Medicare eligibility:
Who qualifies for Medicare coverage?
Will I be eligible for Medicare at age 65?
How do I qualify for a private Medicare plan?
Do I need to be a U.S. citizen to be eligible for Medicare?
Can I get Medicare coverage if I never worked?
What if I qualify for veterans’ benefits?
I’m on disability. When will I be eligible for Medicare?
Am I eligible for Medicare?
If you’re like most people, you will become eligible for Medicare when you turn 65. You can also become eligible if:
- You have a qualifying disability at any age (Medicare eligibility begins after 24 months of receiving Social Security Disability Insurance benefits)
- You have a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease) at any age
You will be enrolled in Original Medicare automatically if:
You are receiving Social Security or Railroad Retirement Board benefits when you turn 65, or you are eligible for Medicare because of a disability or medical condition.
You must enroll yourself in Medicare Part A and Part B if:
You are not receiving Social Security benefits when you become eligible for Medicare. You can enroll in Medicare Part A and Part B online at www.ssa.gov, in person at your local Social Security office or by phone at 1-800-772-1213 / TTY: 1-800-325-0778.
Will I be eligible for Medicare at age 65?
You are eligible for Medicare when you turn 65. You may be working, not working or retired. You may or may not be receiving Social Security or other retirement benefits. Your age is what matters.
Could I be eligible for Medicare before age 65?
You can become eligible for Medicare before age 65 if you have a qualifying disability or medical condition.
- If you receive Social Security Disability Insurance payments, you will be eligible for Medicare the month you receive your 25th benefit payment.
- If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease), you will be eligible for Medicare immediately or within a few months, depending on your diagnosis.
Will I still be eligible for Medicare if I work past age 65?
Yes. If you plan to keep working or you have employer health coverage through a spouse, you may be able to delay enrolling in Medicare.
Depending on your situation, you may not be able to delay enrollment. For example, if your employer has fewer than 20 employees, you may be required to enroll in Medicare.
How do I qualify for a private Medicare plan?
Once you are enrolled in Original Medicare (Part A and Part B), you can receive coverage from the federal government. At that point, you can choose coverage from a private insurance company.
- To be eligible for a Medicare Advantage (Part C) plan, you must have Original Medicare (Part A and Part B).
- To be eligible for a Chronic Special Needs plan (C-SNP), you must have Original Medicare and a qualifying chronic condition.
- To be eligible for a Dual Special Needs plan (D-SNP), you must qualify for both Medicare and Medicaid.
All Special Needs plans are Medicare Advantage plans.
- To be eligible for a Medicare Supplement (Medigap) plan, you must have Original Medicare.
- To be eligible for a Medicare Part D prescription drug plan, you must have Medicare Part A or Part B.
Do I need to be a U.S. citizen to be eligible for Medicare?
Yes, or a qualified legal resident. To qualify as a legal resident, you must have lived in the United States for at least 5 years in a row before applying for Medicare coverage.
Can I get Medicare coverage if I never worked?
Maybe. First you need to be a U.S. citizen or legal resident who has lived in the United States for at least 5 years in a row before applying. Then you need to be 65 or older, or have a qualifying disability or medical condition. After that:
If your spouse is eligible
If you have been married for at least one year to someone with enough work credits, you are eligible for premium-free Medicare Part A. Your spouse must earn at least 40 work credits (about 10 years of working and paying FICA taxes) to qualify for premium-free Part A at age 65.
If you are divorced
If you are divorced but were married for at least 10 years to someone who qualifies for Social Security benefits, you may be eligible for Medicare coverage.
If you are widowed
If you were married for at least nine months to someone who was eligible for Social Security and has since died, and you are now single, you may qualify.
What if I qualify for veterans’ benefits?
If you’re a U.S. veteran, you may have other insurance, such as TRICARE or Veterans Affairs (VA) benefits . But you may still want to enroll in a Medicare plan. In fact, the VA recommends it .
Care through the VA covers services at VA facilities or others authorized by the VA. Medicare can cover care at private hospitals and doctors outside the VA system. Having both kinds of coverage means you can get care in more places.
Enrolling in Original Medicare and then a Medicare Part D plan, or private insurance like a Medicare Advantage plan, may help you get coverage for more of your needs.
I’m on disability. When will I be eligible for Medicare?
It depends on your disability. If you have been receiving Social Security Disability Insurance benefits for at least 24 months, you should be eligible for Medicare coverage.
Are Medicare and Social Security eligibility the same?
No. Medicare eligibility and benefits are separate from Social Security eligibility and benefits.
You can enroll in Medicare at age 65 or with a qualifying disability or medical condition. Your Social Security eligibility depends what year you were born, when you retire and other factors.
Learn more about Social Security eligibility
I’m eligible for Medicare. What do I do next?
If you first become eligible because you are turning 65, you will have an Initial Enrollment Period (IEP) that begins three months before the month of your 65th birthday and ends three months afterward. During your IEP, you can enroll in Original Medicare (Part A and/or Part B). Then you can choose to enroll in a Medicare Advantage (Part C) or Medicare Part D prescription drug plan, or apply for a Medicare Supplement (Medigap) insurance plan.
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