Medicare Eligibility: Who Qualifies?

Medicare eligibility: the basics

January 6, 2022

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3 minute read

Do you know how to become eligible for Medicare? More than 18 percent of Americans depend on Medicare for their health coverage, and in 2019 Medicare enrollment reached over 60 million. Here’s a straightforward guide to Medicare eligibility.

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 a certain period of time. 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 2022, the standard premium is $170.10 (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?

If you are a U.S. citizen over 65 and you or your spouse did not pay Medicare taxes for long enough, you may be eligible to purchase Medicare Part A health insurance. In 2022, seniors who did not receive premium-free Part A coverage paid $499 or $274 per month depending on how long Medicare taxes have been paid through employment.

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 or RRB benefits on the basis of disability 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 Social Security or RRB benefits 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 disability 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.

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 should not purchase a separate Part D drug plan if you are enrolled in Medicare Part C plan that includes drug coverage. 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. You can avoid paying a late penalty in most cases if you have existing drug coverage.

HealthMarkets can help 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 for your lifestyle, and which plans fit. Get started now.