Medicare Eligibility
Who qualifies for Medicare, when coverage begins, and what you need to do to enroll. Find out if you're eligible and when to take action.
Who Qualifies for Medicare?
Medicare eligibility is based on age, disability status, or certain medical conditions. Most Americans become eligible when they turn 65, but there are other pathways to coverage. Below, we explain each qualification category in detail.
Turning 65 — The Most Common Path
The majority of Medicare beneficiaries become eligible at age 65. To qualify, you must be:
- A United States citizen, or
- A legal permanent resident who has lived in the U.S. continuously for at least five years
Premium-Free Part A
If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you qualify for premium-free Part A. This means you will not pay a monthly premium for hospital insurance. If you have fewer than 40 quarters of work history, you may still enroll in Part A by paying a monthly premium.
Your Initial Enrollment Period (IEP)
When you turn 65, you get a 7-month Initial Enrollment Period. It begins 3 months before the month you turn 65, includes your birthday month, and extends 3 months after your birthday month. Enrolling during this window ensures you avoid late enrollment penalties and gaps in coverage.
Example
If your 65th birthday is in June, your IEP runs from March 1 through September 30. For the earliest possible coverage start date, enroll during the first three months of your IEP (March, April, or May).
Automatic Enrollment
If you are already receiving Social Security retirement benefits when you turn 65, you will be automatically enrolled in Medicare Parts A and B. Your Medicare card will arrive in the mail about three months before your 65th birthday. If you are not yet collecting Social Security, you will need to actively sign up for Medicare through the Social Security Administration.
Under 65 With a Disability
You do not need to wait until age 65 to receive Medicare if you have a qualifying disability. Here's how it works:
- Social Security Disability Insurance (SSDI): If you have been approved for SSDI, you automatically become eligible for Medicare after a 24-month waiting period. Your Medicare coverage begins the 25th month after your SSDI benefits start.
- Railroad Retirement Board (RRB) disability: If you receive disability benefits from the RRB, the same 24-month waiting period applies.
During the 24-month waiting period, you may need to rely on other health insurance options such as employer coverage, COBRA, Marketplace plans, or Medicaid. Our agents can help you find bridge coverage during this time.
End-Stage Renal Disease (ESRD) & ALS
End-Stage Renal Disease (ESRD)
If you have permanent kidney failure requiring regular dialysis or a kidney transplant, you may qualify for Medicare regardless of your age. Key details:
- Coverage generally begins the fourth month of dialysis treatments, though it can begin earlier under certain conditions (such as participating in a home dialysis training program).
- If you receive a kidney transplant, Medicare may cover transplant-related services even before dialysis begins.
- Medicare coverage for ESRD may end 12 months after you stop dialysis or 36 months after a successful kidney transplant, depending on the circumstances.
ALS (Lou Gehrig's Disease)
If you are diagnosed with Amyotrophic Lateral Sclerosis (ALS), you receive special treatment under Medicare rules:
- There is no 24-month waiting period. Your Medicare benefits begin the same month your SSDI benefits start.
- You are automatically enrolled in both Part A and Part B.
Still Working at 65?
If you are still employed and have health insurance through your employer (or your spouse's employer) when you turn 65, you have options:
- Large employer (20+ employees): Your employer plan is the primary payer, and Medicare is secondary. You can delay enrolling in Part B without penalty as long as you have creditable employer coverage.
- Small employer (fewer than 20 employees): Medicare becomes the primary payer once you turn 65. You should enroll in Parts A and B during your IEP to avoid coverage gaps.
When your employer coverage ends (due to retirement, job change, etc.), you qualify for a Special Enrollment Period (SEP) that gives you 8 months to sign up for Part B without a late enrollment penalty.
It is important to enroll in Part A at 65 even if you delay Part B. Part A is typically premium-free and can serve as secondary coverage alongside your employer plan.
Important Note
COBRA and retiree health plans are not considered creditable employer coverage for Medicare purposes. If your only coverage is COBRA or a retiree plan, you should enroll in Medicare during your IEP to avoid penalties.
Late Enrollment Penalties
Missing your enrollment windows can result in permanent penalties added to your premiums:
- Part A penalty: If you must pay a premium for Part A and you delay enrollment without qualifying coverage, your premium may increase by 10%. This penalty applies for twice the number of years you could have been enrolled but were not.
- Part B penalty: Your monthly premium increases by 10% for each full 12-month period you could have had Part B but did not sign up. This penalty lasts as long as you have Part B.
- Part D penalty: If you go 63 or more consecutive days without creditable prescription drug coverage, you'll pay an extra 1% of the national base beneficiary premium for each month you were without coverage. This penalty is permanent.
These penalties are entirely avoidable with proper planning. Our agents can help you understand your enrollment deadlines and ensure you sign up on time.
Not Sure When to Enroll?
Our licensed agents will review your situation, identify your enrollment window, and make sure you don't miss any deadlines — all at no cost to you.