Original Medicare Eligibility
Wondering if you’re eligible for Original Medicare? Here's what you need to know.
Original Medicare (often just called "Medicare") is a health insurance program offered by the U.S. government. It helps cover many medical expenses, such as hospital visits and doctors appointments.
It is mostly a program for people 65 and older, but Medicare is also available to certain people under 65 with qualifying disabilities or medical conditions such as end-stage renal disease (ESRD, which is permanent kidney failure that requires dialysis or a transplant).
Medicare eligibility can be confusing, but we'll help guide you through the important information so you understand if you qualify.
Am I eligible for Original Medicare?
For most people, age is the most important factor in Medicare eligibility. Generally, people age into the program when they turn 65. Below are general guidelines. For questions about your eligibility, contact your local Social Security office.
Your current age and other factors will determine your eligibility:
I am 65 or older... |
Your 65th birthday comes with a reason to celebrate—you can join Medicare!
You're eligible for Medicare Part A at no cost and to purchase Part B for a premium if you've been a U.S. permanent resident for at least five consecutive years and are receiving (or eligible to receive) Social Security or Railroad Retirement benefits.
Alternatively, if you or your spouse worked long enough in a government job where you paid Medicare taxes, you're eligible.
I am younger than 65... |
Some people under the age of 65 can also qualify for Medicare.
If you've been covered by Social Security Disability Insurance (SSDI) for 24 months, or are receiving a disability pension from the Railroad Retirement Board, you might be eligible.
Additionally, specific conditions like Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS), or permanent kidney failure may also provide Medicare eligibility.
Other Options for Medicare Eligibility
If you don’t qualify for Medicare on your own or through your spouse’s work history, but meet the U.S. citizenship and residency requirements, you can buy into Medicare when you turn 65 by paying premiums for Part A.
You can also enroll in Part B by paying premiums, but if you buy Part A, you’ll have to buy Part B as well. And, if you’re interested in Medicare Advantage, you’ll have to be enrolled in both A and B.
When can I enroll in Original Medicare?
If you're eligible for Medicare, you can first enroll during one of the designated enrollment periods, which include:
Initial Enrollment Period (IEP) |
When you turn 65, you have a 7-month Initial Enrollment Period (IEP) to sign up for Medicare.
This begins three months before the month you turn 65, includes your birthday month, and extends three months after your birthday month. Signing up during this time helps you to avoid late enrollment penalties.
General Enrollment Period |
If you miss the IEP, you can still sign up during the General Enrollment Period.
This period runs from January 1 to March 31 each year. But, it’s important to remember that this could be considered a "late enrollment", which could incur penalties.
What if I qualify for Medicaid?
Medicaid is a joint federal and state program and offers benefits beyond Medicare to people with limited income, such as coverage for nursing home care and personal care services. Some seniors are eligible for both Medicare and Medicaid, which is sometimes referred to as being “dual eligible”.
Medicaid eligibility differs by state, but if you qualify for both, most of your health care costs are likely covered. If this describes your situation, you can decide whether to enroll in an Original Medicare plan or a Medicare Advantage (Part C) plan.
Next Steps...
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