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Medicare Requirements: Who Is Eligible?

What Is Medicare?

Turning 65 may have its disadvantages, but one definite advantage is that you’ll be able to take part in Medicare, the federal government’s health insurance program. Medicare has four separate programs to reimburse you for your healthcare expenses:

  • Part A covers hospital and nursing home stays.
  • Part B covers doctors’ visits, medical supplies, and preventive care.
  • Part C (Medicare Advantage) plans offer all the benefits of parts A and B, but they’re offered by private companies rather than directly by Medicare. You can decide to sign up for one of these plans instead of for Medicare Part A and B.
  • Part D covers prescription drugs.

Medicare also covers people under age 65 who have certain health conditions and long-term disabilities.

Am I Eligible for Medicare?

Here’s how to figure out whether you qualify for Medicare.

Are You 65 or Older?

You can start taking advantage of Medicare on your 65th birthday. Sign up starts three months before your 65th birthday and continues until three months after your birthday.

Are You a U.S. Citizen or Permanent Resident?

You must be either a U.S. citizen or have been a legal resident of this country for at least five years.

How Long Have You Worked?

You or your spouse must have worked in the United States for at least 10 years and paid Medicare taxes. You can look at your paycheck stub or call your employer to find out if you paid.

There are a few exceptions to these rules, though.

Ways to Qualify if You’re Under 65

You don’t necessarily have to be 65 to get Medicare. Younger people may also qualify if they meet these four criteria:

  • If you have a disability and have collected Social Security Disability Insurance for at least 24 months (two years), although those 24 months don’t have to be consecutive.
  • If you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. People with ALS automatically qualify for Medicare.
  • If you have end-stage kidney disease and require hemodialysis or a renal organ transplant to manage kidney failure, you likely will qualify.
  • If you’ve worked for the railroad. Some people who receive disability pensions from the Railroad Retirement Board (RRB), a benefits program for railroad workers and their families, qualify for Medicare.

What if I Don’t Qualify?

If you haven’t worked at all, or you worked for less than the 10 years needed to qualify for Medicare, don’t worry. You can still get Medicare benefits once you turn 65, but you will have to pay for part or all of the cost of your monthly coverage. This is called a premium.

Premium costs vary by Medicare plan. For example, buying Part A insurance would cost you $407 per month in 2015, while the Part B premium was $104.90 per month in 2015.

Where Do I Start?

Find your situation below to see how to start receiving Medicare benefits.

You’re Turning 65

Enrollment in Medicare begins three months before your 65th birthday and continues for 7 months. Sign up for Medicare by:

To ensure coverage starts as soon as you turn 65, enroll as early as possible.

If you’re still working, it’s possible you don’t need to sign up for Medicare immediately. However, if you’re not working, it’s very important to sign up for Medicare during your initial enrollment period. If you don’t sign up right away, you will be penalized and you’ll have to wait for the general enrollment period, between January 1 and March 31, to enroll.

You’re Turning 65 and You Already Get Social Security or RRB Benefits

You don’t need to do a thing. Your Medicare card will arrive in the mail three months before your 65th birthday. And you’ll automatically start receiving Medicare benefits on the first day of the month you turn 65. If your birthday lands on the first of the month, you’ll receive Medicare benefits on the first day of the month before.

You Have a Disability

You’ll automatically start getting Medicare benefits after you’ve been on disability for two years.

You Have ALS

You’ll automatically start getting Medicare benefits on the month your disability benefits start.

You Have End-Stage Kidney Disease

You’ll have to sign up for Medicare. You can do this in one of a few ways:

If you worked for the railroad, call the RRB at 877-772-5772.

Read This Next

When Should I Apply for Medicare: Timeline and Strategies
What You Should Know About the Medicare Fee Schedule
Medicare Supplement Insurance: What Is It?
What Medicare Does and Does Not Cover
Medigap Plans
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