Medicare Eligibility

Some of the most common questions asked in the Medicare realm are: Who’s eligible for Medicare? And When can you get it? Midwest Trusted Benefit is your reliable source for Medicare answers and information.

Medicare eligibility begins for the majority of people at 65 — whether you’ve retired or not. There are some exceptions, though, which we’ll explain in more detail.

Who’s Eligible for Medicare Part A?

You qualify for Medicare when you turn 65 if you or your spouse has worked for 10 years in the United States. During those working years, you paid Medicare taxes toward your Part A (hospital) benefits. These taxes are the reason why most people don’t pay premiums for Part A when they qualify. 

If you’ve worked less than 10 years, you can still purchase Part A, but it will cost you money. There are partial premiums in some cases. 

When you turn 65, you may be auto-enrolled in Part A if you’ve already enrolled in Social Security benefits. Look out for your Medicare card around one month before your 65th birthday.

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Who’s Eligible for Medicare Part B?

You’re also eligible for Part B at age 65. You’ll pay a monthly premium for this part. 

Some people turning 65 are still actively working and have health coverage through their employer. These folks can wait to enroll in Part B — in favor of their group health plan — without accruing a late penalty.

If you delay your Part B enrollment, consider working with a Medicare agent who can explain the special enrollment periods you must use later on. 

Who’s Eligible for Medicare Part C?

If you want to get your benefits through a private company instead of Original Medicare, you can join a Medicare Advantage (Part C) plan. Some of these programs have built-in drug coverage. 

To be eligible for Medicare Advantage, you must first:

  • Be enrolled in Medicare Parts A and B, and
  • Live in the plan’s service area

You must stay enrolled in both A and B during the whole time that you’re enrolled in an Advantage plan. Learn more about Medicare Advantage here.

Who’s Eligible for Medicare Part D?

If you’re enrolled in EITHER Part A or Part B (or both) and live in the plan’s service area, you can enroll in Medicare Part D.  

You should sign up when you’re first eligible unless you have additional (creditable) drug coverage. Those who delay Part D enrollment will risk having to pay a costly penalty. 

Who’s Eligible for Medigap Insurance?

Medigap plans are supplemental insurance that you can add to your Original Medicare benefits. So, you need to be enrolled in both A and B to be eligible for Medigap.

Medicare Eligibility: FAQ

Does Everyone Qualify for Medicare?

No. You have to be a U.S. citizen or a permanent resident who has lived in the U.S. for five straight years. 

Who’s Eligible for Medicare Under 65?

While Medicare was originally designed for people age 65 and older, it has changed over time. These people can now qualify as well:

1. Individuals who get Social Security disability income benefits for 24 months are auto-enrolled in Medicare — on the 25th month.

2. People who get Social Security disability income benefits and are diagnosed with Lou Gehrig’s disease (ALS) are enrolled in Medicare — in the first month.

3. Those on kidney dialysis (ESRD) or kidney transplant patients qualify for Medicare. The benefits will take effect depending on your circumstances.

Who’s Eligible for Medicare and Medicaid?

It’s possible to qualify for both Medicare and Medicaid. People who do are known as dual-eligibles. Medicare will be their primary insurance, and Medicaid will be secondary.

Is it Mandatory to Sign Up for Medicare at 65?

No. However, if you don’t have other “creditable” health insurance, you’ll need to pay fines for waiting to enroll in Medicare.

Note: When you sign up for Social Security income benefits, you’ll be auto-enrolled in Medicare Part A. You can’t have Part A without SS or vice versa. 

Are You Eligible for Medicare? Find Out Today

Determining your Medicare eligibility can be challenging. We take several questions about when to get Medicare, how to qualify, when to sign up, and how to add supplement insurance. The process may feel complicated and overwhelming, but we make it easy for you! Call (402) 740-5505 to see if you’re eligible for Medicare.