# April, 28, 2020

Medicare Eligibility Age: How Do You Qualify for Medicare?

Medicare is America’s federally-run health insurance program. Currently, there are more than 59 million Americans enrolled in Medicare, with over 83 percent qualifying based on age. However, reaching the Medicare eligibility age is not the only requirement. This post explains the different ways you may qualify for Medicare.

How Old Do You Have to Be to Get Medicare?

The Medicare eligibility age is 65, although you may qualify if you’re younger and meet certain conditions (more on that below). However, turning 65 is not the only requirement. You must also be either a United States citizen or a permanent legal resident who has lived here for at least 5 years.

Can You Get Medicare Before Turning 65?

Yes, you can get Medicare before you turn 65 if you meet certain requirements.

Medicare qualifications before turning 65 include:

  • Qualifying for Social Security disability benefits for 24 months
  • Getting certain Railroad Retirement Board disability benefits
  • Having amyotrophic lateral sclerosis (ALS), more commonly known as Lou Gehrig’s disease
  • Having end-stage renal disease (ESRD)

Only one of these needs to apply to you for you to qualify for Medicare.

If you receive Social Security disability benefits, you’re automatically enrolled in Medicare Parts A and B in your 25th month.

People who have ALS are enrolled automatically the same month their disability benefits take effect. Those who have ESRD must sign up for Medicare.

Medicare Part A Eligibility

The eligibility rules for Part A are the same as for Medicare Parts B, C, and D. When people ask about Medicare Part A eligibility, they’re usually wondering whether they qualify for premium-free Part A.

Original Medicare includes two parts, A and B. Medicare Part A is also known as hospital insurance. It helps pay the cost of covered inpatient care, mainly surgical procedures.

You qualify for premium-free Medicare Part A if you or your spouse earned 40 credits. You earn credits by paying Medicare payroll taxes for at least 10 years. If you did not work the required 40 quarters, you may qualify under your spouse’s work record. Said spouse must be age 62 or older and you must be age 65 or older.

If you or your spouse do not have the required 40 credits, you still qualify for Medicare Part A, you just have to pay a monthly premium. The standard Medicare Part A premium is $458 per month for anyone who paid Medicare taxes for less than 30 quarters. If you worked between 30 and 39 quarters, your monthly premium is $252.

Qualifying for Medicare Parts B, C, and D

The second half of Original Medicare, Part B, is also known as medical insurance. It helps cover the cost of outpatient services, such as doctor appointments, preventive screenings, and lab work.

The standard monthly premium is $144.60 in 2020 (the amount changes from year to year). If your annual income exceeds $87,000 ($174,000 for married couples who file jointly), your premiums may be higher. Other out-of-pocket costs include the annual deductible and coinsurance, usually 20 percent of the cost of approved services.

Medicare Part C is more commonly known as Medicare Advantage (MA). Plans are sold by private insurance companies and resemble the group health plans many people had through an employer. Every MA plan must provide the same coverage as Original Medicare. However, they may also offer extra benefits, like prescription drug coverage. Premiums and other out-of-pocket costs vary according to the plan and provider. Please note that, even if you choose an MA plan, you still have to pay your Part B premiums. (And Part A if you don’t qualify for premium-free.)

Medicare Part D is how beneficiaries get prescription drug coverage. These plans are also provided by private insurance companies. Premiums, deductibles, and copays vary according to the plan and provider.

Some beneficiaries choose to enroll only in Part A, usually because they have a group health insurance policy when they turn 65. However, it’s important to note that, even if you have insurance, you may still need to enroll in Medicare Parts B and D to avoid late penalties. For example, if your plan is through a company that employs fewer than 20 people, it automatically becomes secondary insurance once you turn 65. Our article on creditable coverage explains all of the scenarios in which you may delay signing up for Medicare without incurring lifelong penalties.

Compare Medicare Plan Options

Compare Your Medicare Plan Options

Our Find a Plan tool makes comparing your Medicare plan options easy. Just enter your location information and coverage start date. Then hit Continue to see the Medicare plans in your area.

Look at the full cost of the plan, not just the monthly premium. This includes deductibles, co-pays, and yearly out-of-pocket maximums. Also, when reviewing prescription drug coverage, either through an MA plan or a standalone Part D plan, make sure the drug formulary includes your medications.

Medicare Eligibility FAQ

Is Everyone Eligible for Medicare When They Turn 65?

In addition to being age 65 or older, Medicare eligibility rules require you to be either a U.S. citizen or permanent resident who has lived in American for at least 5 years.

What Is the Medicare Eligibility Number?

If you have questions about the Medicare benefit age, call 1-800-MEDICARE (633-4227).

Are There Medicare Eligibility Income Limits?

Unlike Medicaid, where income is the main requirement, there are no income limits for Medicare.

Does Each State Have Different Medicare Requirements?

No, Medicare is a federal program. Whether you live in New York, Alabama, or California, Medicare eligibility requirements are the same.

Is There a Medicare Age Limit?

The standard Medicare age is 65 or older. There is no upper Medicare age limit, meaning you can’t “age out” of the program. However, there is a minimum age for Medicare if you qualify based on health issues or disability. In these instances, the Medicare coverage age range is 18 to 65.


Chris Gasparini

Chris Gasparini has been a licensed insurance agent since 2005. He enjoys helping Medicare beneficiaries navigate their options to find the best solution for their unique needs. Chris feels as though his work truly helps people. Because he represents multiple insurance companies and plan types, Chris is able to help Medicare beneficiaries find the best, most cost-effective plan. Every day, he leaves work knowing he did what was right for each and every client he serves.

The MedicareUSA website is operated by HealthPlanOne, LLC a licensed health insurance agency based in Connecticut; in California d/b/a HPOne Insurance Agency, license #OF30784. HealthPlanOne, is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

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Last Updated 12/21/2018