Priscilla Wright

(657) 205-1081

Medicare Eligibility


Who is eligible for Medicare anyway? And when can you get Medicare? Medicare eligibility begins for most people at age 65. Individuals who have been entitled to Social Security disability for at least 24 months also qualify.

Many people confuse their Medicare Eligibility date with their Social Security retirement age. They are different. A person can apply for full retirement income benefits at around age 67. This is considered their retirement age. However, this does not affect the age at which they qualify for Medicare.

There is no such thing as a Medicare retirement age. The normal Medicare eligibility age for Medicare is age 65, whether you have retired or not. You can qualify for Medicare coverage at age 65 (or older) if you are a U.S citizen or a permanent resident and you’ve lived here continuously for 5 years or more.

You can also qualify for Medicare under these circumstances when you are under age 65:
•if you are permanently disabled and you have been receiving Social Security disability income benefits for 24 months.
•when you have end-stage renal disease, which is kidney failure that requires you to get dialysis or you are waiting for a kidney transplant
•if you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease

Read on for further Medicare eligibility details:

Eligibility for Medicare Part A

Who qualifies for Medicare? Medicare Eligibility begins at age 65 for most people.

You are eligible for Medicare Part A at age 65 if you or your spouse has legally worked for at least 10 years in the U.S.

During those years, you paid taxes toward your Part A hospital benefits. This is why most Americans pay no Part A premiums when they become eligible for Medicare. Part A mainly covers your hospital stays.

If you have not worked the required 10 years to qualify for Medicare Part A at no cost, you can purchase Part A. Contact Social Security to find out the cost.

If you must purchase Part A, the coverage will cost over $400/monthly. In some cases, however, there are partial premiums for people who have worked over 30 but less than 40 quarters.

You may be automatically enrolled in Part A (and Part B) at the time you turn 65 if you have already enrolled in Social Security income benefits. Your Medicare card will usually arrive in your mailbox about 4 – 6 weeks before you turn 65.


Eligibility for Medicare Part B

You are eligible for Medicare Part B at age 65 as well. However, you must pay a monthly premium for Part B. This provides for your outpatient benefits such as doctor visits, lab work, surgery fees, and more. Check out our Part B page for more on what Part B covers.

Some people turning 65 still have health insurance through an employer. They can delay their enrollment into Part B in favor of their group health insurance without fearing a late penalty.

If you delay enrollment into Part B, consult with an insurance agent who specializes in Medicare. He or she can explain the special election periods which you must use later on so that you won’t be subject to a late enrollment penalty.


Eligibility for Medicare Part C

Medicare Part C is another name for the Medicare Advantage program. You can enroll in Part C if you wish to get your benefits through a private insurance company instead of Original Medicare. Usually these plans have smaller networks than Medicare, but some of them include built-in Part D coverage.

To be eligible for Part C, you must first be enrolled in both Medicare Parts A and B. You must also live in the plan’s service area.

Many people think that if they enroll in a Medicare Advantage plan, they can drop their Part B and escape paying Part B premiums. This is NOT the case. You must have both A and B to even be eligible to enroll in either a Medicare Advantage plan or Medigap plan. You must continue to be enrolled in Parts A and B during the entire time that you are enrolled in a Medicare Advantage plan.


Eligibility for Medicare Part D

You are eligible for Medicare Part D as long as you are actively enrolled in either Part A and/or B. You must also live in the Part D plans’s service area. Though Medicare Part D is voluntary, we strongly recommend it if you have no other drug coverage. Part D provides your insurance against future catastrophic medication costs. It will also help give you lower copays on medications you take now.

Be aware that if you do not enroll in Part D and you have no other creditable coverage, you may incur late penalties when you enroll later on.


Frequently Asked Questions

Is everyone eligible for Medicare?

No. You must be a U.S. Citizen or a permanent resident who has lived continuously in the United States for at least 5 years.

When do I qualify for Medicare?

If you aging into Medicare, you will qualify at age 65. This is regardless of when you apply for Social Security income benefits.

Who is eligible for Medicare under age 65?

Although Medicare was originally for only people aged 65 and over, that has changed over the years. The following people can now also qualify as stated above:
•Individuals who receive Social Security disability income benefits for 24 months are automatically enrolled in Medicare on the 25th month
•People who receive Social Security disability income benefits and are diagnosed with Lou Gehrig’s disease are enrolled in Medicare on the first month
•People on kidney dialysis or who are a kidney transplant patient are eligible for Medicare. When those benefits will begin depends on your specific circumstances

Is it mandatory to sign up for Medicare at age 65?

No, but if you do not have other creditable health coverage, you will face penalties for delaying your Medicare enrollment. You should also know that when you enroll into Social Security income benefits, you will be automatically enrolled into Medicare Part A. You cannot have one without the other.

Who is eligible for Medicare and Medicaid?

Medicare is our national health insurance system for people aged 65 and older and people with certain disabilities. Medicaid is a joint federal and state program to provide benefits for people with low incomes. It is possible to have qualify for both Medicare and Medicaid. In this scenario, Medicare is primary and Medicaid is secondary.

Find out about your Medicare Eligibility

Determining your Medicare eligibility is sometimes tricky. I often get many questions about how to qualify for Medicare, what the Medicare requirement are, when to enroll in Medicare, and how to set up Medicare supplement insurance. Though the process may seem overwhelming to you, I deal with these processes every day and can guide you easily through the process.

You are not alone – let Priscilla Wright, a licensed agent assist you in making this entire process easier.

Call 657-205-1081 or to request a free appointment!