Simplifying Medicare Eligibility

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

You can qualify 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 get grouped together because they arrive around the same age and you apply for Medicare through Social Security. But, they’re actually separate and you don’t need to take Social Security income to receive Medicare.


Medicare Eligibility In Depth

To understand the full picture of Medicare eligibility, we’ve broken down each part of Medicare individually.

Eligibility for Medicare Part A

Medicare Part A eligibility starts at 65, as long as you or your spouse has legally worked for at least 10 years in the United States. So, even if you haven’t worked 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. By working at least 10 years, you’ve paid into the Medicare system and are entitled to receive these benefits at no additional cost to you once you’re eligible.

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

If you haven’t met these qualifications, you can still 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 at age 65 for most. Unlike Medicare Part A, everyone must pay a monthly premium for Part B. For more on Medicare Part B costs, visit Medicare Part B cost and coverage. If you’ve already enrolled in Social Security income benefits before turning 65, you’ll be automatically enrolled in Medicare Part B with an option to opt out. 

Working after age 65 and receiving health insurance through an employer is becoming more common. Opting out of Part B at 65 allows people to avoid paying for Part B and avoids any risk of paying a penalty, as 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. Take a look at Employer Coverage and Medicare for more information.

If you’ve delayed your Part B and want to start Medicare, but you’re not sure where to start, contact an AHIC agent to learn about the special enrollment periods that apply and the options available to you.  

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Eligibility for Medicare Part C (Medicare Advantage)

Medicare Part C differs from Part A and Part B, as it’s offered through private insurance companies rather than Medicare. Enrolling in a Medicare Part C Plan allows a private insurance company to manage your healthcare, usually requires you to use a network of doctors, and often includes Part D coverage. Medicare Advantage usually offers cost savings and additional benefits. 

Medicare Advantage Eligibility:

  • Enrolled in Medicare Parts A and Part B
  • Must continue to pay Part B premium
  • Live in the service area of the plan

While many Medicare Advantage Plans have a small or potentially no additional monthly premium to pay, you must continue to pay your Part B premium to remain eligible for Medicare Advantage. Visit Medicare Part C (Medicare Advantage) for more information on Part C.

Eligibility for Medicare Part D

Medicare Part D is voluntary prescription drug coverage that’s offered through private insurance companies for a monthly premium. To be eligible for Medicare Part D, you must be currently enrolled in either Part A or Part B and live in the service area of the plan.

While voluntary, we strongly recommend choosing a Part D. Part D gives you lower copays for your current prescriptions and protection against sudden prescription drug costs. If you do not have other creditable coverage, usually from an employer, you may accrue a penalty. Visit Medicare Part D (Prescription Drugs) for more information.

We’re on Your Side:

Still have questions or need assistance with Medicare eligibility? Eligibility and enrollment periods can be tricky, but you’re not alone. AHIC is here to walk you through the process of applying for Medicare or shopping for the plan that’s right for you. Our services are free for you and we’ll be here to help for the lifetime of your policy. 

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