Medicare Eligibility

Summary: It is essential to know exactly when you become eligible for Medicare to avoid any late enrollment penalties. Medicare eligibility can be confusing, so it is important to fully understand the criteria and know when you become eligible. Estimated Read Time: 6 min

Reaching Medicare eligibility can be confusing. Thus, understanding when you reach Medicare eligibility and what to do once you are eligible is essential. Below, you will learn everything you need to know about Medicare eligibility, requirements, and qualifications.

Eligibility for Medicare

To be eligible for Medicare, you must meet specific criteria set by the Centers for Medicare and Medicaid Services. These criteria include:

• You must be a legal resident of the U.S. for at least five years.
• You must be age 65
• If under 65 you must have certain diagnoses, or receive Social Security Disability for at least 24 months.

Once you become eligible for Medicare, you are able to enroll in Medicare Part A, Part B, Part C (or a Medicare Supplement plan), and Medicare Part D. Each part of Medicare offers you unique benefits that make up your health insurance coverage.

Who Qualifies for Medicare?

Medicare eligibility is simple. Once you meet the age or disability requirements, you will automatically qualify for health coverage through Medicare if you are a U.S. citizen or have legal residency in the U.S. for at least five years.

Also eligible for Medicare are those younger than 65, collecting Social Security Disability Income (SSDI) benefits for at least 24 months, individuals with diagnoses of end-stage renal disease (ESRD) who require a kidney transplant or dialysis, and those with amyotrophic lateral sclerosis (ALS).

Medicare Age Eligibility

Generally, you must be at least 65 years old to be eligible for Original Medicare (Part A and Part B). However, there are certain circumstances where those under age 65 on disability can enroll in the federal healthcare program.

If you are not yet 65, you may become eligible for Medicare based on your disability status. If you receive Social Security Disability Income (SSDI) checks for at least 24 months, you qualify for Original Medicare.

When are You Eligible for Medicare?

You become eligible for Medicare if you are:

• 65 years of age or older
• A U.S. citizen or permanent legal resident who has lived in the U.S. for at least five consecutive years

However, there are some other circumstances in which you may be eligible for Medicare regardless of age, such as:

• You have been receiving Social Security Disability Insurance (SSDI) for at least two years.
• You have end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS).

If you are eligible for Medicare based on age or disability, you can enroll in Medicare during the Initial Enrollment Period (IEP), which is the seven-month period that begins three months before your 65th birthday month and ends three months after your birthday month. If you miss your IEP, you may be able to enroll during the General Enrollment Period (GEP), which is from January 1 to March 31 each year. However, there may be penalties for late enrollment, so it’s important to enroll in Medicare during your Initial Enrollment Period if possible.

Medicare Age Eligibility Chart

The Medicare eligibility age chart below reviews the qualifications, requirements, and eligibility age.

What is the Maximum Income to Qualify for Medicare?

Income is not a factor in Medicare eligibility. You are entitled to coverage if you meet the basic Medicare eligibility requirements.

However, your income will affect how much you pay for coverage. If you are a high earner with an annual income over a specific limit, you will be responsible for additional premiums due to IRMAA. This amount applies to Medicare Part B and Medicare Part D prescription drug plans.

You may become eligible for low-income subsidies, Medicaid, and Medicare Savings Programs if your monthly income is below a certain threshold. These programs offer financial assistance to those on Medicare with low incomes to ensure coverage.

Medicare Part A Eligibility Requirements

Many believe Medicare is free, but only Medicare Part A hospital coverage does not include a monthly premium – if you or your spouse qualify.

To be eligible, you or your spouse must have paid Medicare taxes for at least 40 quarters or ten years. If not, you will need to buy into Medicare Part A according to how many working quarters you paid the tax.

Your premium-free Medicare Part A eligibility status is available through your SSA.gov account. There, you can see how many eligible working quarters you paid Medicare taxes– determining your Medicare Part A premium cost.

Medicare Part B Eligibility Requirements

If you do not qualify for Medicare before you turn 65, you will meet Medicare eligibility requirements for Medicare Part B on your 65th birthday. Additionally, you must be a citizen or legal resident of the U.S. for at least five years to qualify for Original Medicare.

Unlike Medicare Part A, Medicare Part B eligibility requires a monthly premium from beneficiaries, regardless of how many quarters you pay Medicare taxes while working. This premium depends on your modified adjusted gross income (MAGI) from two years prior.

High-income earners must pay an IRMAA. Those with low incomes may qualify for help paying their premiums. Furthermore, low-income earners could be eligible for Medicare and Medicaid – the latter of which is on the state level.

Medicare Disability Eligibility Requirements

Typically, you will automatically enroll in Medicare at the start of your 25th month of collecting Social Security Disability Income (SSDI) benefit checks. However, certain circumstances do not require patients to wait for 24 months.

Those on disability because of ALS automatically start Medicare the same month their disability benefits begin. Medicare is not responsible for determining whether you qualify due to disability. The Social Security Administration oversees that decision, as they administer your SSDI checks.

If you reach Medicare eligibility due to an end-stage renal disease (ESRD) diagnosis, you must enroll yourself in Medicare. You can do so by contacting your local SSA office or completing the process online.

Can You Get Medicare if You Have Never Worked?

If you have never worked, you are still eligible for Medicare when you turn 65 – if you are a U.S. citizen or legal resident of at least five years. However, you may not qualify for premium-free or reduced-premium Medicare Part A if you do not have a spouse who qualifies.

Fortunately, Medicare qualifications don’t require you to have worked in the U.S. The only perk of having enough working years in the U.S. is the potential to reduce your Medicare Part A premium. Thus, if you did not work in the U.S., you must cover the Medicare Part A premium out-of-pocket each month.

How to Learn About Medicare Eligibility

Understanding if you are eligible for Medicare is the first step to gaining Medicare health coverage. If you have questions or concerns regarding your eligibility, contact a licensed Medicare agent who can help review your plan options and guide you in the right direction regarding coverage. To get a quote for supplemental Medicare coverage, fill out our online rate form.

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