Medicare Eligibility

Almost all Americans who have a history of working will be eligible for Medicare at some point in their lives. This is because as an American, your taxes have helped to support Medicare and keep its benefits alive for the entire time you've been working.

Here are some general guidelines that will help you understand when you become eligible for Medicare and who is eligible for benefits.

1. Citizenship

Medicare is only available to citizens and permanent residents of the United States. This includes individuals who were born in the United States as well as those who became naturalized within the country later on in their lives.

2. Age

Virtually all Medicare beneficiaries are at least sixty-five years of age. When you turn sixty-five, you will have a defined window of opportunity of about seven months to enroll in the program. This will include the three months prior to your birthday and three months following it.

If you fail to enroll in Medicare at that time, you will have additional chances to do so during the "open enrollment" periods each year. Generally speaking, you can only enroll in Medicare during open enrollment. However, if you move or meet other criteria, you may be able to enroll under "special" enrollment.

"Open enrollment" is a time when you can enroll in or change your Medicare plan. It is the time to make changes such as adopting Medigap insurance, which can help you pay for medical services that Medicare does not generally cover on its own. Even if you miss your original enrollment date, you will always be able to change coverage each year.

3. Work History

You will only be eligible for Medicare Part A if you worked for at least ten years in Medicare covered employment. If you worked for less than ten years total in a situation where you paid taxes linked to the upkeep of Medicare, you will usually not be able to collect Medicare benefits. Naturally, this is not the case for very many individuals aged 65 or older.

There are other scenarios that can allow you to receive coverage under Medicare Part A without paying premiums. If you receive retirement benefits from either Social Security or the Railroad Retirement Board, you are automatically eligible for Part A at age sixty-five. This is true even if you have not yet filed to collect those benefits.

If you were employed in a government position that was covered by Medicare, you are eligible for Medicare at age sixty-five regardless of how long you maintained the position. This is also true if your spouse held such a position. This is one of the only scenarios in which a spouse's employment history can "transfer" eligibility to another. If you receive a government pension linked to previous public service, you are very likely to be eligible for Medicare.

Note that you are eligible for Medicare benefits even if you are not receiving Social Security retirement benefits. The status of your Social Security retirement benefits is not related to your eligibility for Medicare. You must simply be age sixty-five or older to ensure that you qualify for the general level of coverage.

Note that the above conditions are for Medicare Part A, which covers such things as in-patient treatment. You will never pay a premium for Medicare Part A as long as you meet the three basic requirements or the extended eligibility requirements.

However, Medicare Part B, which covers outpatient treatment and medical supplies, will always require a deductible and may have other costs associated with your treatments. When people talk about Medicare eligibility, they are usually referring to Part A.

How Does Eligibility Differ for Medicare Part B Versus Medicare Part A?

You may be eligible for Part B if you are a legal resident or citizen who has been in the country for no less than five consecutive years. However, you will still have to wait until age sixty-five, the age of eligibility. You can be eligible for Medicare Part B even if you are not enrolled in Medicare Part A.

Is Medicare Eligibility Possible For Those Younger than 65?

In very rare cases, it is possible to become eligible for Medicare benefits younger than age sixty-five. If any of these apply to you, you may become eligible for Medicare benefits immediately, regardless of your age. Again, this refers to "premium-free" eligibility under Medicare Part A, the standard by which the government judges your general eligibility for Medicare benefits.

Persons younger than 65 may become eligible for Medicare if:

  • You received Social Security disability benefits OR you received disability benefits from the Railroad Retirement Board for longer than a certain period. At present, that period is set at 24 months -- so you must have received benefits for at least 24 months and one day to become eligible.
  • You have end-stage renal disease, also known as kidney failure. The kidney failure must be permanent, and require either dialysis or transplant. If a transplant restores you to a state of health, you may not continue receiving benefits until you meet any of the other eligibility criteria outlined above.

Medicare eligibility is one of the simplest and most straightforward topics in Medicare. More than 99% of citizens will have no trouble receiving coverage as soon as they turn sixty-five. Coverage earlier than this date is reserved for very serious medical problems. There are no other ways to become eligible for Medicare, and no other avenues where you can become eligible sooner.