Medicare: Eligibility, Age, Qualifications, And Requirements

Fact Checked
Contributing expert: Ron Elledge, Medicare consultant
Reviewed by: Kelly Blackwell, Certified Senior Advisor®, Caren Lampitoc, Medicare consultant
Updated: September 23, 2021

Are you approaching your 65th birthday and ready to look into Medicare? Understand eligibility qualifications and requirements to help you enroll in Medicare with confidence.

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Ron Elledge
Medicare Consultant and Author
Ron Elledge
Medicare Consultant and Author

Ron Elledge is a seasoned Medicare consultant and author of “Medicare Made Easy.” As a Medicare expert, he regularly consults beneficiaries on Medicare rules, regulations, and strategies.

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Kelly Blackwell
Certified Senior Advisor (CSA)®
Kelly Blackwell
Certified Senior Advisor (CSA)®

Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.

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Caren Lampitoc
Medicare Consultant
Caren Lampitoc
Medicare Consultant

Caren Lampitoc is an educator and Medicare consultant for Medicare Risk Adjustments and has over 25 years of experience working in the field of Medicine as a surgical coder, educator and consultant.

If you’re turning 65 or have a qualifying disability, you can get Medicare coverage for your health care needs. Understand your eligibility, qualifications, and requirements for Medicare’s programs and learn how you can take advantage of them.

Medicare Qualifications

In general, you are eligible for Medicare if:

  • You are age 65 or older and a U.S. citizen or permanent legal resident for at least five consecutive years immediately prior to applying for Medicare.
  • You are disabled and receiving disability benefits. Medicare enrollment is automatic after you have been on Social Security disability for 24 months.
  • You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

Medicare Enrollment

Do you have to enroll in Medicare? You may be eligible for automatic enrollment. Otherwise, you’ll need to contact the Social Security Administration.

Automatic enrollment: Individuals already receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before being eligible, who reside in the United States (except residents of Puerto Rico), are automatically enrolled in both premium-free Medicare Part A and Part B. People living in Puerto Rico who are eligible for automatic enrollment are only enrolled in premium-free Part A. Automatic enrollment can be a problem if you are enrolled in a Health Savings Account (HSA). You cannot contribute to an HSA once you are on any part of Medicare.

Manual enrollment: If you are not receiving Social Security or RRB benefits, you are not automatically enrolled. You must apply by contacting Social Security. Call three months before your eligibility date.

Who Receives Premium-free Part A and Who Must Pay for Medicare Part A?

You must be entitled to receive Medicare based on your own earnings or those of your spouse, parent, or child to be eligible for premium-free Part A. The worker must have a qualifying number of quarters of coverage earned through payment of payroll taxes under the FICA during their working years.

The exact number of quarters required is dependent on eligibility for premium-free Part A is based on age, disability, or End-Stage Renal Disease (ESRD). The general rule for qualifying based on age 65 is 40 quarters of work during the worker’s lifetime.

If you are not eligible for premium-free Part A based on 40+ tax quarters, you may purchase Part A with the following monthly premiums: If you paid Medicare taxes for less than 30 quarters, the standard Part A monthly premium is $471 for 2021. If you paid Medicare taxes for 30-39 quarters, the standard Part A monthly premium is $259 for 2021. Other eligibility requirements still apply.

The eligibility rules for Part B depend on whether you are eligible for premium-free Part A or you must pay a premium for Part A coverage.

If you are eligible for premium-free Part A, you are also eligible to enroll in Part B when you enroll in Part A.  Enrollment in Part B can only happen at certain times.

If you must pay a premium for Part A, you must meet certain requirements to enroll in Part B. You must be age 65 or older. If you qualify for premium-free Part A, residency is not a requirement. However, if you do not qualify for premium-free Part A, you must be a U.S. resident and be either a U.S. citizen OR  a permanent resident who has been residing in the United States for five continuous years prior to the month of application. You may enroll in Part B without purchasing Part A, but if you purchase Part A, you must enroll in Part B..

Medicare Supplement, Medicare Advantage, and Medicare Prescription Drug Plan (PDP) Enrollment

Medicare Supplement Insurance Plans (Medigap) and Medicare Advantage Plans require that you maintain Part A and Part B enrollment to qualify.

A Prescription Drug Plan (PDP), also known as Medicare Part D, can be obtained as a Stand-Alone (PDP) Plan or included in a Medicare Advantage (MA-PD) Plan. You must be eligible for Part A and/or enrolled in Part B for the stand-alone PDP Plans.

Medicare Advantage Plans with prescription drug coverage (MA-PD Plans) require Parts A and B to remain active. Further discussion of this topic can be found in the article: Medicare Enrollment: Who, When, and How to Enroll.

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