Medicare Eligibility Simplified

There can be a lot of confusion when it comes to who qualifies for Medicare and when can they get it.  For most, eligibility for Medicare starts the month an individual turns 65. You must also be a citizen of the United States or have been a legal resident for at least 5 years.

Other qualified for Medicare under the age of 65 if:

  • you are permanently disabled and you have been receiving Social Security disability income benefits for 24 months.
  • you have end-stage renal disease (kidney failure that requires dialysis or or kidney transplant)
  • you have Amyotrophic Lateral Sclerosis (ALS), also called “Lou Gehrig’s Disease”

Social Security income and Medicare often get grouped together because they come around the same age and you actually apply for Medicare through Social Security. But, they are in-fact separate and you DO NOT need to take Social Security income to receive Medicare. 

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Medicare Eligibility In Depth

To get the full picture of Medicare eligibility, lets break down Medicare into its parts and look at each one individually. 

Eligibility for Medicare Part A

Medicare Part A eligibility starts at age 65 as long as you OR your spouse has legally worked for at least 10 years in the U.S. That right, even if you have not worked the required 40 quarters, your spouse can still qualify you by meeting these requirements.

Medicare Part A is mostly funded by the Medicare taxes paid by working Americans. So by working at least 10 years you have paid into the Medicare system and you are entitled to receive these benefits at no extra cost to you once you become eligible.

If you have already enrolled in Social Security income benefits before 65, you will be automatically enrolled in Part A and Part B. You Medicare card will be automatically mailed to you and can arrive 3 months before you turn 65. 

If you have not met these qualifications and worked the required 10 years, you can purchase Medicare Part A. Social Security will calculate the cost of Part A for you in the form of a monthly premium. For more information on the Part A premium see our Medicare Part A article.

Eligibility for Medicare Part B

Eligibility for Medicare Part B starts for most at age 65. Unlike Medicare Part A, everyone must pay a monthly premium for Part B.  Check out our Medicare Part B page for more on Medicare Part B cost and coverage. Again if you have already enrolled in Social Security income benefits before 65 you will be automatically enrolled in Medicare Part B with the option to opt out. 

More and more people turning 65 are continuing to work and have health insurance through their employer. Opting out of Part B at 65 allows them to avoid paying for Part B and avoids any risk of paying a Part B penalty as the employer coverage is creditable coverage. Deciding whether or not to delay your Part B can be a tricky option as there are some things to consider before making that choice. We recommend working with an agent who can go over the possible pitfalls as well as the benefits to making that choice. Take a look at our write up on Employer Coverage and Medicare for more information.

If you have delayed your Part B and are looking to start Medicare and are not sure where to start, contact an AHIC agent and will go through the special enrollment periods that apply to you and options available for you.  

Contact and agent.   

Eligibility for Medicare Part C (Medicare Advantage)

Medicare Part C differs from Part A and Part B as it is offered through private insurance companies rather than Medicare. Enrolling in a Medicare Part C plan allows the private insurance company to manage your healthcare and will usually require you to use a network of doctors and often include Part D coverage. There are many advantages to Medicare Advantage such as cost saving and extra benefits. 

Medicare Advantage Eligibility:

  • Enrolled in Medicare Parts A AND Part B
  • Must continued to pay Part B premium
  • Reside in the plans service area

While many Medicare Advantage plans will have little or even no additional monthly premium to pay, you MUST continue to pay your Part B premium to Medicare to remain eligible for Medicare Advantage. 

Check out our Medicare Part C (Medicare Advantage) page for more information on Part C. 

Eligibility for Medicare Part D

Medicare Part D is prescription drugs coverage that is offered through private insurance companies for a monthly premium and is voluntary. To be eligible for Medicare Part D you must be currently enrolled in either Part A and/or Part B and live in the plans service area.

While Part D is voluntary, we strongly recommend choosing a Part D. Part D gives you protection against sudden prescription drug costs and lower copays for prescriptions taken now. not having Part D can accrue a penalty over time if you do not have other creditable coverage, usually from an employer. 

Check out our Medicare Part D (Prescription Drugs) page for more information. 

Get someones on your side:

Still have questions or need assistance with Medicare eligibility? Eligibility and enrollment periods can be tricky, but you are not alone, AHIC is here to help. If you would like someone to walk you through the process of applying for Medicare, shopping for a plan, then please click on the link below. Our services are at NO COST to you and we will be here to help you for the lifetime of your policy. 

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