Who Can Apply for Medicare? Key Eligibility Requirements

More than 60 million people in the United States get their healthcare coverage through Medicare. Are you wondering if you’re eligible for coverage? Here’s what you need to know about who can apply for Medicare.

Basic Eligibility

Medicare is a federal healthcare program. U.S. citizens and legal permanent residents who are at least 65 years old are typically eligible for Medicare coverage. Additionally, some younger individuals with disabilities or End Stage Renal Disease also qualify for Medicare coverage. Most people who are enrolled in Medicare qualify for premium-free Medicare Part A. However, some people who do not qualify for premium-free Medicare Part A may be able to buy into the program if they choose to do so. Medicare Part B is not free, and people pay a monthly premium for coverage. There is also a monthly premium for Medicare Part D Prescription Drug Coverage and Medicare Supplement Plans, and Medicare Advantage plans may have an additional premium that is paid on top of the Medicare Part B premium.

Aging into Medicare

Who can apply for Medicare? Most people first qualify for Medicare coverage when they turn 65. The Initial Enrollment Period lasts for seven months, and it includes the three months before your birthday month, your birthday month and the three months after your birthday month.

Depending on when you were born, your full retirement age for Social Security retirement benefits may be after your 65th birthday. However, you still age into Medicare when you turn 65, even if you’re not claiming Social Security benefits. Likewise, if you retire before you turn 65, you still won’t qualify for Medicare until you turn 65. In this case, you will need to find an alternative source of health insurance coverage until you turn 65 and age into Medicare.

In many cases, it is important to sign up for Medicare when you first become eligible. If you don’t enroll on time and you don’t qualify for penalty-free late enrollment, you may have to pay a lifetime late fee when you sign up, and you may have gaps in your coverage as a result.

However, if you receive qualifying healthcare coverage through active employment, you may be able to delay enrollment without facing a late penalty. In this case, when your employment stops or your coverage based on current employment ends, you will have an eight-month Medicare enrollment period. If you don’t sign up during this period, you may have to pay late enrollment penalties, and you may have coverage gaps. To avoid late penalties, you should sign up for Medicare during this eight-month enrollment period, even if you have elected to enroll in COBRA coverage. Also, to avoid penalties and other problems, verify that you qualify for penalty-free late enrollment based on employer-based group health plan before you decide to delay enrollment, and find out exactly when you will be expected to enroll.

If you miss your enrollment period, you can sign up for Medicare during the General Enrollment Period, which runs from January 1 to March 31 every year. Again, there may be late penalties and coverage gaps if you go this route.

Health Conditions That Qualify You for Medicare

Some people qualify for Medicare coverage before turning 65 based on health conditions.

People with End Stage Renal Disease may qualify for Medicare regardless of their age. Medicare coverage will typically start with the fourth month of dialysis at a dialysis facility. However, coverage may start with the first month of dialysis under certain circumstances.

If a person is eligible for Medicare based on End Stage Renal Disease, coverage will stop at the end of the 12th month after the month when dialysis treatments are stopped or at the end of the 36th month after the month of a successful kidney transplant. If dialysis is needed again, or if another kidney transplant is needed, eligibility for coverage can resume.

People with disabilities may also qualify for Medicare enrollment at any age. You will be eligible for Medicare if you have been receiving Social Security disability benefits for 24 months, or if you have been receiving certain Railroad Retirement Board disability benefits for 24 months. If you qualify for Medicare based on your disability, you will receive a notice that you are being automatically enrolled in Medicare.

People with Lou Gehrig’s disease, or Amyotrophic Lateral Sclerosis (ALS), can also qualify for Medicare, and they do not have to wait 24 months before becoming eligible. Coverage begins the same month disability benefits begin.

If you have a qualifying disability and you decide to go back to work, you may be able to keep your Medicare coverage.

Premium-Free Medicare Part A Eligibility

Most people on Medicare qualify for premium-free Medicare Part A. Eligibility is based on work history and the payment of relevant taxes.

If either you or your spouse worked and paid Medicare taxes for at least 10 years, you can qualify for premium-free Medicare Part A coverage when you turn 65. If you are receiving Social Security retirement benefits, or if you are eligible for these benefits but have not started claiming them yet, you will qualify for premium-free Medicare Part A. You may also be eligible if you are receiving Railroad Retirement Board retirement benefits or are eligible for these benefits or if you or your spouse had Medicare-covered government employment.

Individuals who qualify for Medicare based on disability status or End Stage Renal Disease may also qualify for premium-free Medicare Part A.

The other parts of Medicare require a premium.

Buying into Medicare

If you do not qualify for premium-free Medicare Part A, you may still be eligible for coverage, but you will have to pay a premium.

You can pay to enroll in Medicare Part A if you are at least 65 years old and either a citizen or permanent resident of the U.S. The premium cost has two levels based on work history. If you worked and paid Medicare taxes for 30 to 39 quarters, the standard Medicare Part A premium is $252 per month for 2020. If you worked and paid Medicare taxes for less than 30 quarters, the standard Medicare Part A premium is $458 per month in 2020. The monthly premium may change each year, and if you do not enroll when you turn 65 and become eligible, you may have to pay a higher monthly premium as a late penalty.

The other parts of Medicare are not free, so you will have to pay a premium to enroll whether or not you qualify for premium-free Medicare Part A.

Spouse Coverage and Eligibility

When you age into Medicare, you qualify for self-coverage only. Your spouse will qualify for Medicare separately when he or she turns 65. Your spouse does not become eligible for Medicare just because you have aged into it.

However, you may qualify for premium-free Medicare Part A coverage based on your spouse’s work history, or vice versa. You are typically eligible for premium-free Medicare Part A as long as you are at least 65 years old and either you or your spouse worked and paid Medicare taxes for at least 10 years.

Let’s look at a hypothetical example to see how this works. Imagine you’re 60 and your spouse is 65. Your spouse worked and paid Medicare taxes for at least 10 years, but you did not work outside the house. Your spouse has aged into Medicare and is eligible for premium-free Medicare. You have not aged into Medicare, so you are not eligible for coverage. However, in five years you will age into Medicare, and then you will qualify for premium-free Medicare Part A based on your spouse’s work history.

This is just a hypothetical example. Your situation may be different, and other factors may impact your eligibility. If you have questions about your eligibility, you can use the Medicare Eligibility & Premium Calculator.

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