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Do You Qualify for Medicare?

You must meet certain requirements for Medicare eligibility

En español | Nobody is automatically entitled to Medicare, the federal government's health insurance for senior and disabled people that has been around for more than 50 years.

President Lyndon Johnson signed the law that led to both Medicare and Medicaid, the federal health plan for the poor, on July 30, 1965. Before Medicare, nearly half of Americans age 65 or older had no insurance to cover hospitalization and even more lacked plans that covered doctor visits.

Plus, older Americans who did have private medical insurance sometimes found their coverage cut off if their companies considered them high risk.

These days, seniors — and any others with public or private insurance — don't have to worry about their insurance being terminated for preexisting conditions. But to qualify for Medicare, you must meet certain requirements.

Age 65 and older Medicare rules

You qualify for full Medicare benefits at age 65 or older if:

  • You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years; and
  • You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits — usually having earned 40 credits from about 10 years of work — even if you are not yet receiving these benefits; or
  • You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.

Note: Earning 40 credits through payroll taxes while working guarantees that you will not have to pay premiums for Part A benefits, mainly coverage for inpatient hospital care.  You do not need any work credits to qualify for Part B, which is mainly doctors’ services and outpatient care, or for Part D prescription drug coverage.

You can qualify for premium-free Part A benefits on your spouse's work record if the spouse is at least 62 years old and you are at least 65. You also may qualify on the work record of a divorced or deceased spouse.

Following the Supreme Court's 2015 ruling, people in same-sex marriages can qualify for Medicare on their spouse's work record, regardless of where they live or where they were married.

Younger than 65? You still may be eligible

You qualify for full Medicare benefits under age 65 if:

  • You have been entitled to Social Security disability benefits for at least 24 months that need not be consecutive, or
  • You receive a disability pension from the Railroad Retirement Board and meet certain conditions, or
  • You have Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, which qualifies you immediately; or
  • You have permanent kidney failure requiring regular dialysis or a kidney transplant — and you or your spouse has paid Social Security taxes for a specified length of time depending on your age.

Other ways to get coverage

If you do not qualify on your own or your spouse's work record but are a U.S. citizen or have been a legal resident for at least five years, you still can get full Medicare benefits at age 65 or older. You just have to buy into them by:

  • Paying premiums for Part A, the hospital insurance. If you have fewer than 30 work credits, you pay the maximum premium, $437 in 2019. If you have 30 to 39 credits, you pay less, $240 a month in 2019. If you continue working until you gain 40 credits, you will no longer pay these premiums.
  • Paying the same monthly premiums for Part B, which covers doctor visits and other outpatient services, as other enrollees pay. In 2019, the amount is $135.50 for individuals with a yearly income of $85,000 or less or those filing a joint tax return with $170,000 in income or less. Rates are higher for people with higher incomes, but fewer than 1 in 10 Medicare beneficiaries had income of more than $85,000 in 2016, according to the Kaiser Family Foundation.
  • Paying the same monthly premium for Part D prescription drug coverage as others enrolled in the drug plan you choose.

You can enroll in Part B without buying Part A if you want to. But if you buy into A, you also must enroll in B.

You can get Part D if you're enrolled in either A or B.

You cannot enroll in a Medicare Advantage plan, such as health maintenance organization or a preferred provider organization, or buy a Medigap supplemental insurance policy unless you’re enrolled in both A and B.

Most people receive statements from Social Security saying whether they're yet eligible on their work records. If you don't get these statements or are still not sure if you qualify, call Social Security at 800-772-1213.

Patricia Barry is the author of Medicare for Dummies 3rd edition (Wiley/AARP, October 2017).

Editor's note: This article, previously updated in 2016, was updated with 2019 information.


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