If you’re a United States citizen or legal permanent resident of at least five continuous years, you may be eligible for Original Medicare, Part A and Part B. This includes individuals who live in the U.S. territories, such as Puerto Rico, American Samoa, Guam, the Northern Mariana Islands, or the U.S. Virgin Islands.
You can qualify for Medicare in a few different ways:
- You’re 65 years old or older.
- You’re younger than 65 and have been receiving Social Security or Railroad Retirement disability benefits for at least two years.
- You’re younger than 65 and have end-stage renal disease.
- You’re younger than 65 and have amyotrophic lateral sclerosis.
Let’s take a look at how Medicare eligibility works in each of those scenarios.
Medicare eligibility if you’re turning 65
If you are currently receiving Social Security (SSA) or Railroad Retirement Board (RRB) benefits when you turn 65, you’ll be automatically enrolled in Original Medicare, Part A and Part B, on the first day of the month that you turn 65.
Most people get Part A for free if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes. If you don’t qualify for premium-free Part A, you can still qualify for it based on your spouse’s employment history if he or she has worked long enough to get Part A without a premium. Otherwise, you can still sign up Part A and pay a monthly premium for it, which will vary depending on how long you worked. Most people pay a monthly premium for Part B unless they qualify for low-income assistance.
If you are not currently receiving Social Security or Railroad Retirement benefits, you’re still eligible for Medicare, but you’re not automatically enrolled. You can sign up manually during your Initial Enrollment Period, which starts three months before your 65th birthday and lasts seven months. Keep in mind that if you don’t sign up for it when you’re first eligible, you could have to pay a late-enrollment penalty later on. You can take a look at this article for more information on Medicare enrollment periods and how to sign up.
Medicare eligibility if you’re disabled
You can also qualify for Medicare before 65 if you’re disabled and have been getting disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board. You’re eligible for Medicare Part A and Part B after 24 months of disability benefits; you’re automatically enrolled in the 25th month of disability benefits.
In addition, you may qualify for Medicare if you meet the eligibility requirements for the SSA disability program and you’re a child or widow(er) 50 years or older of someone who has worked long enough as a government employee through which Medicare taxes were paid.
Medicare eligibility if you have amyotrophic lateral sclerosis
You may qualify for Medicare at any age if you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Unlike those who qualify for Medicare because of other types of disabilities, there’s no two-year waiting period if you have amyotrophic lateral sclerosis and qualify for SSA or RRB disability benefits. Instead, you’re automatically enrolled in Medicare on the first day that your disability benefits start.
Medicare eligibility if you have end-stage renal disease
Like ALS, you may qualify for Medicare at any age if you have end-stage renal disease, also known as permanent kidney failure. You’re eligible if:
- Your kidneys no longer function.
- You need regular kidney dialysis.
- You’ve had a kidney transplant.
In addition, you must meet one of the following requirements:
- You’ve worked long enough to receive benefits under Social Security, the Railroad Retirement Board, or as a government employee.
- You’re eligible for or are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are the spouse or dependent child of someone who meets one of the first two requirements.
If you’re eligible for Medicare because of end-stage renal disease, contact Social Security or the Railroad Retirement Board (if you worked for a railroad) for more information. You can reach Social Security by calling 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM. To reach the RRB, call 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM; TTY users may call 1-312-751-4701.
The timing of when you’re first eligible and the start of your Medicare coverage may vary when you have end-stage renal disease, depending on a few factors. Your Medicare coverage typically starts on the first day of the fourth month that you start dialysis, but you may be eligible for Medicare benefits earlier than that if all of the following applies:
- You participate in an in-home dialysis training program to learn how to give yourself dialysis at home. The program must be offered through a Medicare-certified facility.
- Your doctor expects you to complete the training program and be able to perform your own dialysis.
- You continue to get the regular course of dialysis treatment during the three-month waiting period that would otherwise apply.
If you’re eligible for Medicare because of end-stage renal disease, you’ll lose your Medicare coverage 12 months after the month that you stop dialysis or 36 months after the month that you have your kidney transplant.
You may be eligible for Medicare benefits again if:
- You resume dialysis.
- You get a transplant within 12 months after the month that you stopped dialysis treatment.
- You start dialysis or get another transplant within 36 months after the month that you got your kidney transplant.
Eligibility for Medicare plans
Keep in mind that eligibility works differently for other parts of Medicare, including Medicare Part D (prescription drug coverage), Medicare Part C (Medicare Advantage), and Medicare Supplement (Medigap). You’ll need to manually sign up for these Medicare plans if you want it, and each type of coverage comes with its own rules when it comes to eligibility and when you can enroll.
Do you have questions about Medicare eligibility or other coverage options? If you’re interested in plan options that may work for your unique health needs and budget, you can contact a licensed insurance agent for help with your Medicare questions; just dial the number on this page to get started.