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Medicare Basics

When Am I Eligible for Medicare

The U.S. government established Medicare, a health insurance system, to help U.S. residents who meet certain criteria meet the costs of their healthcare. There are various ways you can qualify:

Age-Related Medicare: Turning 65

Most people meet Medicare’s eligibility requirements the year they turn 65. However, the Initial Enrollment Period (IEP) actually lasts for seven months. It begins three months before the month of your 65th birthday and extends through the three months that follow your birthday. So, if your birthday is on Valentine’s Day, your Medicare entitlement begins in November and extends through May. Coverage begins on the first day of the month of your 65th birthday. In this example, that would be February 1.

The Medicare and Social Security Connection

For many of us, Medicare and Social Security benefits are closely linked. That’s because, until recently, eligibility for both began at age 65. And, if you receive Social Security benefits by age 65, you do enjoy automatic enrollment in Medicare. However, in 2012, the Social Security Administration increased the retirement age to 66 for individuals born between 1948 and 1954. What’s more, people born after 1954 won’t receive their Social Security benefits until age 67. In other words, Medicare and Social Security eligibility are no longer linked.

Medicare Eligibility Is Not Automatic

One of the more common misconceptions about Medicare eligibility is that everyone receives their benefits upon turning 65. This is not true. Age-related Medicare eligibility requires meeting the following criteria:

  • You are either an American citizen or a permanent, legal resident who has resided in the U.S. for at least five years.
  • Either you or your spouse worked for at least 10 years to earn the 40 credits necessary to receive railroad retirement or Social Security benefits. One credit equals three months (one-quarter of a year). You receive Part A services without paying a premium only if you earned 40 credits.
  • Either you or your spouse is employed by or retired from the government and did not pay into Social Security but did pay Medicare taxes while employed.

If you did not earn 40 credits, you must pay a monthly premium for Medicare Part A hospital insurance. You can also apply for Part A coverage without paying a premium based on your spouse’s work record if you are at least 65 and your spouse is at least 62.

Medicare Entitlement when Under the Age of 65

You may qualify for Medicare benefits before turning 65 if you meet one of the following criteria:

  • You have received Social Security Disability Insurance checks for at least 24 months
  • You receive a disability pension from the Railroad Retirement Board and meet certain conditions
  • You have amyotrophic lateral sclerosis (ALS, commonly known as Lou Gehrig’s disease)
  • You need a kidney transplant or dialysis due to permanent kidney failure and your spouse paid the requisite amount in Social Security taxes for a specified period