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Medicare Eligibility (Who Qualifies for Medicare?)

02/17/2022
  • Medicare with Melissa

To meet your Medicare Eligibility requirements, you must be age 65 or older, a U.S. citizen (or able to prove permanent U.S. residency for at least five years and worked 40 quarters (10 years) and paid Medicare taxes (likely through your payroll).

However, there is more than one way to meet the requirements for Medicare.

You can qualify for Medicare if you are under age 65 and have been collecting Social Security Disability benefits for 24 months.

You will also meet the requirements to qualify for Medicare if you have been diagnosed with End Stage Renal Diseases (ESRD) requiring dialysis treatments or a kidney transplant.

Lastly, you can qualify for Medicare if you have been diagnosed with Lou Gehrig’s Disease (ALS or amyotrophic lateral sclerosis).

Medicare Eligibility: Age 65

As of 2021, approximately 54 million that meet the Medicare requirements, are age 65 and older. In fact, a little over 10,000 people are turning 65 each day until 2030.

In some cases, you may be enrolled in Medicare automatically and other cases, you are not.

We have an excellent article we recommend you read to learn more about Applying for Medicare if you are 65. If you would like our help applying for Medicare, call us today (866-633-4427) or click here to schedule an appointment.

When you meet the Medicare requirements, you will have the option to stay on Original Medicare Part A and Part B and enroll in a Medicare Supplement (if you enroll in a Medicare Supplement Plan, its highly recommended to add a Medicare Drug Plan). Or you can enroll in a Medicare Advantage, such as a PPO or HMO (most include prescription drug coverage)

Deciding to apply for a Medicare Supplement or Medicare Advantage plan is an important one, but tricky. We break down the most common Medicare Plan questions here.

Medicare Eligibility: Under Age 65

In 2021, Kaiser reported that approximately 9 million of the 63 million Medicare beneficiaries were under 65 and met the Medicare qualifications to get Part A and Part B benefits.

Qualifying for Medicare under 65 may mean that not all Medicare Supplement plans are available to choose from, as if you were 65 or older.

Furthermore, each state can have different rules or regulations on which plans are offered. Once the state has its rules in place, the Medicare insurance carriers must follow the rules, at minimum, but can choose to offer more plans, if they choose.

To be certain on Medicare Supplement Availability, just give us a call now, 866-MEDIGAP (633-4427). Or schedule an appointment at a time convenient for you. If you prefer to get quotes on your own, click here to compare the Best Medicare Supplement Plans in your area (here’s a secret, you actually get quotes!)

Medicare Eligibility: Medicare Part A (Hospital Benefits)

Your Medicare Part A benefits will start on the 1st day of the month and after you meet the Medicare requirements (Turning 65, Under 65 collecting Social Security Disability Benefits for 24 months or are diagnosed with End Stage Renal Disease or Lou Gehrig’s Disease).

If you are turning 65, your Medicare Part A benefits will begin on the first day of the month you turn 65.

99% of Medicare beneficiaries qualify for premium-free Medicare Part A. Qualifying for premium-free Medicare Part A is not based on income. Instead, the federal government looks to see if you’ve paid into Medicare taxes for 10 years (40 quarters).

If you do not qualify for premium-free Medicare Part A, the monthly cost is $499.

You do not have to enroll in Medicare Part B, just because you are eligible and or enrolled in Medicare Part A.

Medicare Eligibility: Medicare Part B (Physician Services)

The Medicare requirements to be eligible for Medicare Part B are the same as the Part A requirements. And, like Part A, your Part B benefits always start on the 1st of the month.

Upon turning 65 and if your birthday is in the middle of the month, your Medicare Part B benefits still begin on the 1st day of the month.

Unlike Part A, everyone must pay a premium for Medicare Part B. The Medicare Part B premium in 2022 is $170.10. Your monthly Part B premium could be higher based on your income (there is no premium-free Part B).

However, if you are eligible for Medicaid and based on the level of Medicaid you qualify for, Medicaid may be some or all of your Part B premium.

If you don’t know if you’re eligible for Medicaid, or would like to apply for Medicaid, you can contact your state for details.

Alternatively, you can call the friendly team at Senior HealthCare Solutions and we will help you determine eligibility and apply for Medicaid.

Medicare Eligibility: Medicare Part C (Medicare Advantage)

There is no Medicare age requirement to be eligible to enroll in a Medicare Advantage plan. However, to be Medicare eligible to enroll in a Medicare Advantage plan you must be eligible for and/or enrolled in Original Medicare Part A and Part B.

Although Medicare Advantage plans are the primary payor, it’s still required that you are eligible for and/or are enrolled in both Part A and Part B.

You can enroll in a Medicare Advantage plan when you are new to Medicare Part A and Medicare Part B (also known as the Initial Coverage Election Period, ICEP). This election period happens when you are eligible for Medicare and under 65 or turning 65.

After your Initial Coverage election period, you can enroll in or change your Medicare Advantage plan during the Annual Enrollment Period (October 15th-December 7th). There are other special circumstances (Special Enrollment Periods, SEP) such as, losing creditable insurance, moving out of the plans service area, became eligible for Medicaid and many more.  

Don’t miss your chance to enroll in a Medicare Advantage plan, schedule your appointment now. Or just give us a call, 866-MEDIGAP (633-4427) and one of the Senior HealthCare Solutions team members will compare over 25 carriers and find a plan suitable for you, for free!

More of a do-it-yourselfer? Compare Medicare Advantage Plans with our quote and enrollment tool (no agent required). You can also read a related article: Difference between HMO and PPO

Medicare Eligibility: Medicare Part D (Medicare Drug Coverage)

To be eligible for Medicare Part D you only need to be eligible for and/or enrolled in Medicare Part A. You do not need to be eligible or enrolled in Medicare Part B to obtain your Medicare Part D drug coverage.

Whether you are under 65 or over 65, if you are eligible for and/or enrolled in Part A, you can enroll in a Medicare Part D plan.

It’s important to note that not all Medicare Part D plans may be available in your state. And not all Medicare Part D plans cover the same drugs nor have the same preferred pharmacies.

Our team will take the time with you to collect and enter your medications and preferred pharmacy (including mail order). Then, we advise of what Medicare Part D plans are available to you, what’s covered and which plan seems most suitable. Lastly, we help secure your coverage by submitting your application to the insurance carrier.

If you prefer to Compare Medicare Part D Plans on your own, we offer a self-quote and enrollment tool.

Otherwise, call 866-MEDIGAP (633-4427) now and we will take the burden from you and bring some peace of mind to your Medicare Drug Plan coverage. If you need to schedule an appointment, click here.

Eligibility for Medicare Supplement (Medigap Plan Eligibility)

To meet the Medicare requirements to enroll in a Medicare Supplement Plan, you must have and or be enrolled in both Medicare Part A and Medicare Part B.

The age for Medicare supplement plan eligibility starts at under 65. However, not all Medicare supplement plans in all states are available for people under 65.

If you are age 65 and older, you will have a wider range of plans to choose from, in most cases (again, this is state specific).

The best time to enroll in a Medicare supplement plan is when you are new to Medicare Part A and Part B (also known as your Open Enrollment Period, OEP, when choosing Medigap Plan). During this time, you cannot be declined Medicare Supplement coverage due to pre-existing conditions.

You can enroll in a Medicare Supplement plan or change Medicare Supplement plans after your Open enrollment Period, however you may be required to answer medical questions and the insurance company reserves the right to decline coverage based on pre-existing conditions.

The team at Senior HealthCare Solutions can help bring you peace of mind by comparing over 25 Medicare supplement insurance companies in your area. Give us a call today at 866-MEDIGAP (633-4427).

If you’re not ready to speak with an agent, you can schedule an appointment at a time that’s more convenient for you. Or if you’re simply not wanting to speak with an agent, go ahead and use our self-quoting tool and click here to compare Medicare supplement plans in your area.

Keep Medicare Eligibility Simple and schedule and appointment to speak with one of our experienced, friendly team members that will help answer your Medicare eligibility, explain cost and coverage options and if needed, help you apply for Medicare . Or just call now 866-MEDIGAP (633-4427) and you can start to take control of meeting your Medicare requirements.

Medicare Eligibility Frequently Asked Questions

Who is eligible for Medicare?

To be eligible for Medicare you must be a US citizen or a permanent resident that has resided in the US for 5 consecutive years.

Who qualifies for Medicare?

You can qualify for Medicare if you are under 65 and have been collecting Social Security Disability Benefits for 24 consecutive months. Or if you are under 65 with certain disabilities, such as Lou Gehrig’s disease or in stage renal disease that requires dialysis treatments or an organ transplant. And if you are age 65 or older.

When can I apply for Medicare?

Apply for Medicare when you have met the Medicare Requirements (under 65 and collecting SSDI, under 65 with certain disabilities or turning 65).

At what age can you get Medicare?

You can get Medicare under age 65 with certain requirements. You can also get Medicare when you are age 65 or older.

When can I apply for a Medicare Supplement Plan?

You can apply for a Medicare Supplement Plan when you have become eligible for and/or are enrolled in Medicare Part A and Part B.

When can I apply for a Medicare Advantage Plan?

Apply for a Medicare Advantage plan when you have become eligible for and/or are enrolled in original Medicare Part A and Medicare Part B.

When Can I apply for a Medicare Part D Plan?

To apply for a Medicare Part D plan, you only need to be eligible for and/or are enrolled in Original Medicare Part A. Unlike Medicare supplement plans or Medicare Advantage plans, you do not need to have original Medicare Part B to enroll in a Medicare Part D prescription drug plan.

Meet Melissa MacCalla

Medicare is not simple and can be hard, frustrating, and downright confusing for most. I love when I get someone on the phone and I am given the opportunity to explain the difference in plans to them and have Medicare make sense. I enjoy talking to clients year after year, hearing about their families growing or them asking about mine.

-Melissa

Oh my gosh!! I was so confused about the Medicare Supplement process. I am turning 65 soon and am retired and have always had insurance thru my former employer. I didn’t know a thing about going on Medicare and was struggling to sort it all out.

A friend of mine recommended contacting Senior HealthCare Solutions, so I did. Melissa was FANTASTIC!! She was professional, responsive, caring and friendly. She explained the steps I needed to take, gathered my information, helped me choose good plans for MY specific needs and took care of my applications over the phone. 1-2-3, eesy-peesy and I was done!! And it didn’t cost me a DIME!!! WOW!!! I HIGHLY recommend Senior Healthcare Solutions for anyone who’s overwhelmed with making the right choices with Medicare Supplemental Insurance and Rx coverage. It’ll take a load off your mind!

Janice W.

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