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Medicare Age Eligibility: What Are the Qualifications and Requirements?

Published: June 18th, 2020

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Maybe you already know that you need to be at least 65 to sign up for Medicare, the health insurance program for older adults run by the U.S. federal government.1 To qualify, you must also be a U.S. citizen or have been a legal resident of the U.S. for at least five years. 2 

But did you know that some people are eligible to sign up even before age 65?3 (More on that below.) And you can still sign up even after age 65, though you might have to pay a penalty.4  

If you or your spouse paid Medicare taxes on your salary for 10 years or more, you’re eligible for Medicare once you turn 65 and you won’t without any need to pay premiums on Medicare Part A (hospital care).

If you or your spouse worked for less than 10 years, you still qualify for Medicare Part A, but you may need to pay a monthly premium, which will be based on how long you worked. 

And if your spouse has worked for more than 10 years, you still qualify for Medicare Part A with no premiums as soon as your spouse turns 62. Your spouse, though, will have to wait until he or she turns 65 to be eligible for Medicare, even though they have made you eligible.5

Everyone who receives Medicare Part B (medical, or outpatient insurance) is required to pay a monthly premium, which is based on your income.6 (Medicare Parts A and B together are often called “Original Medicare.”)

And all Medicare beneficiaries pay a monthly premium for Medicare Part D (prescription drug coverage) based on the plan they choose.7 Parts A, B and D and may even cover extra health costs such as vision or dental care or even exercise classes—none of which are covered under original Medicare.8 Medicare Part C is also known as Medicare Advantage.9  

When Are You Eligible to Enroll in Medicare?

You can apply for Medicare during the Initial Enrollment Period, which includes the three months before your 65th birthday, the month of your 65th birthday and the three months after your 65th birthday.10

If you didn’t apply for Medicare within the seven months surrounding your 65th birthday, the window to apply opens again at the beginning of each year, from January 1 to March 31. But your actual health coverage won’t begin until July of that year.11

What If You’re Over 65?  

You can still sign up for Medicare if you didn’t do so at age 65. But you may have to pay a 10% penalty on the monthly premiums for Medicare Part B (medical insurance) for every 12-month period you didn’t opt in for Medicare coverage after becoming eligible. 

Less commonly, if you didn’t sign up at age 65, you may have to pay a surcharge for Medicare Part A as well.12

What If You’re Younger Than 65?  

Special circumstances do qualify some people for enrollment in Medicare before age 65:

  • If you have end-stage renal disease (ESRD), you’re generally eligible for Medicare three months after you begin dialysis or as soon as you have had a kidney transplant.
  • If you have a disability and are receiving Social Security benefits, you’re eligible for Medicare 24 months after the Social Security benefits begin.
  • If you have the degenerative condition called amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s Disease) you are eligible for Medicare as soon as your Social Security disability benefits begin.13

What Should You Do If You’re Nearing Medicare Age Eligibility?

If you’re under 65 and already receiving Social Security benefits, you don’t need to do a thing to sign up for Medicare as your 65th birthday approaches. You’ll automatically be enrolled in Medicare Part A and Medicare Part B, both of which will be effective the month you turn 65.14

You’ll then get your Medicare card in the mail, which you’ll need to show at all healthcare visits.15 And you’ll also receive information packets explaining your Medicare benefits, which include a comprehensive free checkup during the first year you’re a Medicare beneficiary.16

If you’re not already receiving Social Security benefits, it’s up to you to contact the Social Security Administration to sign up for Medicare.17And if you want coverage for prescription drugs, you’ll have to apply for  Medicare Part D coverage on your own.  

Are There Other Ways to Get Health Insurance Coverage?

If you’re still working at age 65, you have health insurance through your employer and your company doesn’t require those over 65 to sign up for Medicare, you can keep your employer coverage and you won’t be penalized if and when you do sign up, even if it’s after you turn 65.18

If you or your spouse haven’t worked for at least 10 years in total, you won’t qualify for no-premium Medicare Part A (hospital insurance). But you can still sign up for Part A insurance; you’ll just have to pay a monthly premium. (Keep in mind that in many cases you may qualify for no-cost Part A coverage even if you’re divorced or your spouse died.)19

Medicare offers excellent health benefits for  millions of Americans. Knowing your options will help you choose the right time to sign up.


Sources

1.  U.S. Government Website for Medicare. “Enrolling in Part A and B.” medicare.gov (accessed June 2020).

2.  U.S. Department of Health and Human Services, “Who Is Eligible for Medicare?” hhs.gov (accessed June 2020).  

3.  Social Security Administration. “Medicare Benefits.” ssa.gov (accessed June 2020).  

4.  Social Security Administration. “Medicare.” ssa.gov (accessed June 2020).

5.  U.S. Government Website for Medicare. “What’s Medicare?” medicare.gov (accessed June 2020).

6.  U.S. Government Website for Medicare. “Part B Costs.” medicare.gov (accessed June 2020).

7.  Medicare Rights Center. “Medicare Part D.” medicareinteractive.org (accessed June 2020). 

8.  What’s Medicare? 

9.  Medicare Rights Center. “The Parts of Medicare (A,B,C,D).” medicareinteractive.org (accessed June 2020). 

10.  U.S. Government Website for Medicare. “Parts A and Part B Sign Up Periods.” medicare.gov (accessed June 2020). 

11.  ”Part A and Part B Sign Up Periods.”

12.  ”Part A and Part B Sign Up Periods.”

13. Center for Medicare Advocacy. “Medicare for People Under 65.” medicareadvocacy.org (accessed June 2020).

14.  “Enrolling in Part A and B.”

15.  U.S. Government Website for Medicare. “Your Medicare Card.” medicare.gov (accessed June 2020).

16.  U.S. Government Website for Medicare. “Mail You Get About Medicare.” medicare.gov (accessed June 2020)

17.  Social Security Administration. “Medicare.” ssa.gov (accessed June 2020).

18.  Centers for Medicare and Medicaid Services. “Fact Sheet: Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65.” cms.gov (accessed June 2020).

19.  U.S. Government Website for Medicare. “Part A Costs.” medicare.gov (accessed June 2020). 

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