If you’ve turned 65, you’re eligible for Medicare. Your enrollment period begins three months before your birth month. In rare cases, certain people under 65 are eligible for Medicare benefits. Find out how that works, plus when you should enroll, below.
How do I qualify for Medicare?
If you meet any of the following criteria, there is a good chance you qualify for Medicare benefits:
- You are 65 or older
- You have been receiving Social Security disability benefits for at least two years
- You have been diagnosed with end-stage renal disease (ESRD)
- You have been diagnosed with amyotrophic lateral sclerosis (ALS)
Note: How you qualify for Medicare can affect the type of coverage you’re eligible for, when your coverage starts, and how much it costs.
Does Medicare have a citizenship requirement?
As Medicare is a federally funded program, there are some citizenship requirements that you must meet in order to qualify.
If you have a green card and have lived in the United States for at least the last five years, you could be eligible for Medicare. Likewise, if you are a citizen and meet the age requirements, you are eligible for Medicare.
If you do not meet citizenship status on your own, but are married to a United States citizen or legal resident, you may still be able to get full Medicare coverage before the five year mark if you meet all of the following requirements:
- You’re 65 or older
- Your spouse is age 62 or over and has earned forty work credits
- You’ve celebrated your first-year wedding anniversary
When does Medicare enrollment begin?
If you are already receiving Social Security or Railroad Retirement Board benefits by your 65th birthday, you will be auto-enrolled in Medicare Part A and Medicare Part B (also known as Original Medicare). Keep an eye on your mailbox for an enrollment packet explaining your benefits.
If you are 65 but not taking Social Security yet, you can enroll in Medicare beginning three months before your birth month and continuing for three months after you birth month. This seven month window, called the Initial Enrollment Period, is your best time frame to sign up for Medicare.
When does my Medicare coverage begin?
When you register can affect when your Medicare coverage begins.
If you were auto-enrolled, or registered for Medicare during the first three months of your Initial Enrollment Period, your Medicare coverage begins on the first day of your birth month.
If you wait to register during your birth month, or during the last three months of your Initial Enrollment Period, your Medicare coverage begins on the first day of the next month.
What is the age requirement for medicare?
Are you over the age of 65? Congratulations, you qualify for Medicare!
What qualifies as a disability for Medicare eligibility?
If you are under 65, you may qualify for premium-free Medicare Part A benefits if you meet any of the following criteria:
- You have been receiving Social Security disability benefits for at least 24 months
- You receive a disability pension from the Railroad Retirement Board and meet certain criteria
- You have amyotrophic lateral sclerosis (ALS)
- You have end-stage renal disease (ESRD) requiring regular dialysis or a kidney transplant, and you or your spouse has paid Social Security taxes for a length of time that depends on your age
If you are eligible to purchase premium-free Medicare Part A, you are also eligible to enroll in Medicare Part B.
What is the 24-month rule?
While most beneficiaries qualify for Medicare by reaching the age requirement, you don’t have to be over the age of 65 to qualify for Medicare benefits.
If a beneficiary has received Social Security Disability Insurance or Railroad Retirement Board disability benefits for two years (a full 24 months), they become eligible for Medicare beginning their 25th month on disability. This rule is commonly known as the 24-month rule.
Do the 24 months need to Be consecutive?
No, these 24 months aren’t required to be consecutive. Rather, once you accumulate a month of disability, you’ll stay eligible for up to 93 months after your disability benefits end. If you continue to need SSDI payments, you remain eligible for the rest of your life.
When is the initial enrollment period for people who qualify through disability?
Similarly to those who qualify based on age, beneficiaries who qualify for Medicare through disability will have their own Initial Enrollment Period. This IEP runs starting three months before the beneficiary is set to become eligible for Medicare, the month you become eligible, and the three months after. This makes the disability IEP seven months long as well.
Similar to beneficiaries over 65, those eligible for Medicare through disability will also have to choose carefully when they sign up to avoid being without coverage. If a beneficiary enrolls in Medicare during the first three months of their IEP, their coverage will begin on the first day of the 25th month they are set to receive disability benefits. Enrolling after that period means coverage will begin the following month.
The 24-month rule can seem daunting for anyone looking for the financial relief Medicare coverage could provide. And, if you’re like most people, your disability may leave you with limited income and increased healthcare costs. For those with conditions that might require extra medical attention or long-term care, there is another way you can qualify for Medicare.
Qualifying for medicare with end stage renal disease (ESRD)
If you are diagnosed with end stage renal disease (ESRD), you can be qualified for Medicare just four months after your first treatment. End stage renal disease is a condition where a person’s kidneys are in the final stages of failing. Most people diagnosed with ESRD must undergo regular dialysis, and might require a kidney transplant to live.
Due to the high, long-term costs associated with this condition, beneficiaries looking for relief from Medicare don’t have to wait the standard 24 months on disability to qualify. They only have to wait four months following their first dialysis treatment.
In order to be fully insured with ESRD, patients must have earned 40 work credits and fulfill the citizenship or residency requirements. Generally speaking, beneficiaries with ESRD are limited by the Centers for Medicare & Medicaid Services to Medicare Advantage plans if they enroll in a Special Needs Plan (SNP). These SNPs are specifically designed for ESRD patients.
Qualifying for medicare with Amyotrophic lateral sclerosis (ALS)
If a beneficiary has been diagnosed with Amyotrophic lateral sclerosis (ALS), they also gain Medicare eligibility prior to turning 65. ALS, also known as Lou Gehrig’s disease, damages the brain and spinal cord, resulting in the inability to move one’s muscles. Once diagnosed with ALS, beneficiaries can enroll in Medicare the same month their Social Security Disability Insurance or Railroad Retirement Board disability benefits start.
What happens when age and disability overlap?
What if you qualify for Medicare based on age and disability? Which category do you fall under when enrolling? If you satisfy the age requirements, this takes precedence over qualifying by disability. In other words, your benefits would follow the regulations that apply to all age-qualified Medicare enrollees.
If you qualify for Medicare based on disability and are turning 65 in the near future, you don’t need to hold off enrolling in Medicare to ensure you’re able to select the best plan for you. People with disabilities can requalify for Medicare benefits at 65. When they do, they experience the same perks that newly age-qualified Medicare enrollees enjoy, including a second IEP, a Medicare Supplement insurance guaranteed issue period, and waived late enrollment penalties moving forward.
Eligibility for each part of Medicare
Each part of Medicare has its own eligibility requirements in addition to those above. Read on to see what qualifications you must meet in order to enroll in each of the five parts of Medicare.
Medicare Part A eligibility requirements
While qualifying for Medicare Part A is straightforward, qualifying for premium-free Medicare Part A is a bit more complicated. When enrolling in Medicare Part A, having the right legal status and meeting the age or disability requirements is enough to be able to buy Medicare Part A.
Your eligibility for premium-free Medicare Part A depends on the amount you’ve paid in Medicare taxes throughout your career. If you have been paying Medicare taxes your whole career, you probably qualify for premium-free Medicare Part A.
The Centers for Medicare & Medicaid Services, or CMS, measures eligibility for premium-free Medicare Part A in “work credits.” In order to avoid paying the premium, you would have to accumulate 40 work credits over your working life. These credits aren’t attached to the amount of money you have paid into Medicare. Instead, it’s a measurement of how long you have been putting money into Medicare.
Each credit corresponds to one quarter-year in which you paid Medicare taxes. Worked for a summer paying Medicare taxes? Congratulations, you’ve earned one working credit. Have you spent ten years behind a desk paying Medicare taxes? Great, you’ve earned 40 work credits and have qualified for premium-free Medicare Part A.
To earn a credit, you must earn at least $1,320 of taxable income and pay into Medicare on the income during one quarter of the year. You do not have to be employed the entire quarter. You can even collect work credits while you’re self-employed, provided you keep paying into Medicare.
If you fail to accumulate 40 work credits, all is not lost when it comes to Medicare Part A. You can still qualify for a premium discount if you worked between 30 and 39 work credits. The cost of the Medicare Part A premium is as follows:
- 0-29 work credits: $437.00
- 30-39 work credits: $240.00
- 40 work credits: $0.00
If you don’t have enough work credits, you might still qualify for premium-free Medicare Part A. The following situations will enable you to enroll in premium-free Medicare Part A:
- You’re self-employed and deduct premiums from your taxes
- You’re serving in the military
- You work for a church or other organization that doesn’t pay Social Security taxes
- You are or were employed by a local or state government agency that doesn’t participate in Social Security
- You were a domestic or farm worker
- Your spouse is 62 or older and has earned enough work credits
Medicare Part B eligibility requirements
If you’re over 65 or have certain disabilities, generally you should have no problem enrolling in Medicare Part B. The only other requirement relates to citizenship: you or your spouse must be a United States citizen or permanent resident for at least five years. If qualifying for Medicare Part B is based off your spouse’s citizenship, you must be at least 65 and your spouse must be at least 62.
Beyond that, the only other requirement to remain eligible for Medicare Part B is paying your premium. While you may be able to get Part A without paying a premium, you will be required to pay a premium for Medicare Parts B, C, D, and Medigap. If you need extra help paying these premiums, you can see if you qualify for your state’s Medicare program or Extra Help for reduced (or even free) premiums.
Unlike Part A, Medicare Part B premiums are calculated by income and not by how much you’ve paid into Medicare taxes. The table below will show you what you potentially owe for a Medicare Part B premium based off your income:
Part B premium adjustments are based on income earned two years prior. For example, your 2018 income will be used to determine your IRMAA adjustment for 2020.
Medicare Advantage eligibility requirements
Medicare Advantage (also known as Part C) has its own set of eligibility requirements, which makes it a little more complicated than Medicare Parts A and B. For starters, you must be enrolled in both Medicare Part A and Medicare Part B in order to enroll in a Medicare Advantage plan. There must also be a plan available where you live.
In order to remain eligible for Medicare Advantage, you must continue paying your premiums. These premiums include your Part A premium (if you don’t qualify for premium-free Medicare Part A), your Medicare Part B premium, and any additional Medicare Advantage premium charged by your insurance carrier.
Before you start to sweat over paying these three premiums, the price you end up paying is not as bad as it sounds. Most beneficiaries qualify for premium-free Part A, and Medicare Part B is cheaper than several health insurance plans offered by employers. Furthermore, the average monthly premium for Medicare Advantage is only $28.00 in 2019. Some plans also charge $0 premium or give you a Part B rebate.
Most Medicare Advantage plans offer more extensive coverage than Original Medicare, like dental, vision and hearing coverage. Several Advantage plans also offer prescription drug coverage as well, meaning you may be off the hook for Medicare Part D premiums.
Medicare Part D eligibility requirements
The requirements for qualifying for Medicare Part D is quite simple: You just need to have Part A, Part B or both. Many Medicare Advantage plans include prescription drug coverage (MAPD), in which case, Medicare Advantage eligibility requirements apply.
If you are enrolled in an HMO or PPO Medicare Advantage plan that doesn’t offer prescription drug coverage, you cannot have a stand-alone prescription drug plan. If you enroll in a Medicare Advantage PFFS plan, you can enroll in Medicare Part D.
Like other parts of Medicare that feature premiums, in order to remain eligible you must continue to pay the monthly premium for Medicare Part D. The average basic premium for Medicare Part D is $33.19 in 2019.
Medicare Supplement (Medigap) eligibility requirements
If you qualify for Medicare by age, you also qualify for Medigap insurance. The six-month period when you are both enrolled in Medicare Part B and 65 years old are called your guaranteed issue period.
During those six months, the federal government prevents Medicare Supplement insurance providers from charging you higher premiums, denying you coverage, or making you wait for coverage due to a preexisting condition.
Outside of your guaranteed issue period, you will likely be subject to medical underwriting. Major life events may qualify you for a Special Election Period with another guaranteed issue period.
Can I have both a Medicare Supplement Policy and a Medicare Advantage Policy?
No. It is illegal to have both a Medicare Supplement policy and a Medicare Advantage policy.