What you need to know about Medicare eligibility

Understanding Medicare eligibility requirements
Sep 5, 2018 ·
Senior couple listening to someone and smiling


Turning 65 this year? You’re likely making sure you're on track for retirement. Below are some questions that will help you better understand Medicare.

What is Medicare?

Medicare is a federal program that offers insurance to people 65 and older. There are two parts:

  1. No cost, government-sponsored benefits, also called Parts A and B.
  2. Extra, paid health insurance plans, commonly known as Medigap, because they fill in some of the areas Medicare doesn’t cover.
When are you eligible for Medicare?

When you turn 65, the enrollment process for Parts A and B is automatically started, so you're covered at the start of your birthday month. However, you have three months before your birthday and three months after your birthday to sign up. During this time period, you can also buy Medigap coverage.

If you miss your 7-month enrollment period, there are two other times you can sign up – during open enrollment or a special enrollment period.

What other things affect my eligibility?

Along with turning 65:

  • You need to be a U.S. citizen for at least five years
  • You or your spouse must have earned about 40 quarters (4 quarters per year) by paying Social Security and Medicare payroll taxes while working – equal to about 10 years of work
  • You or your spouse must have been employed by the government and paid Medicare payroll taxes while working
How else do I qualify?

If you need Medicare and aren't 65, there are other ways to qualify.

Disabilities

You're eligible for Parts A and B if you:

  • Have been receiving Social Security Disability Insurance (SSDI) for more than two years
  • Have been getting benefits from the Railroad Retirement Board (RRB) for at least two years. In both cases, receiving Medicare will not stop your SSDI or RRB benefits.
  • Suffer from Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS)
  • Have end-stage renal disease (ESRD) and suffer from kidney failure. You're usually eligible for Medicare three months after a kidney transplant or if you are a dialysis patient.

Difficult times

You may be able to sign up for Medicare and prescription drug plans during special enrollment periods. These could be due to:

  •  Loss of current coverage
  •  Relocation
  •  Change in your policy

Payment of monthly premium

If you turn 65 without having worked for a period equal to 40 credits or paid health taxes for at least 10 years, but you're a legal U.S. resident, or have been a citizen for at least five years, you can get Medicare for a monthly premium. Once you pay what’s equal to 40 credits, you no longer have to pay premiums to get your coverage.

It’s important to note that you don’t have to buy both Parts A and B. But if you want to buy Medigap, you will face some restrictions if you have bought only A or only B. Because Medicare covers about 80% of immediate cost of care, most people opt for Medigap to pay for the remaining 20%. If you’re interested in this option, click here to get an estimate of what your premium may look like.

While it’s comforting to know that you’ll get Medicare at age 65 if you're eligible, it’s also good to know there are other ways to qualify.