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Medicare Eligibility: Do You Qualify?

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Medicare Eligibility: Do You Qualify?

Ronald Barba
by   

Updated: August 28, 2017    Published: June 8, 2017

Medicare Eligibility: Do You Qualify? | The CheckUp by HealthCare.com
Image: fiction of reality / Flickr

Whether you’re getting closer to turning 65 or you’re nowhere near that age, this is what you need to know about Medicare eligibility.

There are currently more than 55.5 million people in the United States covered under Medicare, according to stats from the Kaiser Family Foundation. Typically, most Medicare recipients are 65 and older, but there are a few cases where those under 65 can qualify for Medicare coverage. (The figure from KFF includes both recipients years 65 and older, as well as those younger than 65).

Whether over 65 or under 65, here’s the core details you need to know about Medicare and Medicare eligibility.

What Is Medicare?

Medicare is a federal social insurance program that provides health insurance for the elderly and some disabled individuals. People sometimes confuse Medicare with Medicaid, but unlike Medicaid, which is backed by a joint effort between federal and state governments, Medicare is exclusively backed by the federal government. Because of this, Medicare eligibility requirements and policies are the same for people regardless of where they live in the United States.

Medicare Eligibility

Medicare eligibility is universal across the United States. Eligibility can be separated into two separate groups:

65 Years and Older

This is the primary group for which Medicare was set up. To qualify, you’ll need to fulfill two requirements:

  1. You must have been a U.S. citizen or permanent resident for more than 5 years, AND
  2. You must have paid Medicare taxes for at least 10 years.

If you fulfill these requirements, then you become automatically enrolled into Medicare Part A when you reach the age of 65 and become eligible for Social Security. You’ll also qualify for Medicare Part B, but you’ll need to manually sign-up for it.

If you’re already getting Social Security or Railroad Retirement Board (RRB) benefits, then you’ll automatically get Medicare Parts A and B when you turn 65 years old.

64 Years and Younger

There are few cases where people under the age of 65 are eligible to get Medicare benefits. To qualify, you’ll need to belong to one of three groups:

  1. You’re permanently disabled and you’ve received Social Security Disability Insurance (SSDI) for at least the last two years; OR
  2. You’re suffering from end-stage renal disease (ESRD)/end-stage kidney disease and need to undergo continuous dialysis or need a kidney transplant; OR
  3. You receive Social Security disability benefits for amyotrophic lateral sclerosis (ALS)/Lou Gehrig’s disease.

What Is the Right Kind of Medicare Coverage?

With Medicare eligibility settled, the next question becomes: which type of coverage is right for you? The answer: it all depends on what your needs look like. You can read more about how to choose the right Medicare coverage here.

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