Medicare Eligibility & Qualifications

Navigating Your Medicare Options

Navigating Medicare eligibility can seem daunting. Whether you’re approaching 65, considering retirement, or managing a disability, understanding your Medicare options is crucial. To become eligible for Medicare, you typically need to meet certain requirements. If you or your spouse worked in Medicare-covered jobs for at least 10 years and you’re 65 years old or older, as well as a U.S. citizen or permanent resident, you’ll generally qualify. If you’re under 65, you may also be eligible if you have collecting Social Security Disability Insurance (SSDI), or if you have been diagnosed with Amyptrophic Lateral Sclerosis (ALS) or End-Stage Renal disease (a serious kidney condition that needs dialysis or a transplant). Let’s explore each Medicare eligibility category in more detail.

Understanding Age Based and Disability-Based Medicare Eligibility Criteria

To become eligible for Medicare, you typically need to meet certain requirements. For those under 65, eligibility may also extend if you have a disability or End-Stage Renal Disease (ESRD), a serious kidney condition requiring dialysis or a transplant.

Age-Based Medicare Eligibility

If you or your spouse worked in Medicare-covered jobs for at least 10 years and you’re 65 years old or older, as well as a U.S. citizen or permanent resident, you’ll generally qualify. When you reach the Medicare eligibility age of 65, several options become available. It’s a pivotal time to make informed decisions about your senior health plan future.

Disability-Based Medicare Eligibility

Navigating the complexities of Medicare eligibility is challenging, especially when considering specific medical conditions and disability benefits. There are three main disability conditions and special circumstances where you can qualify for Medicare regardless of age:

• Social Security Disability Insurance (SSDI): If you’ve been receiving Social Security Disability Insurance (SSDI) benefits for 24 months, you automatically become eligible for Medicare, regardless of your age. The 24-month waiting period begins the first month you receive your SSDI benefits.
• End-Stage Renal Disease (ESRD): People with End-Stage Renal Disease (ESRD) requiring dialysis, or a kidney transplant are eligible for Medicare, no matter how old you are. There is no waiting period for ESRD patients; you can enroll as soon as you are diagnosed with the condition or start receiving dialysis treatment.
• Amyotrophic Lateral Sclerosis (ALS): Better known as “Lou Gehrig’s disease,” Amyotrophic Lateral Sclerosis (ALS) is a progressive neurological condition that affects nerve cells responsible for controlling muscle movement. People diagnosed with ALS are eligible for Medicare as soon as they begin receiving Social Security Disability benefits, without any waiting period.

The Cost of Medicare

You can get Part A at age 65 without having to pay premiums if:

• • • You already receive retirement benefits from Social Security or the Railroad Retirement Board.
    • You are eligible for Social Security or Railroad benefits but haven’t filed for them yet.
    • You or your spouse had Medicare-covered government employment.

For those under 65, you can get Medicare Part A without having to pay premiums if you have:

• • • Received Social Security or Railroad Retirement Board disability benefits for 24 months.
    • Have End-Stage Renal Disease (ERSD) or another qualifying disability and meet certain requirements.

If you meet certain conditions, you won’t have to pay a premium for Medicare Part A Coverage. However, if you want a Medicare Part B Plan, you’ll need to pay for it. The monthly premium for Part B in 2023 is $164.90. You can find more information at www.medicare.gov. The premium amount is taken out of your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t receive any of those payments, Medicare will send you a bill every three months for your Part B premium.

Note: You will reach Medicare eligibility nationwide when you turn 65 even if you are not eligible for Social Security retirement benefits.

Medicare Enrollment Eligibility Periods

How & When to Sign Up for Medicare – A Step-by-Step Guide:

Your first Medicare eligibility period is a 7-month Initial Enrollment Period, starting 3 months before you turn 65. It includes the month you turn 65 and ends 3 months after. Missing this window can lead to late enrollment penalties, so it’s crucial to be timely.

If you didn’t sign up for Medicare Part A and/or Part B (for which you must pay premiums) when you were first eligible, and you aren’t eligible for a Special Enrollment Period, you can sign up during the General Enrollment Period between January 1–March 31 each year. In this instance, your basic Medicare coverage will start July 1. You may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

For more specific information on enrollment, please visit our Medicare Enrollment informational page.

How to get Medicare Eligibility Help

Still have questions about your Medicare eligibility? Our senior health expert team is ready to guide you through every step of the process. Contact us today for personalized assistance and let us help you make the best decision for your Medicare senior health needs.

Medicare Eligibility FAQs

FAQ #1: Who qualifies for Medicare?


A: You qualify for Medicare if you’re 65 and above, a citizen or permanent resident of the United States and you paid Medicare taxes for at least 10 years (40 working quarters). Additionally, Medicare covers certain individuals who have disabilities, such as Lou Gehrig’s disease (ALS) or end-stage renal disease (ESRD). You also qualify for Medicare if you’ve been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months, even if you’re under the age of 65.

FAQ #2: Do you automatically receive Medicare when you turn 65?


A: If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits, you’ll automatically be enrolled in Medicare Part A and Part B when you turn 65. Expect your Medicare card to be mailed to you about three months before your 65th birthday.

FAQ #3: Am I eligible for Medicare at age 62?

A: Typically, you can’t receive Medicare at age 62 based on age alone, because Medicare eligibility generally starts at age 65. However, if you have a qualifying disability and have received Social Security Disability Insurance (SSDI) benefits for at least 24 months, or if you have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), you may be eligible for Medicare before age 65.

FAQ#4: Do I automatically receive Medicare when I turn 65?

A: If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits, you’ll automatically be enrolled in Medicare Part A and Part B when you turn 65. Expect your Medicare card to be mailed to you about three months before your 65th birthday.

FAQ #5: What is the maximum income to qualify for Medicare eligibility?

A: There is no maximum income to qualify for Medicare in the United States. Medicare eligibility is mainly based on age, disability, and certain medical conditions, and not on income. Most people are eligible for Medicare when they turn 65 years old, regardless of their income. However, some people may have to pay higher premiums for Medicare Parts B and D if their income is above certain thresholds. These higher premiums are known as income-related monthly adjustment amounts (IRMAA).