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Medicare Eligibility: 3 Facts You Should Know

By Kaelyn Johnson, MPH, RD
Are you looking for information about Medicare eligibility? Here are 3 facts you should know.

Medicare is federal health insurance for people who are 65 or older and certain younger people with qualifying disabilities or illnesses. If you are approaching retirement age or have recently been diagnosed with a serious illness, you may find yourself wondering whether you qualify for Medicare. Read on for 3 key facts about Medicare eligibility. 

Age is a Primary Medicare Eligibility Factor

Medicare is generally known as the federal health insurance program for people age 65 and older. Original Medicare is the name for Medicare Part A (hospital insurance) and Part B (medical insurance). 

According to the U.S. Department of Health & Human Services (HHS), you are eligible for premium-free Part A coverage if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least ten years.

 Additionally, you’re eligible for premium-free Part A coverage at age 65 if: 

  • You are currently receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB)
  • You are eligible for Social Security or RRB benefits, but you have not yet filed to obtain them
  • You or your spouse worked for a Medicare-covered government employer

If you’re age 65 or older and a citizen or permanent resident of the United States, but you or your spouse did not pay Medicare taxes while employed, you may be able to buy Part A coverage. 

Part B coverage is a different story, according to HHS. While you become eligible for Part B coverage at age 65, all enrollees in Part B must pay a monthly premium. The amount of this premium will be deducted from your Social Security, Railroad Retirement, or Civil Service Retirement disbursements. If you do not receive any of those forms of payment, you can expect a bill from Medicare for your Part B coverage every three months. 

Disabilities Can Also Affect Medicare Eligibility

According to the Centers for Medicare and Medicaid Services, certain individuals with disabilities can also qualify for Medicare before age 65. You will be automatically eligible for Medicare Part A once you’ve received monthly Social Security or RRB benefits on the basis of disability for 24 months. 

Additionally, disabled employees of the federal, state, or local government who aren’t eligible for monthly Social Security or RRB payments may gain eligibility for disability benefits and Medicare Part A coverage after being disabled for 29 months. 

There’s also special coverage for those who have Lou Gehrig’s disease, also known as ALS. These individuals become eligible for Part A during the first month that they become entitled to Social Security or RRB disability cash benefits—they are not subject to a waiting period. 

Unfortunately, there is no exception for children with disabilities. Because Social Security Administration (SSA) rules dictate that child disability benefits cannot begin before age 18, children cannot become eligible for Part A coverage based on child disability benefits. Those who begin receiving SSA disability benefits at age 18 must therefore wait the standard 24 months before gaining eligibility for Medicare Part A. 

There is Special Coverage for End-Stage Renal Disease (ESRD)

The Centers for Medicare and Medicaid Services reports that, if you have end-stage renal disease and regularly receive dialysis or have a kidney transplant, you are eligible for premium-free Medicare Part A if you’ve filed a Medicare application and meet 1 of these requirements:

  • You’ve worked the required amount of time under Social Security, RRB, or as a government employee
  • You are currently receiving or are eligible to receive Social Security or RRB benefits
  • You are the spouse or dependent child of someone who has worked the required amount of time under Social Security, RRB, or as a government employee

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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.