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Who Qualifies

Medicare Eligibility Explained

Most people become eligible for Medicare at 65, and some qualify earlier. Here is a clear look at who qualifies, when coverage can start, and what to do next.

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Eligibility

Ways You May Qualify for Medicare

You generally must be a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five continuous years.

Age 65 or older

Most people qualify when they turn 65.

Disability benefits

People under 65 who have received Social Security or certain Railroad Retirement disability benefits for 24 months.

End-Stage Renal Disease

People of any age with permanent kidney failure requiring dialysis or a transplant.

ALS

People with ALS (Lou Gehrig’s disease) usually qualify as soon as disability benefits begin.

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Costs

Will You Pay a Premium for Part A?

Most people do not pay a monthly premium for Part A. You generally qualify for premium-free Part A if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters).

If you have fewer work credits, you may still be able to buy Part A. Part B has a standard monthly premium that most people pay, and higher-income beneficiaries may pay more.

Premium and deductible amounts are set each year by CMS. You can find current figures on Medicare.gov, or ask one of our agents.

Signing Up

Will You Be Enrolled Automatically?

Some people are enrolled in Parts A and B automatically, while others need to sign up through Social Security.

  • Automatic enrollmentIf you already receive Social Security or Railroad Retirement benefits before 65, you are usually enrolled automatically and receive your card in the mail.
  • Manual enrollmentIf you are not yet receiving benefits, you typically sign up through Social Security online, by phone, or at a local office.
  • Still working at 65?If you have coverage through your own or your spouse’s current employer, you may be able to delay Part B without a penalty. Rules depend on employer size.
Your situationWhat typically happens
Receiving Social Security at least 4 months before 65 Automatically enrolled in Parts A and B
Not yet receiving Social Security Sign up through Social Security during your Initial Enrollment Period
Under 65 with disability benefits Automatically enrolled after 24 months of benefits
ESRD Sign up through Social Security
ALS Automatically enrolled when disability benefits begin

General information only. Your situation may differ. Contact Social Security or a licensed agent for guidance.

Getting Ready

Preparing for Your Medicare Eligibility

A few months before you become eligible, these steps can help you feel prepared.

  1. Mark your Initial Enrollment Period

    It is a 7-month window: the 3 months before, the month of, and the 3 months after the month you turn 65.

  2. Review any current coverage

    Find out how your employer, union, or retiree coverage works with Medicare.

  3. Gather your information

    List your doctors, prescriptions, and preferred pharmacies.

  4. Compare your options

    Decide whether Original Medicare with Medigap and Part D, or a Medicare Advantage plan, suits you best.

See Enrollment Periods

Next Steps

Keep Learning

Enrollment Periods When you can sign up for or change coverage.
Medicare Advantage An all-in-one alternative to Original Medicare.
Medicare Supplement Help paying costs Original Medicare does not.

Questions

Medicare Questions, Answered

Still have questions?

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Medicare is the federal health insurance program for people 65 and older, as well as some younger people with certain disabilities, End-Stage Renal Disease (ESRD), or ALS. It is made up of several parts that cover hospital care, medical services, and prescription drugs. Many people also add private coverage to help with costs Medicare does not fully pay.

Medicare Advantage, also called Part C, is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare. These plans cover everything Parts A and B cover (except hospice, which Original Medicare still covers), and many include prescription drug coverage and extra benefits such as dental or vision. Plans usually use provider networks, and costs and benefits vary by plan and location.

A Medicare Supplement plan, also known as Medigap, is a private insurance policy that works alongside Original Medicare. It helps pay some of the costs Original Medicare does not, such as deductibles, coinsurance, and copayments. Medigap plans do not include prescription drug coverage, so many people pair them with a Part D plan.

Medicare Part D is prescription drug coverage offered by private insurers approved by Medicare. You can get it as a stand-alone plan that works with Original Medicare, or as part of a Medicare Advantage plan. Each plan has its own list of covered drugs, so it is important to check that your medications are included.

Most people first enroll during their Initial Enrollment Period, a 7-month window that includes the 3 months before, the month of, and the 3 months after the month they turn 65. After that, you can make changes during the Annual Enrollment Period from October 15 to December 7, or during a Special Enrollment Period if you have a qualifying life event. Enrolling late in some parts may result in penalties.

Yes, during certain times of the year. The Annual Enrollment Period (October 15 to December 7) lets you join, switch, or drop Medicare Advantage and Part D plans, and the Medicare Advantage Open Enrollment Period (January 1 to March 31) lets Advantage members make one change. You may also qualify for a Special Enrollment Period after events like moving or losing other coverage.

Turning 65 Soon?

Get Clear Answers About Your Medicare Timeline

A licensed agent can help you understand your eligibility, your enrollment window, and the coverage choices available to you.

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