Understanding Medicare Eligibility

Medicare is a federal health insurance program designed to provide seniors and certain younger Americans access to affordable health care coverage and key medical services. For most individuals in the United States, approaching age 65 marks the beginning of their Medicare eligibility.

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While most people become eligible for Medicare upon turning 65, this isn’t the only way to qualify for Medicare health insurance. Here’s a closer look at who is eligible for Medicare.

Who can get Medicare coverage?

If you’re wondering, “How do I qualify for Medicare?” the short answer is that you will be eligible when you turn 65. When you reach age 65, you typically qualify for Medicare Part A and Part B. Once you turn 65, you may be automatically enrolled in Medicare if you’ve met certain other requirements. Otherwise, you can enroll yourself during what’s referred to as the “Initial Enrollment Period.” The Initial Enrollment Period, or IEP, is your first Medicare enrollment opportunity, which begins three months before the month of your 65th birthday, includes the month you turn 65 and extends for three months afterward.

Beyond meeting the age requirement, other criteria may qualify you to receive Medicare coverage. These include:

• Receiving SSDI benefits: For anyone under age 65 who becomes disabled, once you have been receiving Social Security Disability Insurance (SSDI) cash benefits for at least 24 months, you will qualify for Medicare coverage.
• Living with specific disabilities: Those who have disabilities such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) will qualify to receive Medicare benefits before age 65 as well. For those with ESRD, there are additional criteria to meet before qualifying for Medicare, but with ALS, as soon as you begin receiving disability benefits, you will be automatically enrolled in Medicare Part A and Part B coverage.

How do I know if I will be automatically enrolled in Medicare when I turn 65?

If you’re wondering if you will be automatically enrolled in Medicare, the answer depends on when you begin receiving Social Security retirement or disability benefits.

If you start receiving Social Security retirement benefits (or benefits from the Railroad Retirement Board) at least four months before age 65, you will be automatically enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) the month you turn 65.

If you wait to receive Social Security retirement benefits but wish to receive Medicare when you turn 65, you will have to actively enroll when you qualify for coverage.

Click here to read more about being automatically enrolled in Medicare.

How do I know if I qualify for premium-free Medicare?

There is one form of Medicare coverage that can be “premium-free” for qualifying individuals: Medicare Part A, also known as “hospital insurance.” To be eligible for Medicare Part A coverage without any premiums, your work earnings need to reflect the minimum number of “quarters of coverage,” or QCs, that accrue through your payment of payroll taxes under the Federal Insurance Contributions Act (FICA).

The number of QCs needed to qualify for premium-free Medicare Part A depends on whether you want to enroll in Medicare based on your age or another reason, such as receiving SSDI benefits or having certain disabilities.

While Medicare Part A can be premium-free, Part B is considered voluntary coverage and requires premium payments. Individuals who are eligible for premium-free Part A coverage are also automatically eligible for Part B (though they can choose to decline it), while individuals who don’t qualify for premium-free Part A must meet the following requirements to enroll in Part B:

• Be age 65 or older;
• Be a U.S. resident; AND
• Be either a U.S. citizen, OR
• Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for five continuous years before the month of applying for Medicare.

How do I qualify for Medicare Part D?

To meet the eligibility requirements for Medicare Part D (prescription drug coverage), you must meet the following criteria:

• Be eligible for Medicare Part A and/or Part B, and
• Meet residency requirements for the service area of the Medicare Part D plan you are looking to enroll in

How do I qualify for Medicare Part C coverage?

While Medicare Parts A and B (often referred to as “Original Medicare” or “Government Medicare”) are available through the federal health insurance program, Medicare Part C, also called Medicare Advantage, is an alternative insurance option offered through private insurance companies that replaces Original Medicare.

If you are eligible for Medicare Parts A and B, you can opt for a Medicare Part C plan. To enroll in a Medicare Advantage plan, you must be enrolled and live in the service area of a Medicare Advantage provider you’re looking to purchase a plan from, and they must be accepting new plan users during your enrollment period.

Click here to learn more about Medicare Advantage and determine whether it may be the right option for you.

Who is not eligible for Medicare?

Most people qualify for Medicare health insurance when they turn 65. However, those under age 65 are usually not eligible, except for qualifying SSDI beneficiaries and those with ALS or ESRD.

In addition, anyone who is not a U.S. citizen or legal permanent resident who has lived in the United States for at least five years would also be considered ineligible for Medicare coverage, along with those without the necessary work history.

Next steps.

For more information about who qualifies for Medicare coverage or when you will be eligible to enroll in Medicare, visit the Medicare.gov website.

You can also contact an Aevo representative for a free one-on-one consultation anytime you have questions about Medicare or how to begin the enrollment process. We will get to know more about you and your unique situation to help offer you the most personalized experience possible as you make the important choice to enroll in Medicare. We can help you if you’re looking for the first time or are hoping to change your existing Medicare Advantage or Part D coverage options.