Who is Eligible for Medicare?

Medicare is comprised of four different parts:

• Medicare Part A, which covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home healthcare services.
• Medicare Part B, which covers outpatient care, preventative care, certain doctors’ services, and medical supplies.
• Medicare Part C, also known as Medicare Advantage, are health plans offered by private insurance companies that contract with Medicare to provide all Part A and Part B benefits, as well as prescription drug plans in most cases. Individuals who want coverage through Medicare Advantage must enroll through a separate process, and their services are paid for by the private insurance company, not Medicare.
• Medicare Part D, which provides prescription drug plans to individuals on Medicare. These plans are offered separately by insurance companies and other private companies approved by Medicare.

Medicare typically does not cover long-term care related to basic needs like washing and dressing; dental care; eye exams related to prescribing glasses; dentures; cosmetic surgery; acupuncture, hearing aids and fitting exams, and routine foot care.

Individuals can purchase Medicare Supplement Insurance, also known as Medigap, to help pay for healthcare costs not covered by Medicare.

All U.S. citizens and permanent residents for at least five years who are age 65 and older are eligible for Medicare. Citizens and permanent residents under age 65 who meet certain criteria are also eligible for Medicare.

You can find out if you are eligible for Medicare, or when your eligibility begins, using Medicare.gov’s eligibility calculator.

Certain criteria will determine whether you are automatically enrolled in Medicare, and what you will have to pay for your benefits. Read on for more information about specific Medicare eligibility requirements.

U.S. citizens and permanent legal residents who have lived in the U.S. for at least five years are eligible to sign up for Medicare.

Your work history and marital status affects how much you will pay for your Medicare benefits. If you or your spouse worked long enough to be eligible for Social Security or Railroad Retirement Benefits – usually at least 10 years – or if you or your spouse is a government employee or retiree who paid Medicare payroll taxes while employed, you will not have to pay premiums for Medicare Part A, which covers inpatient hospital stays and other kinds of inpatient care.

You can use your spouse’s work record to qualify for premium-free Part A benefits as long as you are 65 or older and your spouse is 62 or older. You can use your spouse’s work record even if they are deceased or you and your spouse are divorced. These rules apply to same-sex as well as heterosexual couples. All Medicare customers pay premiums for Part B and Part D.

If you do not meet any of these criteria, you are still eligible for Medicare when you turn 65. You will, however, need to pay premiums for Medicare Part A. Your premium amount is based on the number of years you worked. You will also pay the same premiums for Part B and Part D as all Medicare customers do.

You can get an estimate of how much your premiums will be using Medicare.gov’s premium calculator.

Medicare benefits are also available to individuals under age 65 who:

• Are permanently disabled, and have received Social Security Disability benefits for at least 24 months (these months do not need to be consecutive)
• Have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
• Have Amyotrophic Lateral Sclerosis (commonly known as ALS, or Lou Gehrig’s disease)

For individuals with ESRD, they become eligible three months after a course of regular dialysis begins, or after a kidney transplant. Individuals with ALS become eligible as soon as they start collecting Social Security Disability benefits.

If you are enrolling in Medicare because you are turning 65, your initial enrollment period lasts for seven months – the three months before you turn 65, the month you turn 65, and the three months after you turn 65.

If you are enrolling in Medicare because you are permanently disabled, you are entitled to begin receiving Medicare benefits after receiving disability benefits for 24 months. Individuals who have ALS are eligible to begin receiving benefits the first month they are entitled to to Social Security or Railroad Retirement Board benefits. There is no waiting period for these individuals.

Individuals with ESRD are eligible to begin receiving Medicare at the following points: the third month after the month in which a regular course of dialysis begins; the first month a regular course of dialysis begins if the individual engages in self-dialysis training; the month of kidney transplant; or two months prior to the month of transplant if the individual was hospitalized during those months in preparation for the transplant.

If you are already receiving Social Security benefits when you turn 65, you will automatically receive Medicare Part A and Part B coverage when you become eligible. You will not need to sign up for these parts of Medicare, although you will need to sign up for Medicare Part D.

If you are not receiving Social Security benefits, you will need to sign up for Medicare during your initial enrollment period. If you do not enroll during your seven-month initial enrollment period, you may face penalties, including higher premium payments. You can sign up for Medicare online or by contacting your local Social Security office.

• Medicare.gov
• Medicarerights.org
• CMS.gov
• SSA.gov
• What is Medicare Advantage
• How to Compare Medicare Advantage Plans