Medicare Eligibility: Who Qualifies?

An estimated 63 million Americans were enrolled in Medicare in 2021.

That represents nearly one out of every five Americans.

The federal government launched the Medicare program in 1965 to provide health insurance to citizens as they approach retirement, a time in their lives when getting coverage through employment ceases to be an option for many.

The program is tied to employment in another way: It largely is funded through taxes collected throughout your career. Then, when you reach a certain age, your contributions through the years are put to work for you through your Medicare coverage.

So, what are the eligibility requirements for Medicare?

65 or older

Since the birth of the program, 65 has been the standard Medicare eligibility age. It’s the Medicare Part A eligibility age. It’s the Medicare Part B eligibility age (Parts A and B comprise Original Medicare). And yes, 65, also is the Medicare Part D eligibility age.

Furthermore, 65 is the eligibility age for Part C, also known as Medicare Advantage. Medicare Advantage eligibility requirements and Original Medicare eligibility requirements are the same.

Turning 65 is a pretty big deal.

If you are a U.S. citizen, you are eligible for Medicare when you turn 65 years old. It’s as simple as that, and that population of older Americans dominates the Medicare population.

In addition, some people qualify for Medicare before age 65.

Medicare disability eligibility

While 65 is the standard age for Medicare eligibility, when is a disabled person eligible for Medicare?

If the particular disability qualifies and some specific terms are met, then Medicare is an option regardless of age.

What exactly are the Medicare eligibility requirements under 65?

If you qualify for Social Security Disability Insurance (SSDI), then once you receive 24 monthly SSDI payments, you are eligible for Medicare regardless of age. Social Security’s strict definition of disability requires that:

• You cannot do work that you did before because of your medical condition.
• You cannot adjust to other work because of your medical condition.
• Your disability has lasted or is expected to last for at least one year or to result in death.

In addition to disabilities covered by SSDI leading to Medicare eligibility, a couple of specific medical conditions also trigger coverage regardless of age.

• If you have been diagnosed with end-stage renal disease (ESRD), you also gain Medicare eligibility regardless of age. You usually qualify the first day of your fourth month of dialysis treatments.
• If you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, you qualify for Medicare regardless of age. You can begin Medicare once you start receiving SSDI payments, as opposed to the standard 24-month requirement.

Can I receive Medicare at 62?

Outside of the above-mentioned scenarios, you cannot receive Medicare before age 65. Some people ask about age 62 because of a couple of things related to the number:

• Currently, 62 is the age when you can start drawing Social Security benefits, and if you are on Social Security as well as Original Medicare, your monthly premiums A premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. are deducted from your Social Security check. Even if you do opt for partial Social Security benefits before age 65, you still aren’t eligible for Medicare until 65.
• Also, if you are on Medicare but are among the small group of people who don’t qualify for premium-free Medicare Part A because you haven’t worked at least 10 years, you can qualify based on the work history of a spouse who is at least 62. Even so, neither you nor your spouse would be eligible for Medicare at age 62.

Yes, everyone who meets citizenship standards is eligible for Medicare at age 65.

You must be:

• A United States citizen, OR
• A person lawfully admitted to the United States for permanent residence who has resided in the U.S. for at least five continuous years prior to applying for Medicare.

As long as you apply in a timely fashion, Medicare coverage starts when you turn 65. Actually, it starts the first day of the month you turn 65. Or, if you were born on the first day of the month, it starts the first day of the month before you turn 65.

If you want your Medicare coverage to start at age 65, you need to apply early in your Initial Enrollment Period — a seven-month period that surrounds your 65th birthday.

If you apply before your birthday month, your coverage will start on the first day of your birthday month. If, however, you don’t apply until your birthday month, Medicare says your coverage will begin the next month. If you wait until the month after you turn 65, coverage will start two months after you sign up. If you wait until the final two months of your Initial Enrollment Period – so two or three months after you turn 65 – your coverage will begin three months after you sign up.

If you qualify for premium-free Part A like most people, you have some leeway because you’re eligible for up to six months of retroactive Part A coverage. That isn’t the case, however, with Medicare Part B.

You are not eligible for Medicare if you are not yet 65 years old — unless you have drawn 24 months of Social Security Disability Insurance benefits or if you have end-stage renal disease or Lou Gehrig’s disease.

You may be eligible for benefits similar to Medicare before age 65 in the form of Medicaid. In 2021, Medicaid provided health insurance to more than 70 million Americans, regardless of age, who qualified based on financial need.

Reasons Medicare coverage may be denied

In addition to the aforementioned reasons you might be denied the ability to sign up for Medicare, people who are on Medicare are denied specific coverage at times.

Before getting medical services, it’s important that you understand what Medicare doesn’t cover.