Skip to content
 

     

Medicare Eligibility: Do You Qualify?

Here are the requirements to be eligible for health care coverage

woman looks at papers as she sits in front of a computer

John Fedele/Getty Images

En español | For 55 years, Medicare has provided health insurance to Americans 65 and older as well as to people with disabilities. But qualifying for the program is not automatic. Here’s how to determine if you are eligible.

You’re 65 or older.

You qualify for full Medicare benefits 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 are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.
  • 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.

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 (ALS), 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 period, depending on your age.

Other ways to get Medicare coverage

 If you do not qualify on your own or through your spouse’s work record but are a U.S. citizen or have been a legal resident for at least five years, you 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. How much you would have to pay for Part A depends on how long you’ve worked. The longer you work, the more work credits you will earn. Work credits are earned based on your income; the amount of income it takes to earn a credit changes each year. In 2020 you earn one work credit for every $1,410 in earnings, up to a maximum of four credits per year. If you have accrued fewer than 30 work credits, you pay the maximum premium — $458 in 2020. If you have 30 to 39 credits, you pay less — $252 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 2020 the amount is $144.60 for individuals with a yearly income of $87,000 or less or those filing a joint tax return with $174,000 in income or less. Rates are higher for people with higher incomes.
  • 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. But if you buy Part A, you also must enroll in Part B.

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

You cannot enroll in a Medicare Advantage plan, which is a private insurance alternative to Original Medicare, or buy a Medigap supplemental insurance policy unless you’re enrolled in both A and B.

Editor's note: Patricia Barry contributed to this story, which has been updated with 2020 information.

Join the Discussion

0 | Add Yours

Please leave your comment below.

You must be logged in to leave a comment.