Medicare is a federal health insurance program for legal U.S citizens or legal residents, people 65 years old or older, people of any age with certain disabilities, people of any age with End-Stage Renal Disease (ESRD), permanent kidney failure requiring dialysis or a kidney transplant.
As you or a loved one prepare to join Medicare, it’s helpful to know a little about the eligibility criteria for Medicare.
Medicare Eligibility: Age
You’re eligible for Medicare because of your age if you meet all of the following criteria:
- You are 65 years or older. Note that you must be 65—your spouse’s age does not count.
- You or your spouse paid Social Security taxes for at least 10 years.
- You are a legal U.S. citizen who has lived in the U.S. for at least five consecutive years.
If you’re 65 or older and collecting Social Security, you’ll automatically be enrolled in Original Medicare (Parts A and B) when you turn 65. Your Part B premium will be deducted from your Social Security benefits. If you’d like to join a Medicare Supplement plan, Medicare Advantage plan (Part C), and/or Medicare Part D* (prescription drug coverage), you may enroll through the private insurance company that offers the plan(s) you choose
Everyone who “ages into” Medicare has an Initial Enrollment Period (IEP) during which they may select the plan(s) they’d like and enroll.
If you aren’t getting Social Security benefits and won’t be getting them at age 65, you’re still eligible for Medicare. However, enrollment in Original Medicare is not automatic. If you want Original Medicare, you’ll need to enroll through your Social Security office.
Medicare Eligibility: Disability
If you receive disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board (RRB), you’ll automatically be enrolled in Original Medicare starting the first day of the 25th month after your benefits began.
If you choose to enroll in a Medicare Advantage plan or Medicare Part D* (a prescription drug plan), you may enroll between the 21st and 27th month after disability benefits begin. Coverage will begin after you have been eligible for disability benefits for 24 full months.
There is an exception to these guidelines for individuals who have Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s disease). If you have ALS, there is no wait period. You are automatically enrolled in Original Medicare (Parts A and B) as soon as your disability benefits begin.
Medicare Eligibility: End-Stage Renal Disease (ESRD)
If you have ESRD, you are eligible for Medicare if:
- You need regular kidney dialysis
- Have a kidney transplant
- You have worked the required amount of time under Social Security, the RRB or as a government employee. (Or you’re the spouse or dependent child of someone who has.)
- You’re preparing for or are eligible for Social Security or RRB benefits. (Or you’re the spouse or dependent child of someone who is.)
If you’re eligible for Medicare because you have ESRD, contact your Social Security office to enroll in Original Medicare. (People with ESRD are not automatically enrolled.) Medicare coverage usually starts the first day of the fourth month of your dialysis treatments.
You usually can’t join a Medicare Advantage plan unless you’ve had a transplant. You may be eligible for a Special Needs Plan (a type of Medicare Advantage plan for people with certain chronic diseases). Learn more about Special Needs Plans.
*If you don’t join a Medicare prescription drug plan when you’re first eligible, you must wait until your next enrollment opportunity to join a drug plan, and you may have to pay a higher premium because of a late enrollment penalty.
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact Medicare Made Clear at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
Enrollment Windows and Timing – MedicareMadeClear.com
General Medicare Enrollment and Eligibility – Medicare.gov
Medicare and Home Health Care – Medicare.gov
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