Eligibility FAQs

Medicare Eligibility: Age, Qualifications & Requirements

Medicare is a federal health insurance program designed mainly for people aged 65 and older. It also covers some younger individuals with disabilities and anyone with end-stage renal disease (ESRD). While the basic eligibility rules are consistent, the timing of when you can enroll might vary.

Who is eligible for Medicare?

Medicare has two main parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Here’s who can get Medicare:

Age 65 or Older

You’re eligible if you’re a U.S. citizen or permanent resident.
Specifically: Receiving or eligible to receive benefits from Social Security or the Railroad Retirement Board (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 where you paid Medicare taxes.
You’re the dependent parent of a fully insured deceased child.

Under Age 65

You might still qualify if you meet certain conditions.

With a Qualifying Disability

You’ve been entitled to Social Security Disability Insurance (SSDI) benefits for at least 24 months.
You’re receiving a disability pension from the RRB and meet certain conditions.
You’re receiving SSDI benefits due to amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

With ESRD

You have permanent kidney failure requiring dialysis or a kidney transplant.
You or a family member has worked long enough under Social Security or 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.

Automatic enrollment at 65

If you’re already receiving Social Security retirement benefits or Railroad Retirement benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. You’ll receive your Medicare card in the mail. If not, you’ll need to sign up yourself.

Medicare eligibility if you never worked

Even if you never worked, you might still qualify for Medicare. This can happen if:

Your spouse (living or deceased, including divorced spouses) worked and paid Medicare taxes.
You receive benefits from Social Security or the RRB based on your spouse’s work record.

Medicare eligibility if you're still working

If you’re still working when you turn 65, you’re still eligible for Medicare. Your employer’s insurance might be your primary coverage, and Medicare could provide secondary coverage. It’s a good idea to talk to your employer’s benefits administrator to see how Medicare works with your current insurance.

Cost of Medicare

Part A (Hospital Insurance)

What It Covers: Inpatient services like hospital stays and skilled nursing facilities (SNF).

Cost: If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), you usually don’t pay a monthly premium for Part A—this is called “premium-free Part A.” If not, the premium can be up to $518 per month (as of 2025).

Part B (Medical Insurance)

What It Covers: Outpatient care, medically necessary services, and some preventive services.

Cost: Everyone pays a monthly premium for Part B. In 2025, the standard premium is $185, but it could be higher depending on your income. Social Security will inform you of your exact premium amount.

When to enroll in Medicare?

Your Initial Enrollment Period (IEP) is a seven-month window. It starts 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after your 65th birthday month. If you miss this period, you might have to pay a late enrollment penalty.

Coverage Start Dates

Sign Up 1–3 Months Before Your 65th Birthday: Coverage begins on the first day of your birthday month.

Sign Up During Your Birthday Month: Coverage starts the first day of the following month.

Sign Up 1–3 Months After Your Birthday Month: Coverage starts the month after you enroll.

Eligibility for Medicare Part C, Medicare Part D & Medicare Supplement

Medicare Part C (Medicare Advantage)

A private plan offering additional benefits beyond Original Medicare, like vision, dental, and prescription drug coverage.
Eligibility: You’re eligible for Medicare Advantage when you have both Part A and Part B.

Medicare Part D (Prescription Drug Coverage)

Helps cover the cost of prescription drugs.
Eligibility: Available to anyone enrolled in Medicare. You can get Part D through a standalone plan or as part of a Medicare Advantage Plan.

Medicare Supplement (Medigap Insurance)

Supplemental insurance to help cover costs not included in Original Medicare, like copayments, coinsurance, and deductibles.
Eligibility: You must have both Part A and Part B to purchase a Medigap policy.