Medicare Eligibility: Age 65 and Other Ways to Qualify
Most people qualify for Medicare when they turn 65.
You can also get Medicare regardless of your age if you have Lou Gehrig's disease (ALS), kidney failure (end-stage renal disease) or if you've been on disability payments for at least two years.
Medicare eligibility requirements
You can qualify for Medicare by turning 65 or if you have certain health conditions that qualify. In addition, you may need to meet other eligibility requirements, such as being a U.S. citizen or permanent resident.
Medicare eligibility by age
Medicare eligibility by health condition
- Age 65 or older
- U.S. citizen or permanent resident for at least five years in a row
- Must have paid Medicare taxes for at least 10 years to get Medicare Part A for free
- Original Medicare (Parts A and B) available nationwide
- Medicare Advantage, Medigap and Part D plan availability varies by area
Medicare eligibility by age
- Age 65 or older
- U.S. citizen or permanent resident for at least five years in a row
- Must have paid Medicare taxes for at least 10 years to get Medicare Part A for free
- Original Medicare (Parts A and B) available nationwide
- Medicare Advantage, Medigap and Part D plan availability varies by area
Medicare eligibility by health condition
- U.S. citizen or permanent resident for at least five years in a row
- Meets disability or medical requirements
- None for those with a disability who automatically get free Medicare Part A, but those with ESRD have a work requirement
- Original Medicare (Parts A and B) available nationwide
- Medicare Advantage, Medigap and Part D plan availability varies by area
You can sign up for Medicare up to three months before and three months after the month when you turn 65. This is called your initial enrollment period. If you miss your initial enrollment period and you qualify for a special enrollment period , you'll have to wait until Medicare general enrollment which runs from Jan. 1 to March 31.
If you qualify for Medicare because of a disability or medical condition, your coverage will usually begin two years after you start getting disability benefits. However, there's no waiting period if you have Lou Gehrig's disease (ALS). Coverage for kidney failure (end-stage renal disease) usually begins within the first four months, and in some cases immediately, of the start of treatment.
If you don't qualify for Medicare and still need health insurance, you may be eligible for:
- A health insurance marketplace plan: Anyone can buy these plans. People who earn a low income may qualify for discounts.
- Medicaid/ CHIP: Health insurance for those with low incomes
Medicare eligibility at age 65
Nearly all seniors in the U.S. will become eligible for Medicare at age 65.
Additional rules can affect how much you pay and how you get your coverage. But at age 65, you'll usually qualify for Medicare benefits.
Most people will need to apply for Medicare through the Social Security Administration. But you're automatically enrolled in Medicare if you've had Social Security benefits for at least four months before turning 65.
Whether or not you want to start getting Medicare benefits right away, it's important to enroll in Medicare when you turn 65 to avoid any late enrollment penalties.
The Medicare initial enrollment period is the seven months around your 65th birthday. It starts three months before you turn 65, includes your birthday month and ends three months after your birthday month.
Medicare Eligibility Calculator
Calculate your initial seven-month Medicare enrollment period by entering your date of birth.
Birth date
Your initial enrollment period based on your age is
Note that your enrollment period may differ if you currently have a disability or have certain medical conditions.
Medicare eligibility age chart
Medicare eligibility always happens when you turn 65. However, the age requirement for retirement benefits from Social Security varies. You can start getting partial retirement benefits at age 62.
The full retirement age is between 66 and 67 years old, depending on what year you were born. That means you'll qualify for Medicare for one to two years before you start getting full retirement benefits.
Birth year | Medicare eligibility | Full Social Security eligibility |
|---|---|---|
| 1957 | 2022 | 2023 |
| 1958 | 2023 | 2024 |
| 1959 | 2024 | 2025 |
| 1960 | 2025 | 2027 |
| 1961 | 2026 | 2028 |
Disability or medical requirements
People under 65 can qualify for Medicare through a disability or medical condition. Your Medicare plan will cover the same comprehensive health benefits that are offered to seniors. In other words, coverage isn't limited to your qualifying condition.
Qualifying through kidney failure (end-stage renal disease)
You must meet two conditions to qualify for Medicare with end-stage renal disease.
- You need regular dialysis or have had a kidney transplant
- You, a spouse or a family member have paid Medicare taxes for at least 10 years.
Coverage begins four months after starting dialysis or when you're admitted to a hospital for a kidney transplant.
Medicare uses the same eligibility rules for deciding who gets disability benefits as the Social Security Administration. If you qualify for the Social Security Disability Insurance (SSDI) program, you would also be eligible for Medicare before age 65.
After you start getting disability benefits, there is usually a two-year waiting period before Medicare coverage starts. During this time, you may be eligible for other types of health insurance such as coverage through a former employer, a health insurance marketplace plan or Medicaid.
There are two exceptions to when coverage begins:
- If you have Lou Gehrig's disease (ALS), you can get Medicare coverage without a waiting period.
- Disability benefits through Social Security cannot begin before age 18. That means that the earliest you can get Medicare because of a disability is age 20, or age 18 if you have ALS.
If you qualify for Medicare because of a disability, you're eligible for free Medicare Part A without meeting any work requirements. You can remain covered for more than eight and a half years after returning to work as long as you continue to meet the disability requirements. After that, you may have to start paying for Medicare Part A.
Citizenship and residency requirements
You need to be a U.S. citizen living in the U.S. to qualify for Medicare in most cases.
You can also qualify for Medicare if you're a permanent U.S. resident who has been living in the U.S. for five continuous years before you apply for Medicare.
Work history requirements
You're eligible to enroll in the Medicare program without meeting any work requirements. However, the work history of you and your family can affect whether you have to pay for Medicare Part A.
For seniors age 65 and older, you'll be eligible for free Part A if you also qualify for retirement benefits from Social Security or the Railroad Retirement Board. This usually means you've worked for at least 10 years to earn 40 Social Security credits. You can qualify based on your own work history or the history of a spouse.
- If you or your spouse worked less than 10 years, you may need to pay for Medicare Part A, which costs between $278 to $505 per month.
- If you earned less than $6,920 per year when working, you may need a longer work period to earn enough credits to qualify for free Part A.
- Government employees who paid the Medicare portion of FICA when working are eligible for free Medicare Part A, even though they may not be eligible for other Social Security benefits.
Nearly all enrollees qualify for free Medicare Part A. These free benefits are paid for with Medicare taxes, which cover 89% of the funding for Medicare Part A.
Your income does not affect your Medicare eligibility. But, you can dual-enroll in both Medicare and Medicaid if you have a low income, which will lower what you pay for medical care.
Location restrictions
The parts of Medicare that are run directly by the government (Parts A and B) are available everywhere in the country. But that's not the case with the other parts of Medicare that are offered by private insurance companies.
For Medicare Advantage, Medigap and Medicare Part D, you're only eligible for the specific plans offered in your area. Your eligibility to enroll in these plans depends on where you live. Someone in a neighboring county may have access to different plans than you.
If you have multiple homes, you'll only be eligible for the plans sold in the ZIP code of your primary residence. However, it's important to check that the plan will offer coverage in other locations where you regularly spend time.
Most Medicare Advantage plans will have coverage restrictions based on the company's network of doctors and hospitals. You'll have a little more flexibility with a Medicare Advantage PPO plan because they have some coverage for out-of-network health care. Keep in mind that you'll pay more for these services.
You should choose a Medigap plan with Original Medicare (Parts A and B) if flexibility is a high priority for you. Although you'll probably pay more with Medigap, you can see 99% of doctors nationwide with it. You also don't need a referral to see a specialist.
Frequently asked questions
How do you know if you’re eligible for Medicare?
Most people become eligible for Medicare when they turn 65. You can also qualify with certain medical conditions such as End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS). Finally, you're eligible for Medicare if you've gotten Social Security Disability payments for at least two years.
How old do you have to be to get Medicare?
You become eligible for Medicare at age 65. This is earlier than the full retirement benefit eligibility through Social Security, which happens at age 66 or 67 for most people. However, if you're younger than age 65, you can become eligible for Medicare if you have a disability or qualifying medical condition.
Do you automatically qualify for Medicare when you turn 65?
Most people need to apply for Medicare through the Social Security Administration when they turn 65. However, you're automatically enrolled in Medicare at age 65 if you've been getting Social Security benefits for at least four months before your 65th birthday.
Can you get Medicare if you never worked?
Yes, you're eligible for Medicare regardless of your work history. However, for seniors, your work history may determine whether you have to pay for Medicare Part A or if those benefits are free because you paid Medicare taxes.
What happens if I miss my Medicare enrollment?
If you miss your initial enrollment period, you can still sign up for Medicare, but you could face late enrollment penalties. Anyone can sign up during the Medicare general enrollment period, which happens from Jan. 1 to March 31 each year. If you meet the qualifying circumstances, you can sign up at any time through a Medicare special enrollment period.
Sources
Medicare rates and eligibility requirements came from Medicare.gov, the Centers for Medicare and Medicaid (CMS) and the Social Security Administration (SSA).
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