Medicare Eligibility, Age, Qualifications and Requirements

checkmark Fact checked Contributing expert: Kelly Blackwell, Certified Senior Advisor - Published: February 16, 2021

 

Medicare, the federal health insurance program, is available to people 65 and older and for younger people who live with disabilities or permanent kidney failure. To qualify for Medicare, you must be a U.S. citizen or lawful permanent resident, unless you are entitled to receive Social Security retirement benefits, Railroad Retirement Board (RRB) benefits, or Social Security Disability Insurance (SSDI).

What you should know:

  • 1 The age requirement for Medicare is 65, unless you are entitled to disability benefits or have permanent kidney failure.
  • 2 If you don’t qualify for premium-free Part A, you can pay a premium.
  • 3 You must qualify for Parts A and B to opt for Medicare Advantage (Part C) or Part D, or a Medicare supplement (Medigap, which helps cover costs related to Parts A and B).
  • 4 You can use Medicare’s eligibility tool to determine whether you qualify for coverage.

Medicare has four distinct parts:

  • Part A: hospital insurance, which helps cover hospital inpatient stays, skilled nursing facility care, hospice, and home health services
  • Part B: medical insurance which helps cover outpatient doctor visits, durable medical equipment, and some preventive services
  • Part C: Medicare Advantage, which bundles together Parts A, B, and usually D
  • Part D: drug coverage, which helps cover the cost of prescription drugs

You must qualify for Parts A and B to opt for a Medicare Advantage Plan (Part C) or Part D, or a Medicare supplement (Medigap, which helps cover costs related to Parts A and B).

Who qualifies for Medicare?

The age requirement for Medicare is 65, unless you are entitled to disability benefits or have permanent kidney failure. In the case of disability or permanent kidney failure, the age requirement of 65 is not enforced, but restrictions and timeframes apply. Most people who qualify for Medicare do not have to pay a premium for Part A, because they have worked at least 10 years (40 quarters) and paid Medicare taxes, or have worked for the railroad or in a civil service job.

If you are 65 or older, you can receive Medicare Part A benefits premium-free under any of these circumstances:

  • You are receiving or are eligible to receive retirement benefits from Social Security or the RRB.
  • Your spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or RRB benefits.
  • You or your spouse worked long enough in a government job through which you paid Medicare taxes.
  • You are the dependent parent of a fully insured deceased child.

If you are younger than 65, you can receive Medicare Part A premium free under any of these circumstances:

  • You have been entitled to Social Security or RRB disability benefits for 24 months.
  • You have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS). In this case, there is no waiting period, and your Medicare benefits begin the first month you get disability benefits.
  • You worked long enough in a government job through which you paid Medicare taxes, and you have met the requirements of the Social Security disability program for 24 months.
  • You’re the child or widow(er) age 50 or older, including a divorced widow(er), of a worker who has worked long enough under Social Security or in a Medicare-covered government job, and you meet the requirements of the Social Security disability program.
  • You have permanent kidney failure (end-stage renal disease) and you receive maintenance dialysis or a kidney transplant and one of the following applies:
    • You’re eligible for or receive monthly benefits under Social Security or the railroad retirement system.
    • You’ve worked long enough in a Medicare-covered government job.
    • You’re the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.

Is there a way to get Medicare if you don’t qualify for free?

Yes, if you do not qualify for premium-free Part A, you can buy Medicare Part A by paying premiums if you are 65 or older and a U.S. citizen/permanent resident.

You will pay a premium of either $259 or up to $471 each month in 2021 depending on how long you or your spouse worked and paid Medicare taxes. If you or your spouse paid Medicare taxes for 30 to39 quarters, your Part A monthly premium will be $259. If you or your spouse paid Medicare taxes for less than 30 quarters, your premium will be $471 per month. If you are paying premiums for Part A, and if you continue to work and pay Medicare taxes, those quarters will count toward your total number of quarters worked. Your premiums for Part A will be free once you work 40 total quarters.

In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you choose not to buy Part A, you can still buy Part B. Whether you pay Part A premiums or not, and regardless of whether or not you opt for Original Medicare Parts A and B, or a Medicare Advantage or Medigap plan, you will always pay a Part B premium.

You may be able to receive help paying for premiums if you qualify for a Medicare Savings Program if your income and resources are below a certain limit.

To find out if you’re eligible for Medicare and your expected premium go to the Medicare eligibility tool.

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Contributing Expert:

Kelly Blackwell, Certified Senior Advisor (CSA)

Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.