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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 in 2018 Medicare enrollment nearly reached 60 million. 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 Start Receiving Medicare Part A Benefits?

You can start receiving Medicare Part A (hospital insurance) benefits with no premium once you are 65 or older if you or your spouse worked and paid Medicare taxes for at least 10 years. You can know you are eligible for premium-free Medicare A if 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.

When Can I Start Receiving Medicare Part B Benefits?

You can choose to purchase Medicare Part B benefits if you are eligible for Medicare Part A. It is a voluntary program that requires you to pay monthly premiums. For 2020, the standard premium is $144.60 (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 Part B 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 enrollment period, but you will have to pay a late enrollment penalty for as long as you have the coverage.

Can I Get Medicare If I Never Worked?

Yes, you can get Medicare if you never worked, but you’ll need to pay a premium for Medicare Part A. 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 Part A health insurance. In 2020, seniors who did not receive premium-free Part A coverage paid $458 per month if they paid Medicare taxes for less than 30 quarters (7 ½ years); those who paid Medicare taxes for 30 to 39 quarters pay $252 per month.

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.

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 whether or not you are receiving dialysis, have had a kidney transplant, and/or have paid Medicare taxes sufficiently.

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. You are not eligible for a Part D drug plan if you are enrolled in Medicare Part C. 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 enrollment penalty. 

Find Medicare Eligibility Information for Your State

Alabama Medicare Eligibility
Alaska Medicare Eligibility
Arizona Medicare Eligibility
Arkansas Medicare Eligibility
California Medicare Eligibility
Colorado Medicare Eligibility
Connecticut Medicare Eligibility
Delaware Medicare Eligibility
Florida Medicare Eligibility
Georgia Medicare Eligibility
Hawaii Medicare Eligibility
Idaho Medicare Eligibility
Illinois Medicare Eligibility
Indiana Medicare Eligibility
Iowa Medicare Eligibility
Kansas Medicare Eligibility
Kentucky Medicare Eligibility
Louisiana Medicare Eligibility
Maine Medicare Eligibility
Maryland Medicare Eligibility
Massachusetts Medicare Eligibility
Michigan Medicare Eligibility
Minnesota Medicare Eligibility
Mississippi Medicare Eligibility
Missouri Medicare Eligibility
Montana Medicare Eligibility
Nebraska Medicare Eligibility
Nevada Medicare Eligibility
New Jersey Medicare Eligibility
New Hampshire Medicare Eligibility
New York Medicare Eligibility
New Mexico Medicare Eligibility
North Carolina Medicare Eligibility
North Dakota Medicare Eligibility
Ohio Medicare Eligibility
Oklahoma Medicare Eligibility
Oregon Medicare Eligibility
Pennsylvania Medicare Eligibility
Rhode Island Medicare Eligibility
South Carolina Medicare Eligibility
South Dakota Medicare Eligibility
Tennessee Medicare Eligibility
Texas Medicare Eligibility
Utah Medicare Eligibility
Vermont Medicare Eligibility
Virginia Medicare Eligibility
Washington Medicare Eligibility
West Virginia Medicare Eligibility
Wisconsin Medicare Eligibility
Wyoming Medicare Eligibility

HealthMarkets Can Answer Your Medicare Eligibility Questions

If you are eligible for Medicare and are ready to shop for a plan, HealthMarkets can help. We make it easy to compare plans, get free Medicare quotes, and enroll. Answer a few short questions and to see what kind of Medicare plan might work best for your lifestyle, and which plans make the best fit. Get started now.


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References:
https://www.kff.org/medicare/state-indicator/medicare-beneficiaries-as-of-total-pop/ | https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts | https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b | https://www.medicare.gov/your-medicare-costs/part-a-costs | https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol/index.html | https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html | https://www.medicare.gov/getting-medicare-if-you-have-a-disability | https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-eligibility-overview/medicare-eligibility-for-those-under-65 | https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/who-can-join-medicare-advantage-plan.html | https://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-coverage.html

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