Who Qualifies for Medicare?

Aug 1, 2019

No, we all don’t wake up one day with magical healthcare benefits ready to use. But yes, most U.S. citizens will become eligible for Medicare benefits at some point. Keep reading to learn the details on who qualifies for Medicare, and when.

Medicare is Mostly for Seniors…

The age to qualify for Medicare is 65. If you meet the standard requirements, you’ll first become eligible for Medicare three months before your 65th birthday.

You don’t have to start using your Medicare benefits once you become eligible though. If you’re still working at the age of 65, you can use still opt to use your employer coverage, or you can even combine coverage.

…And a Few Others

There are a few exceptions to only those aged 65 plus getting Medicare. You may qualify for Medicare benefits under the age of 65 if you have:

  1. A disability, and are receiving benefits.
  2. End Stage Renal Disease (which requires a kidney transplant).

Medicare Eligibility

For those over the age of 65, there are still a few requirements to be met before qualifying for Medicare:

  1. You must be a U.S. citizen, or a legal resident for at least 5 continuous years (a permanent legal resident).
  2. You must get retirement benefits, whether it’s Social Security or the Railroad Retirement Board.
  3. You’ve paid into the program through paying Medicare taxes for at least 10 years (if you’ve legally worked in the U.S., you’ve paid into this.) This makes you eligible for Medicare Part A without a premium.

What About My Non-Working Spouse?

If you qualify for Medicare, and your non-working spouse meets the above requirements (and is over the age of 62), they can also be covered by your Medicare benefits. The coverage specifics (and costs) will depend on your spouse’s exact age and current healthcare coverage.

What if I Only Meet Some Requirements?

Even if you only meet some of the requirements above, you may still qualify for Medicare. For example:

Did not pay enough Medicare taxes: Depending on how much you’ve paid into the program through working taxes, you can still qualify for Medicare with a higher Part A premium cost. Or, you may qualify based on a former or deceased spouse work history.

Missed initial enrollment: Initial Coverage Election Period starts 3 months before your 65th birthday, includes your birthday month, and extends three months after that. If you are outside that time frame, you can defer to the general enrollment period.

With so many factors affecting your Medicare benefits, we always recommend speaking with someone who’s knowledgeable in Medicare to learn all the options available to you.

Get Started with Medicare

Want to see where you land with Medicare eligibility? Medicare.Gov has a great tool where you can see when your next general enrollment period is (and your initial enrollment period if you’re newly eligible), as well as how much you can expect to pay with your Part B premium: https://www.medicare.gov/eligibilitypremiumcalc/

Get the Power to Compare with the Freedom to Choose

Whether you’re looking to enroll for the first time, or want to switch plans, our independent agents know Medicare. Ask questions, learn all your options and compare plans–without an obligation.

Get Started with Medicare


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