Medicare Eligibility: When Do You Qualify?
Most people qualify for Medicare coverage when they turn 65 years old. You may also be eligible if you are younger than age 65 and have a qualifying disability.
Who Qualifies for Medicare Coverage?
You qualify to apply for Medicare coverage if you fall within one of these two groups of individuals:
- You are age 65 (or you are turning 65 in the next three months – more on that below)
- You are under age 65 and have a qualifying disability
Medicare Eligibility at Age 65
The large majority of Medicare recipients become eligible for coverage when they turn 65 years of age. However, these two requirements are also necessary in order to qualify for Medicare coverage:
- 1. You must be a United States citizen or a legal permanent resident who has lived in the country for a minimum of five years. Providing a valid social security number or proof of residency satisfies this requirement.
- 2. You or your spouse must have worked and paid taxes for enough years to earn your place in the Medicare program. This requirement works out to roughly ten years. (Hint: if your work history qualifies you to receive Social Security or railroad retirement benefits, you should also qualify for Original Medicare.)
If you want your Medicare coverage to begin as soon as you turn 65, enroll during the three months prior to your birthday month. Your Medicare health plan will begin the first day of your birthday month.
Medicare Eligibility Due to Disability (Under Age 65)
You also qualify for Medicare if you are under the age of 65 and meet any of the following conditions:
- you have received disability benefits from the Socal Security Administration (SSA) for at least 24 months (those months don’t need to be consecutive).
- you have received disability benefits from the Railroad Retirement Board (RRB). Note: there are other requirements involved to satisfy this condition.
- you have been diagnosed with end-stage renal disease (ESRD) / permanent kidney failure requiring dialysis or a kidney transplant (and you or your spouse have met the work requirements of payment into the Medicare system).
- you have been diagnosed with Lou Gehrig’s Disease (amyotrophic lateral sclerosis). Medicare eligibility is immediate under this condition.
Once you have verified that you are eligible for Medicare coverage (or will be soon), it is important to understand the various parts of Medicare, what they cover, and when you become eligible for each.
Medicare Part A: Eligibility & Coverage
When Do You Qualify for Medicare Part A?
You become eligible for Medicare Part A when you turn 65 years old, or meet the disability requirements listed above.
What Does Medicare Part A Cover?
- Inpatient hospital care
- Skilled nursing facility care
- Inpatient skilled nursing home care (excludes custodial or long-term care)
- Hospice care
- Home health care
If you or your spouse have paid Medicare taxes for the required 10 years, you will likely qualify for “premium-free” Part A. This means you may acquire Medicare Part A free of charge. (If you do not qualify under these circumstances, you may still be able to purchase Part A at a premium – subject to other requirements.)
Medicare Part B: Eligibility & Coverage
When Do You Qualify for Medicare Part B?
You become eligible for Medicare Part B when you turn 65 years old, or meet the disability requirements listed above.
What Does Medicare Part B Cover?
- Doctor visits
- Emergency room services
- Laboratory work
- Preventative health visits
- Imaging and diagnostic services
- Outpatient services beyond those listed here
Medicare Part C: Eligibility & Coverage
Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans (Part C) are purchased from a private insurance company and replace your Medicare Part A (hospital coverage), Part B (outpatient coverage), and usually include prescription drug coverage (Part D).
When Do You Qualify for Medicare Part C?
You become eligible for Medicare Part B when you turn 65 years old, or meet the disability requirements listed above. You must be enrolled in Part A and Part B in order to purchase a Part C (or Medicare Advantage) plan.
What Does Medicare Part C Cover?
- All services covered under Part A
- All services covered under Part B
- Prescription drugs (in most cases; varies by insurance carrier and plan)
- May offer wellness programs, dental care, vision care, and hearing care (varies by insurance carrier and plan)
Medicare Part D: Eligibility & Coverage
Medicare Part D can be purchased as a stand-alone policy from a private insurance company, or it may be bundled into a Medicare Advantage (Part C) plan (which replaces your Part A, Part B, and Part D coverage).
When Do You Qualify for Medicare Part D?
You become eligible for Medicare Part D when you turn 65 years old, or meet the disability requirements listed above. You must also be enrolled in Medicare Part A and Part B to enroll in Part D.
What Does Medicare Part D Cover?
- Outpatient prescription drugs
When Do I Enroll in Medicare?
Now that you have verified your eligibility for Medicare, you can determine when to enroll. Continue this way for more information on enrollment periods for Medicare.
Ready to Learn More?
Choosing the right Medicare Plan is not a decision that should be taken lightly. With Policy Guide’s assistance, you will have access to the knowledge and expertise of professional agents who can help you compare different health plans, prices, and policies to ensure that you make an informed decision. Let us guide you through this process, so that your chosen plan best suits your needs.
- Medicare Eligibility & Enrollment
- Initial Enrollment Period for Medicare
- How to Enroll in Medicare
- Late Enrollment Penalties for Medicare