premium-free Part A is different for people who receive monthly Social Security or Railroad Retirement Board benefits. They’re not required to file a separate application as long as they get the benefits at least four months before their 65th birthday. Instead, they will automatically get premium-free Part A at 65.

Medicare Eligibility Requirements

There are a few requirements to be eligible for Medicare. As we mentioned above, must pay ten years towards Medicare taxes in order to get premium-free Part A.

Also, if a spouse paid Medicare taxes and you otherwise qualify for Medicare. If you or your spouse didn’t pay Medicare taxes for at least ten years and you’re over the age of 65, you may be able to buy Part A.

Low-income earners may get help paying for Part B. Further, low-income earners could be eligible for Medicare and Medicaid.

High-income earners may pay more for Part B or Part D; this is an Income-Related Monthly Adjustment Amount (IRMAA). Medicare bases the cost on your income from two years ago.

Medicare Disability Eligibility Requirements

At the start of the 25th month that you obtain Social Security Disability checks, you’ll automatically have Medicare. Certain circumstances don’t require patients to wait for 24-months.

Those on disability because of Amyotrophic Lateral Sclerosis automatically start Medicare the same month that disability benefits begin. Medicare isn’t responsible for determining if you qualify for disability; Social Security oversees that decision as they are the ones who administer the checks.

If you have any questions regarding this matter, you should contact your local Social Security Administration office, as they can better assist you.

Do I Automatically Get Medicare When I Turn 65?

Generally, the answer is yes. If you’re receiving Social Security benefits, you’re automatically signed up for Medicare Part A and Part B. Social Security will notify you when it’s time for you to enroll at the beginning of your Initial Enrollment Period.

Medicare Eligibility Verification

When you go to the doctor, the billing department will verify your Medicare eligibility. The billing department will need your full name, Medicare number, gender, and date of birth.

So, when you arrive at the doctors and they request identification, be ready!

FAQs

Who qualifies for Medicare?

You qualify for Medicare once you turn 65 or have been collecting Social Security disability income for 24 months.

When am I eligible for Medicare?

You’re eligible for Medicare once you turn 65 years old. You’re also eligible for Medicare if you’ve been collecting Social Security benefits for 24 months or have been diagnosed with ESRD.

How old do you need to be to get Medicare?

You age into Medicare at 65 years old. Those under 65 are eligible for Medicare as long as they’ve been collecting SSDI for two years.

Who is not eligible for Medicare?

If you aren’t a citizen or legal permanent resident of at least five years, you won’t qualify for Medicare. For premium-free Part A, you must meet minimum work credits of 40 quarters or 10 years.

How do I check my Medicare benefits?

You can check your Medicare benefits online by visiting MyMedicare.gov. Once you create an account, you’ll have full access to your personal information as it relates to Original Medicare benefits.

How long does it take for Medicare to kick in?

Your Medicare starts depending on when you sign up. Many people sign up during their Initial Enrollment Period. Generally, your Medicare coverage starts between one to three months after you enroll.

How long do Medicare benefits last?

For many enrollees, their Medicare coverage lasts up to eight years, as long as their disabling condition still meets Medicare’s requirements. If your condition or health improves, Medicare requires you to report any changes. This ensures that you’re paid on time and correctly. It also determines how long your benefits will last after you return to work.

How can I lose my Medicare eligibility?

You can lose your Medicare benefits only if you get Medicare due to a disability or health problem. Yet, if you received Medicare because of your age, you cannot lose your coverage.

Why would my Medicare be canceled?

There are several reasons why Medicare would cancel your coverage. Examples include moving outside of your plan’s coverage area, Medicare discounting your plan, and not paying your premiums on time.

Will I lose Medicare if I get married?

Generally, if you get married, your coverage will remain the same. Your marital status will not affect your coverage or benefits. (See Medicare & Divorce).

Can I put Medicare on hold?

Typically, you can delay your coverage if you or your spouse have insurance through an employer that has at least 20 employees or more.

What if I don't want Medicare?

Medicare isn’t mandatory. But while you have the option of opting out of Medicare, you may lose benefits, which could result in a penalty fee if you decide to sign up for Medicare in the future.

Can you collect Medicare at 62?

You can only receive Medicare benefits before the age of 65 if you’ve received Social Security Disability Insurance (SSDI) for at least two years.

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How to Learn About Medicare Eligibility

If you have any questions or concerns regarding your eligibility, please contact a Medicare expert. You can reach an expert by calling the phone number above or by filling out the online rate form.