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Medicare Eligibility

How do I know if I'm eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:


  • You already get retirement benefits from Social Security or the Railroad Retirement Board
  • You are eligible to get Social Security or Railroad benefits but have not yet filed for them
  • You or your spouse had Medicare-covered government employment


If you are under 65, you can get Part A without having to pay premiums if:


  • You have received Social Security or Railroad Retirement
  • Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.


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A Quick Recap 

 

 ✔  7-month Initial Enrollment Period

 ✔  Medicare Part A is free for most people – it’s best to enroll during your Initial Enrollment Period

 ✔  Medicare Part B always has a premium based on income. You can delay enrolling in Part B, depending on your current health coverage, without a Part B penalty.

Frequently Asked

Questions

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  • Can I enroll in Medicare before I am 65 years old?

    You are automatically enrolled into Part A and Part B if you are already receiving Social Security or Railroad Retirement benefits. Everyone else will need to apply for Medicare at Social Security.

  • When does my Initial Enrollment Period begin?

    The first time you can enroll is called your Initial Enrollment Period. 


    Your 7-month Initial Enrollment Period usually:

    • Begins 3 months before the month you turn 65
    • Includes the month you turn 65
    • Ends 3 months after the month you turn 65

    For example, let’s say your birthday is May 4th. Your eligibility to enroll begins February 1st. Your Initial Enrollment Period is February 1st  through August 31st.


  • How do I get Medicare Part A without paying a premium?

    Most people qualify for premium-free Medicare Part A based on their work history. Here's what you need to know:


    Eligibility:

    You generally qualify for premium-free Part A if you or your spouse:

    • Paid Medicare taxes for at least 10 years while working.
    • Received Social Security or Railroad Retirement Board benefits for at least 4 months before turning 65.


    Enrollment:

    • If you meet the eligibility criteria, you'll automatically be enrolled in Part A at age 65, and you won't need to pay a premium.
    • If you're already receiving Social Security or Railroad Retirement Board benefits, you don't need to take any further action.
    • If you're not receiving benefits, you should contact the Social Security Administration to verify your eligibility and enrollment.


    Exceptions:

    • If you didn't work long enough to qualify for premium-free Part A, you can purchase it, but it will be considerably more expensive than the standard premium.
    • People with certain disabilities or End-Stage Renal Disease (ESRD) may also qualify for Part A on different terms.

  • Who is the Medicare health insurance program for?

    Medicare is a health insurance program for:

    • People age 65 or older
    • People under age 65 with certain disabilities
    • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant.)

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