Medicare is a federal health insurance program widely used by U.S. citizens and permanent residents age 65 and older. The program also applies to those younger than age 65 who have disabilities, end-stage renal disease (ESRD) or other diseases. But Medicare has multiple parts, and the eligibility requirements vary for each.
Who Is Eligible for Medicare?
U.S. citizens or permanent residents whoâve lived in the U.S. for more than five years qualify for Medicare if theyâre age 65 or older. Those younger than age 65 also qualify for Medicare if they disabilities or life-threatening diseases.
Medicare Eligibility for People Over 65
If youâre age 65 or older, you can get Part A coverage without paying premiums, as long as you or your spouse worked and paid Medicare taxes for at least 10 years, according to the U.S. Department of Health and Human Services. In order to skip the premium payments, though, one of the following must apply to you:
- You are receiving Social Security or Railroad Retirement Board retirement benefits
- You are eligible to receive Social Security or Railroad Retirement Board benefits but have not collected them
- You or your spouse had a Medicare-covered government job
Being eligible for Part A coverage also guarantees your eligibility for Part B Medicare coverage. The only difference is that youâll have to purchase Part B coverage. However, if youâre receiving Social Security or Railroad Retirement Board benefits at least four months prior to turning 65, youâll be automatically enrolled in Part B.
Medicare Eligibility for People Under 65
If youâre under age 65, you can enroll in Medicare if you:
- Have received Social Security Disability Insurance (SSDI) checks for at least 24 months
- Have been diagnosed with end-stage renal disease (ESRD)
- Have amyotrophic lateral sclerosis (ALS)
- Have permanent kidney failure which requires dialysis or a transplant
Youâll automatically receive Part A and Part B coverage if youâve either gotten disability benefits from Social Security for 24 months, or if youâve received certain disability benefits from the Railroad Retirement Board for 24 months, according to medicare.gov.
Medicare Eligibility for Part C and Part D
Medicare Part C is a Medicare health plan thatâs typically offered by private insurance companies. Also known as Medicare Advantage, youâre eligible for Part C if youâre enrolled in Part A and Part B, you donât have ESRD and the option is available in your area. These plans include health maintenance organizations, preferred provider organizations, special needs plans, private fee-for-service plans and Medicare medical savings account plans.
Offered by private insurance companies, Medicare Part D provides prescription drug coverage. Youâll need to be enrolled in Part A or Part B to be eligible. You wonât be eligible, however, if youâre enrolled in Part C coverage.
Bottom Line
Eligibility requirements for Medicare vary based on a number of different factors such as age and medical history and condition. This is why itâs crucial to do your research so you can determine which parts of Medicare best align with your retirement savings goals.
Retirement Planning Tips
- Not sure youâre saving enough for retirement? Our retirement calculator can help you determine your estimated Social Security benefits, how much money you need to retire and how much annual income youâll need in retirement.
- A financial advisor can offer advice on any of your Social Security, Medicare or retirement savings needs. SmartAssetâs free financial advisor matching tool connects you with up to three local advisors.
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