Medicare Eligibility

Medicare eligibility is generally for individuals age 65 and older. In certain circumstances you may qualify for Medicare when you are younger than 65. Medicare maze2

Three months before your 65th birthday most people will be automatically enrolled in Medicare Part A and Part B. If you or your spouse earned Social Security wages for at least 40 quarters you should be Medicare eligible.


Age 65 Medicare Eligibility

Individuals who are 65 or older will meet Medicare eligibility requirements if:

  • You are eligible to receive Social Security Benefits;
  • You are eligible to receive Railroad Retirement Benefits;
  • You (or your spouse) have at least 40 quarters of Social Security wages and paid Medicare taxes

Foreign nationals who are in the United States legally may “buy in” to Medicare once they have been legal residents for 5 years.


Under age 65 Medicare Eligibility

If you are under 65, you can get Medicare Part A (hospital insurance) without having to pay premiums if:

  • You have received Social Security disability benefits for 24 months.
  • You have end-stage renal disease and you meet certain requirements.

You do not have to pay a premium for Medicare Part A if you meet these specific conditions, but you have to pay the Medicare Part B premium if you want it.


When you meet Medicare eligibility requirements for Part A (hospital insurance) you can enroll in Medicare Part B (medical insurance) by paying a monthly premium.

If you are covered under an employer group health insurance plan you should talk to an insurance agent. An insurance agent can help a consumer decide what plan offers the best benefits and coverage for the individual. If you wait to purchase Medicare coverage outside of the enrollment dates are likely to face higher Medicare premiums.

 U.S. citizens who are 65 and older but do not have enough Medicare-covered employment, as well as permanent resident aliens aged 65 and older who have lived in the United States for five years prior to applying for Medicare, are eligible for Medicare benefits. Under this arrangement you must pay monthly premiums for both Medicare Part A and Part B benefits.

Medicare Part A and Part B will not cover all of your medical costs. Some items, such as deductibles, coinsurance and copay’s are  out-of-pocket costs that can be covered by a Medicare supplement plan. Medigap coverage is another name for Medicare supplement. Like Kleenex and tissue, the terms are interchangeable. 

As you can see, Medicare eligibility is determined in many different ways. Contact us if you have questions.