The Basics of Medicare Eligibility

Medicare is a federal health insurance program widely used by U.S. citizens and permanent residents age 65 and older. The program also applies to those younger than age 65 who have disabilities, end-stage renal disease (ESRD) or other diseases. But Medicare has multiple parts, and the eligibility requirements vary for each. 

Who Is Eligible for Medicare?

U.S. citizens or permanent residents who’ve lived in the U.S. for more than five years qualify for Medicare if they’re age 65 or older. Those younger than age 65 also qualify for Medicare if they disabilities or life-threatening diseases.

Medicare Eligibility for People Over 65

If you’re age 65 or older, you can get Part A coverage without paying premiums, as long as you or your spouse worked and paid Medicare taxes for at least 10 years, according to the U.S. Department of Health and Human Services. In order to skip the premium payments, though, one of the following must apply to you:

• You are receiving Social Security or Railroad Retirement Board retirement benefits
• You are eligible to receive Social Security or Railroad Retirement Board benefits but have not collected them
• You or your spouse had a Medicare-covered government job

Being eligible for Part A coverage also guarantees your eligibility for Part B Medicare coverage. The only difference is that you’ll have to purchase Part B coverage. However, if you’re receiving Social Security or Railroad Retirement Board benefits at least four months prior to turning 65, you’ll be automatically enrolled in Part B.

Medicare Eligibility for People Under 65

If you’re under age 65, you can enroll in Medicare if you:

• Have received Social Security Disability Insurance (SSDI) checks for at least 24 months
• Have been diagnosed with end-stage renal disease (ESRD)
• Have amyotrophic lateral sclerosis (ALS)
• Have permanent kidney failure which requires dialysis or a transplant

You’ll automatically receive Part A and Part B coverage if you’ve either gotten disability benefits from Social Security for 24 months, or if you’ve received certain disability benefits from the Railroad Retirement Board for 24 months, according to medicare.gov.

Medicare Eligibility for Part C and Part D

Medicare Part C is a Medicare health plan that’s typically offered by private insurance companies. Also known as Medicare Advantage, you’re eligible for Part C if you’re enrolled in Part A and Part B, you don’t have ESRD and the option is available in your area. These plans include health maintenance organizations, preferred provider organizations, special needs plans, private fee-for-service plans and Medicare medical savings account plans.

Offered by private insurance companies, Medicare Part D provides prescription drug coverage. You’ll need to be enrolled in Part A or Part B to be eligible. You won’t be eligible, however, if you’re enrolled in Part C coverage.

Bottom Line

Eligibility requirements for Medicare vary based on a number of different factors such as age and medical history and condition. This is why it’s crucial to do your research so you can determine which parts of Medicare best align with your retirement savings goals.

Retirement Planning Tips

• Not sure you’re saving enough for retirement? Our retirement calculator can help you determine your estimated Social Security benefits, how much money you need to retire and how much annual income you’ll need in retirement.
• A financial advisor can offer advice on any of your Social Security, Medicare or retirement savings needs. SmartAsset’s free financial advisor matching tool connects you with up to three local advisors.

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