Who Qualifies for Medicare?

FT Contributor  | 

Medicare is a national health insurance program that provides affordable healthcare to people 65 and older. It was started in 1965 when it became increasingly difficult for older Americans to obtain healthcare. Before Medicare, many Americans ages 65 and up had no insurance to cover hospitalization or doctor visits. Today, 15% of the U.S. population is enrolled in Medicare coverage.

People generally qualify for Medicare in three ways: age, disability, and illness. However, there are other eligibility factors for Medicare:

  1. You must be a U.S. citizen or have a residency for at least five years.
  2. A stable U.S. address is required.
  3. You must be a recipient of U.S. health care.
  4. Eligible participants may not be imprisoned or incarcerated, nor may they be contributing to a Health Savings Account.
  5. You or your spouse must have paid Social Security or Medicare taxes.
  6. You have received Social Security Disability Insurance (SSDI) for at least 24 months.
  7. You were diagnosed with end-stage renal disease (ESRD).

Read on to gain a better understanding of the requirements necessary to receive Medicare and the parts you may be eligible for.

Medicare Requirements

Medicare Age Requirement

The typical age is 65, but your coverage begins three months before you turn 65. You may still qualify if you’re under 65 and meet certain requirements:

  1. You have received disability or Social Security benefits for 24 months.
  2. You have end-stage renal disease or amyotrophic lateral sclerosis. If this is the case, you do not have to collect 24 months of disability.

Medicare Disability Requirements

If you are under the age of 65 and enter into your 25th month of Social Security disability benefits, you may qualify for Medicare. You may enroll during the three months leading up to your 25th month of eligibility.

Medicare Eligibility Due to Illness

Certain diseases instantly qualify an individual for Medicare, even if they are under the age of 65. These include:

  1. End-stage renal disease.
  2. Amyotrophic lateral sclerosis.

Medicare Parts Eligibility

There are four types of Medicare that are classified as A through D. A and B are known as Original Medicare and can be enrolled in initially. Each has its own set of requirements to enroll.

Medicare Part A Eligibility

Part A essentially covers any hospital care you might need. To be eligible, you must:

  1. Be collecting retirement benefits from the Social Security Administration or  Railroad Retirement Board.
  2. If you have a disability, you may qualify for Part A before age 65. This includes disability due to end-stage renal disease and amyotrophic lateral sclerosis. Similarly, if you are receiving Social Security benefits for 25 months, you will automatically be enrolled.
  3. You must be either a United States citizen or have been a legal permanent resident for five continuous years.

Medicare Part B Eligibility

Medicare Part B covers health insurance costs. You can have this in conjunction with Medicare Part A or by itself. The eligibility requirements are the same as Part A, as outlined above.

Medicare Part C Eligibility

To enroll in Part C, also called Medicare Advantage, you have to be enrolled in Part A and Part B, and you must meet these additional requirements:

  1. The plan must be available in your area.
  2. You do not have end-stage renal disease.

Medicare Part D Eligibility

Medicare Part D covers prescription drugs. It is also referred to as Medicare Supplement or Medigap. As with Part C, Part D has additional eligibility requirements:

  1. You must be enrolled in Part A and/or Part B.
  2. Enrollment must be completed when you are first eligible for Medicare to avoid a late penalty.

Find out if you’re eligible for Medicare using this calculator.

Enrollment Periods

You cannot just sign up for Medicare whenever. Once you meet the eligibility requirements, you must comply with the government’s enrollment periods. Below is a breakdown of the various enrollment periods that exist for Medicare.

  • Initial enrollment period (IEP): The initial enrollment period (IEP) for Medicare Parts A, B, C, and D establishes the first time you can sign up for Medicare. This can be 3 months prior to your 65th birthday, during your birth month, or 3 months after your 65th birthday.
  • General enrollment period (GEP): General enrollment is for those who missed their IEP. Medicare Parts A and B can be signed up for between January 1 and March 31. Note that coverage will not be effective until July 1 of that year.
  • Special enrollment period (SEP): If you meet specific requirements, you are able to delay your enrollment in Medicare parts A, B, C, and D.
    • If you are covered by your employer or your spouse’s employer, you can delay signing up for Medicare. Sign up can also be delayed during an eight-month gap between the time your employer or union coverage ends, or when unemployment ends.
    • For international volunteers, a delay in applying may be warranted. If you have volunteered time to a nonprofit for at least 12 months, you have six months to apply for Medicare after your volunteering ends.

Understanding the eligibility requirements for Medicare is the first step in choosing the coverage that’s right for you.


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