Medicare Eligibility: Age 65 and Other Ways to Qualify

Medicare Eligibility: Age 65 and Other Ways to Qualify

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You become eligible for Medicare at age 65, or beforehand through a disability or medical condition.

In addition, there are other eligibility restrictions based on citizenship, type of Medicare plan, where you live and your work history.

Remember that income does not affect your eligibility for Medicare. But those who have a low income can be dual-enrolled in both Medicare and Medicaid, which can further reduce your medical expenses.

Medicare eligibility by age
Medicare eligibility by health condition
Main eligibility requirement
Age 65 or older
Meets disability or medical requirements
U.S. citizen or residency requirements
Yes
Yes
Work history requirements
None for enrollment, but there are requirements to determine if you're eligible for free Medicare Part A
None for those with a disability who automatically get free Medicare Part A, but those with ESRD have a work requirement
Location restrictions
No restriction for Parts A and B, but for other Medcare parts, you're only eligible for the plans offered in your area
No restriction for Parts A and B, but for other Medcare parts, you're only eligible for the plans offered in your area

If you qualify for Medicare by age, your initial enrollment period starts three months before your birthday month and ends three months after your birthday month.

If you qualify for Medicare because of a disability or medical condition, your coverage will usually begin two years after you start receiving disability benefits. However, this waiting period varies, and there's no waiting period for those with conditions such as End-Stage Renal Disease (ESRD) or Lou Gehrig's disease (ALS).

If you don't qualify for Medicare and still need health insurance, you may be eligible for:

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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 be eligible to start receiving health insurance benefits through the Medicare program.

Most people will need to apply for Medicare through the Social Security Administration. But if you've been getting Social Security benefits for at least four months before you turn 65, you'll automatically be enrolled in Medicare Parts A and B.

When qualifying for Medicare by age, timing is important.

Whether or not you want to start receiving Medicare benefits right away, it's important to take action on 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 your 65th birthday, includes your birthday month and ends three months after your birthday month.

Enter your birthday below to find out when you should sign up for Medicare.

Medicare Eligibility Calculator

Calculate your initial seven month Medicare enrollment period by entering your date of birth.

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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 receiving partial retirement benefits at age 62, and the full retirement age is between 66 and 67 years old, depending on what year you were born. So as you can see in the Medicare eligibility chart below, you'll qualify for Medicare one to two years before you start getting full retirement benefits.

Birth year
What year you’ll be eligible for Medicare
What year you qualify for full retirement benefits through Social Security
195720222023
195820232024
195920242025
196020252027
196120262028
Show All Rows

Disability or medical requirements

Those who are under 65 can qualify for Medicare through a disability or medical condition. Even though your eligibility is based on a certain condition, your Medicare plan will cover the same comprehensive health benefits that are offered to seniors.

Eligibility for Medicare
When you'll get coverage
Qualifying through a disability
  • Based on Social Security’s determination of disability
Usually a waiting period of two years after you start receiving disability benefits.
Qualifying through a disability (ALS only)No waiting period, and you can get Medicare as soon as you start receiving disability benefits.
Qualifying through ESRD
  • Your kidneys no longer work
  • You need regular dialysis or have had a kidney transplant
  • You meet the work requirements
Must meet all three conditions
Coverage begins four months after starting dialysis or when you're admitted to a hospital for a kidney transplant.

Medicare uses the same eligibility criteria for determining 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 receiving disability benefits, there is usually a two-year waiting period before you can start receiving health coverage through Medicare. 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), a 2015 policy change allows you to get Medicare coverage immediately after becoming eligible for disability benefits, without a waiting period.
  • For those under age 18, 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 premium-free Medicare Part A without meeting any work requirements. And as long as you continue to meet the disability requirements, you can remain covered for more than eight years after returning to work. After that, you may have to start paying for Medicare Part A.

Those who qualify for Medicare because of ESRD must meet both the health criteria and the work requirements for themselves or a family member.

There are two health situation where you can qualify for Medicare through ESRD:

  • If you need regular dialysis and your kidneys no longer work, your Medicare coverage will begin on the first day of the fourth month of your dialysis treatment.
  • If you're getting a kidney transplant, your Medicare coverage will begin the month you're admitted to the hospital for a kidney transplant. This can usually include coverage for health services prior to your transplant if they occur within the same month as the transplant.

With ESRD, if you didn't sign up for Medicare when you became eligible, your coverage can be backdated up to 12 months to when you first became eligible.


Citizenship and residency requirements

In most cases, to be eligible for Medicare, you need to be a U.S. citizen living in the U.S.

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 prior to the month you apply for Medicare.

Even though these two eligibility criteria are specifically for Medicare Part B, they also apply to most other parts of Medicare. That's because Part B enrollment is required for enrollment in Medicare Part C, Medicare Part D, Medigap and the Medicare Part A paid plans.

However, if you qualify for the free Medicare Part A plan because of your work history, you can be enrolled in Part A plan without being enrolled in Part B.


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 $274 to $499 per month.
  • If you earned less than $6,040 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.

For those who qualify for Medicare because of a disability, there are no work requirements to receive free Medicare Part A.

However, those who are qualifying for Medicare because of End-Stage Renal Disease must meet the work requirements through their own work history, the work history of their spouse or the work history of a parent, if they're still a dependent.

The broadness of the eligibility criteria means that 99% of enrollees qualify for free Medicare Part A. These free benefits are because of the Medicare taxes that workers pay with each paycheck, which cover 89% of the funding for Medicare Part A.


Location restrictions

The Medicare options issued 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 that are offered in your area.

This eligibility is based on your primary residence, and someone in a nearby county may have different options than you. To find out what options are offered in your area, you can use the Medicare Plan Finder or request quotes based on your ZIP code.

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Those who have multiple homes will only be eligible for the plans that are issued in the ZIP code of their primary residence. However, it's important to check that the plan will provide coverage in both locations where you spend your 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, even though you'll pay more for these services. A Medigap plan is the best option for location flexibility because you'll have coverage for any medical provider that accepts Medicare, which is most of the doctors and facilities in the country.


Frequently asked questions

How do you know if you’re eligible for Medicare?

You can become eligible for Medicare in three ways: (1) when you turn 65, (2) if you qualify for disability benefits through Social Security and (3) if you have a qualifying medical condition such as End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS).

How old do you have to be to get Medicare?

You become eligible for Medicare at age 65. This is earlier than 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 will need to apply for Medicare through the Social Security Administration when they turn 65. However, you can be automatically enrolled in Medicare at age 65 if you've been receiving 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 any time through a Medicare special enrollment period.


Sources

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