Medicare Eligibility

Are you eligible? Read more to learn who qualifies.

Edward Neeman
Published on
December 6, 2023
Updated on
March 4, 2024

There are a lot of ways that one can become eligible for Medicare. By understanding the eligibility requirements, you can ensure that you are receiving the best health care coverage possible, even if you cannot afford medical premiums.

Here, we will cover the Medicare eligibility age, the Medicare eligibility requirements, and provide you with information on how you can do a Medicare eligibility check on your own. The experience of enrolling in Medicare is different for everyone, so make sure to do ample research before you decide you are ready.

Who Is Eligible For Medicare?

For the most part, most Americans become eligible for Medicare when they turn 65 years old, or if they are entering their 25th month of receiving Social Security Disability Insurance (SSDI). However, there are other criteria that may make you eligible for Medicare even if you don’t meet the criteria above, which will be touched on a bit further down.

It is important to note that Social Security will make the determination on whether you qualify for a Social Security Disability check, not Medicare. While Medicare eligibility may be determined by whether you receive a Disability check, they cannot change the determinations made by Social Security.

If you do not meet Medicare eligibility criteria, you can still apply for Medicare, but you will not receive premium-free healthcare. The premium you will pay is determined by a number of factors and you can find out how much your premium will be by consulting their free Medicare Eligibility Calculator.

Who Isn’t Eligible For Medicare

If you do not think you will qualify for Medicare based on your personal situation, you can review this information. Medicare is not guaranteed to everyone. There are certain Medicare eligibility criteria that must be met in order to qualify for health insurance at no cost, even after you have turned 65 years old.

If you complete our Medicare eligibility check and find that you do not meet Medicare eligibility criteria, take action as soon as possible to put yourself in a better position. You will not qualify for Medicare at no cost if you:

  • Have not been a resident of the United States for at least 5 years.
  • You or your spouse have not paid into Medicare tax for at least 10 years or 40 quarters.
  • You have not paid into Social Security for the same 40 quarters mentioned above.

Criteria To Qualify For Medicare

The requirements for most people to reach Medicare eligibility are simple, they must pay into Medicare tax for a period of 10 years, which equals at least 40 quarters. However, these are not the only eligibility requirements, and if you are not certain you will qualify, you can use their handy online Medicare eligibility check.

If you are not comfortable using their online forms to decide whether you are eligible for Medicare, you can contact your local Social Security Administration and they can run a Medicare eligibility check for you. The standard requirements for enrolling in Medicare when you are 65 years old include:

  • Being 65 or older
  • Being a citizen or legal resident of the United States for at least 5 years
  • Being eligible to receive Social Security Benefits
  • Being disabled
  • Being able to receive Railroad Benefits (even if you have not applied for them)
  • You or your spouse paid into Medicare taxes for 10 years (40 quarters)
  • You receive Social Security Disability
  • You have end-stage Renal Disease
  • You have Lou Gehrig's Disease
  • You are a kidney dialysis patient
  • You require a kidney transplant

If you have any question about Medicare eligibility criteria contact your local Social Security Administration to have them review your specific situation.

Getting Medicare At 62

While 65 years of age is to be the Medicare eligibility age, it is possible to meet Medicare eligibility criteria at the age of 62 or even much younger. Certain circumstances may move the Medicare eligibility age to 62, including a disability, or your spouse is 65 or older and qualified for Medicare benefits.

The Medicare eligibility age may be waived in cases where a person is disabled or meets Medicare eligibility in other areas. We will cover them next.

Other Eligibility Exceptions

There are exceptions that override the Medicare eligibility age. These exceptions include, but are not limited to:

  • Being permanently disabled
  • Receiving full disability benefits for at least two consecutive years.
  • Having end-stage renal disease
  • Having Lou Gehrig's Disease
  • Having ALS (Amyotrophic Lateral Sclerosis)
  • And many other medical conditions.

If you have any question about whether your medical condition qualifies you for enrollment in Medicare, contact your Local Social Security Administration for more information. Do not forget that you must sign up for Medicare before your 65th birthday. Failing to do so can result in serious penalties.

Even if you are not ready to sign up for Social Security Benefits, you must sign up for Medicare. Your Social Security benefit payments can be deferred until a later date, which is something a lot of people who are still able to work decide to do. Understanding the rules surrounding signing up for Medicare on time can save you a lot of hassle, and can help you avoid penalties associated with signing up late.

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