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Medicare Eligibility

Medicare Eligibility

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease or Lou Gehrig’s disease

There are two ways to qualify for Medicare benefits:

  • By age
  • By health status

Let’s look at these two ways to qualify in more detail.

Medicare Eligibility By Age

To qualify for Medicare based on your age, you must:

  • Be 65 years of age or older
  • Be a US citizen or be a permanent resident of the US for 5 years

You earn the right to get Medicare benefits if you or your spouse worked and paid Medicare tax for at least 10 years.

If you are 65 or older and qualify for Social Security or Railroad Retirement Board benefits, you qualify for Medicare benefits. It doesn’t matter if you haven’t filed to receive these benefits. You only need to qualify for them.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A for a monthly premium.

Contact the Social Security Administration with questions about your Medicare eligibility by visiting your local office or calling them at 1-800-772-1213 (TTY 1-800-325-0778).

Medicare Eligibility By Health status

You may qualify for Medicare based on your health if you are under 65. Medicare benefits are available to people under 65 with specific medical conditions and disabilities.

You may qualify for Medicare at any age if you have:

  • End Stage Renal Disease (permanent kidney failure that requires dialysis or a kidney transplant) after four months of dialysis.
  • Amyotrophic Lateral Sclerosis (ALS), also known as (Lou Gehrig’s Disease), and receive your first month’s disability benefit.
  • Received Social Security or Railroad Retirement Board disability benefits for the last 24 months.

Contact the Social Security Administration with questions about your Medicare eligibility by visiting your local office or calling them at 1-800-772-1213 (TTY 1-800-325-0778).

Original Medicare & Medicare Advantage

Everyone who qualifies for Medicare is eligible for Medicare Part A and Part B. These are often called original Medicare.

Medicare Advantage (Medicare Part C) is an popular alternative to original Medicare. You are eligible for Medicare Advantage when you are enrolled in original Medicare Parts A and B.

Medicare Part D Eligibility

Everyone eligible for original Medicare (Medicare Part A and/or Medicare Part B) is eligible for Medicare Part D, Prescription Drug Coverage. There are several ways you can get prescription drug coverage.

  • You can purchase Medicare Part D through a private insurance company.
  • You can get prescription drug coverage as part of your Medicare Part C (Medicare Advantage) policy.
  • You may have existing prescription drug coverage through another insurance policy, like insurance through an employer or retirement system.

If you have prescription drug coverage through another insurance policy, your policy must cover at least as much as Medicare Part D. If it does not, you will be required to enroll in Medicare Part D at age 65 when you are first eligible for Medicare or pay a penalty if you enroll at a later date. Contact your insurance company for details.

If you do not have prescription drug coverage when you enroll in Medicare, and later you choose to enroll in Medicare Part D, you must pay a penalty of 1% for every month you were eligible for Part D but did not enroll. This is lifetime penalty. It remains in effect for the entire time you are enrolled in Medicare Part D.

Now that you understand your Medicare eligibility, let’s talk about how to enroll.