Medicare Eligibility: The Basics

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Do you know how to become eligible for Medicare? More than 18 percent of Americans depend on Medicare for their health coverage, and Medicare enrollment is expected to reach 64 million by 2020. Here’s a straightforward guide to Medicare eligibility and links to specific information for your state.

Medicare Eligibility for People 65 or Older

When Can I Access Medicare Part A Benefits?

At 65 or older, you are eligible to receive Medicare Part A (hospital insurance) if you or your spouse worked and paid Medicare taxes for at least 10 years and one of the following applies to you:

  • You currently receive or are eligible for Social Security.
  • You currently receive or are eligible for Railroad Retirement Board (RRB) benefits.
  • You or your spouse served in a Medicare-covered government job.

If you received Social Security or RRB benefits at least four months prior to turning 65, you will receive Medicare Part A automatically. If not, you need to file an application with the Social Security Administration.

If you are a U.S. citizen over 65 and you or your spouse did not pay Medicare taxes for at least 10 years, you may be eligible to purchase Medicare health insurance. You will not be enrolled automatically, so you need to file an application with the Social Security Administration. You can then enroll in Medicare Part A and Part B for a monthly premium during a valid Medicare enrollment period. You will not be able to purchase Part A alone.

When Can I Access Medicare Part B Benefits?

If you are eligible for Medicare Part A, you can choose to purchase Medicare Part B. It is a voluntary program that requires you to pay monthly premiums. For 2018, the standard premium is $134 (or higher depending on income). If you do not enroll in Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have the coverage.

If you received Social Security or RRB benefits at least four months prior to turning 65, you will receive Part B automatically (unless you live in Puerto Rico). You will have a choice if you want to keep or refuse enrollment. If you refuse, you can re-enroll during a valid enrolment period, but you will have to pay a late enrollment penaltyfor as long as you have the coverage.

Medicare Eligibility for People Under 65

You are eligible for Medicare when you are under 65 years old if you: 

  • Have received Social Security Disability Insurance (SSDI) for 24 months.
  • Have end-stage renal disease (ESRD). 
  • Have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. 

How to Get Medicare Part A and Part B Coverage

  • If you receive SSDI for 24 months, you will automatically be enrolled in Medicare Parts A and B at the beginning of the 25th month.
  • If you have ALS, you will automatically be enrolled in Medicare Parts A and B as soon as you receive the first month of SSDI benefits.
  • If you have ESRD, you must apply for Medicare benefits. Medicare eligibility depends on a variety of factors, including if you are receiving dialysis, have had a kidney transplant, and/or have paid Medicare taxes sufficiently.[HS8]

Private Insurance Options: Medicare Part C and Part D

Medicare Eligibility for Part C (Medicare Advantage)

You are eligible for Medicare Advantage (also known as Medicare Part C) if:

  • You are enrolled in Medicare Part A and Part B. 
  • The plan you want to join is available in your area.
  • You do not have end-stage renal disease (ESRD).

Medicare Advantage plans are run by private insurance companies, so premiums and coverage will vary by plan.

Medicare Eligibility for Part D

To be eligible for Medicare Part D (drug coverage) you must be enrolled in Medicare Part A and/or Part B. Medicare Part D plans are run by private insurance companies, so premium prices and covered drugs will vary by plan.

You should enroll in a Medicare Part D plan when you are first eligible for Medicare, or risk paying a late penalty. You can avoid paying a late penalty in most cases if you have existing drug coverage or you receive extra help from Medicare.

Find Medicare Eligibility Information for Your State

Alabama Medicare EligibilityAlaska Medicare EligibilityArizona Medicare EligibilityArkansas Medicare EligibilityCalifornia Medicare Eligibility
Colorado Medicare EligibilityConnecticut Medicare EligibilityDelaware Medicare EligibilityFlorida Medicare EligibilityGeorgia Medicare Eligibility
Hawaii Medicare EligibilityIdaho Medicare EligibilityIllinois Medicare EligibilityIndiana Medicare EligibilityIowa Medicare Eligibility
Kansas Medicare EligibilityKentucky Medicare EligibilityLouisiana Medicare EligibilityMaine Medicare EligibilityMaryland Medicare Eligibility
Massachusetts Medicare EligibilityMichigan Medicare EligibilityMinnesota Medicare EligibilityMississippi Medicare EligibilityMissouri Medicare Eligibility
Montana Medicare EligibilityNebraska Medicare EligibilityNevada Medicare EligibilityNew Jersey Medicare EligibilityNew Hampshire Medicare Eligibility
New York Medicare EligibilityNew Mexico Medicare EligibilityNorth Carolina Medicare EligibilityNorth Dakota Medicare EligibilityOhio Medicare Eligibility
Oklahoma Medicare EligibilityOregon Medicare EligibilityPennsylvania Medicare EligibilityRhode Island Medicare EligibilitySouth Carolina Medicare Eligibility
South Dakota Medicare EligibilityTennessee Medicare EligibilityTexas Medicare EligibilityUtah Medicare EligibilityVermont Medicare Eligibility
Virginia Medicare EligibilityWashington Medicare EligibilityWest Virginia Medicare EligibilityWisconsin Medicare EligibilityWyoming Medicare Eligibility

HealthMarkets Can Answer Your Medicare Eligibility Questions

If you’d like additional Medicare guidance, consider working with HealthMarkets. Finding Medicare coverage has never been easier. We provide research and comparisons at no cost to you. Find a Medicare agent near you.


Sources: https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-eligibility-overview/medicare-eligibility-for-those-65 | https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-eligibility-overview/medicare-eligibility-for-those-under-65 | https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol/index.html | https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html | https://www.medicare.gov/eligibilitypremiumcalc/ | https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html | https://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-coverage.html | https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/who-can-join-medicare-advantage-plan.html

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