Medicare Eligibility

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

Who Qualifies For Medicare?

Medicare eligibility is simple. Typically, you must be at least 65 years old, and a U.S. citizen or have legal residency in the U.S. for at least five years.

Those younger than 65 and collecting Social Security Disability Income (SSDI) benefits for at least 24 months are also eligible. Lastly, those diagnosed with end-stage renal disease (ESRD) who require a kidney transplant or dialysis and those with an amyotrophic lateral sclerosis (ALS) diagnosis also meet the requirements for Medicare eligibility.

Medicare Eligibility Age Chart

Medicare Eligibility Requirements for Under 65

Medicare Eligibility Requirements for 65+

You are a citizen of the U.S. or a legal resident for at least five years AND:

have been diagnosed with ALS or ESRD.
OR
received Social Security Disability checks for at least 24 months.

You are a citizen of the U.S. or a legal resident for at least five years AND:

paid Medicare taxes for at least 40 working quarters (10 years), so you qualify for premium-free Medicare Part A.
OR
paid Medicare taxes for fewer than 40 working quarters, so you will pay a monthly premium for Medicare Part A.

Is Medicare Eligibility Based on Income?

Medicare eligibility is not based on income. As long as you meet the basic Medicare eligibility requirements, you are entitled to coverage.

However, your income will affect how much you pay for coverage. If you are a high earner and have an annual income over a specific limit, you will be responsible for additional premiums due to IRMAA.

If you receive a monthly income below certain thresholds, you may become eligible for programs like low-income subsidies, Medicaid, and Medicare Savings Programs. These programs offer financial assistance to those on Medicare with low incomes to ensure coverage regardless of income.

Premium-Free Medicare Part A Eligibility

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

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

You can find your eligibility status for premium-free Medicare Part A on your SSA.gov account. There, you can see how many eligible working quarters you have paid Medicare taxes – determining your Medicare Part A premium cost.

Medicare Disability Eligibility Requirements

Typically, you will automatically enroll in Medicare at the start of your 25^th month of collecting Social Security Disability (SSDI) 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 that disability benefits begin. Medicare is not responsible for determining if you qualify due to disability. Social Security 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 Social Security Administration office.

Medicare Part B Eligibility

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

Unlike Medicare Part A, Medicare Part B involves a monthly premium for all beneficiaries, regardless of the years they pay into Medicare taxes. This premium is dependent upon the adjusted gross income of the beneficiary.

Low-income earners may qualify for help paying their premiums. Further, low-income earners could be eligible for Medicare and Medicaid.

High-income earners, however, may pay more for Medicare Part B and Medicare Part D. This increase in premiums is due to the Income-Related Monthly Adjustment Amount (IRMAA). Your income from two years before the current year determines your IRMAA bracket and, thus, your monthly premium.

Medicare Part D Eligibility

As of 2006, anyone eligible for Medicare Part A or Medicare Part B, regardless of health conditions, prescription drug usage, or income, is eligible for prescription drug coverage through Medicare Part D. The only Medicare Part D eligibility requirement is that you must reside in the service area for the plan in which you wish to enroll.

Medigap Eligibility Requirements

You become eligible for a Medicare Supplement (Medigap) plan when you reach Medicare eligibility. To enroll in a Medigap plan, you must first have Medicare Part A and Part B.

Private insurance companies offer Medicare Supplement plans. So, after you enroll in Original Medicare, you will need to choose a Medicare Supplement plan option and find a carrier offering your Medigap plan choice.

When you reach Medicare eligibility, it is essential to know which Medigap plan is best for you. Once you are eligible for Medicare, your Medicare Supplement Open Enrollment period begins. This enrollment period is the best time to sign up for a Medigap plan.

Medicare Advantage Eligibility Requirements

Once you are eligible for Medicare Part A and Part B, you will automatically qualify for Medicare Advantage plans. Like Original Medicare, Medicare Advantage plans have specific enrollment periods by which you must abide.

If you decide to enroll in a Medicare Supplement plan, you are not eligible for a Medicare Advantage plan and vice versa. You can only have one plan at a time. Thus, once you reach Medicare eligibility, it is vital to understand which plan type will be best for your needs.

FAQs

How do I check my Medicare benefits?

You can check your Medicare benefits online by visiting MyMedicare.gov. Once you create an account, you will have full access to your personal information about your 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.

Can I get Medicare if I have never worked?

If you have never worked, you are still eligible for Medicare when you turn 65 – as long as 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.

How can I lose my Medicare eligibility?

You can lose your Medicare benefits only if you are eligible due to disability and no longer receive SSDI. Yet, if you receive Medicare because of your age, you can only lose coverage due to premium nonpayment.

Can I put Medicare on hold?

You can safely delay your coverage if you or your spouse have insurance through an employer with a sufficient number of employees. Otherwise, you will need to pay a penalty.

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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 a licensed agent to learn more about your coverage options by calling the phone number above or filling out our online rate form.

Sources:

Original Medicare Eligibility and Enrollment, CMS. Accessed April 2022.
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol
Who is Eligible for Medicare, HHS. Accessed April 2022.
https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
Understanding Medicare Part C and D, Medicare. Accessed April 2022.
https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

2 thoughts on “Medicare Eligibility”

Jagger Esch says:

March 7, 2022 at 2:35 pm

Tom, when turning 65, most people enroll in Medicare Part A and Medicare part B. If you decide to delay Part B due to your wife’s coverage, you must ensure it is credible group coverage, so you do not incur a late enrollment penalty.

Tom says:

February 9, 2022 at 6:49 pm

I will be turning 65 later this year. My wife still works and I have medical insurance thru her. What medicare coverage do I need? I also started collecting Social Security at 62. What will happen when I turn 65? Do I need to enroll in Medicare? Do I need a supplement or can my wife’s Medical Insurance cover that?
Not as easy as I thought it would be…