Medicare Eligibility: Do You Qualify?

Age Requirement

You must be 65 years or older.

Full Medicare Benefits Eligibility

• You are a U.S. citizen or a permanent legal resident with at least five years of residence in the United States.
• You are receiving Social Security or railroad retirement benefits, or have worked enough to be eligible for these benefits—even if you are not currently collecting them.
• You or your spouse is a government employee or retiree who did not contribute to Social Security but has paid Medicare payroll taxes during employment.

Early Eligibility and Special Conditions

Medicare is typically for individuals aged 65 or older, but early eligibility applies if:

• You have a disability.
• You have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).
• You have ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig's disease.

Medicare Parts Overview

• Part A: Hospital Insurance
• Part B: Medicare Insurance
• Part C: Medicare Advantage Plans
• Part D: Prescription Drug Coverage

Medicare Part A Eligibility (Hospital Insurance)

Medicare Part A generally starts at age 65. You automatically qualify if you or your spouse has worked legally for at least 10 years in the U.S., paying taxes toward Medicare during that time. Most Americans pay no premiums due to this work history.

If you haven't met the 10-year requirement, you can purchase Part A for:

• $505/month (2023 rate) if you have less than 30 work credits.
• $278/month if you have 30 to 39 credits.

Medicare Part B Eligibility (Outpatient Insurance)

Covers outpatient services, including doctor visits and surgery fees. Requires a monthly premium. If you have employer health insurance at age 65, you can delay enrollment without penalties. Consult a Medicare specialist to avoid late fees when transitioning.

Medicare Part C Eligibility (Medicare Advantage)

Combines benefits of Part A and Part B. Offered through private insurance companies. Requires enrollment in both Part A and Part B.

Note: You cannot drop Part B and its premiums while enrolled in a Medicare Advantage Plan.

Medicare Part D Eligibility (Drug Coverage)

Provides prescription drug coverage. Available to those enrolled in Part A and/or Part B. Living within the plan's service area is required. Highly recommended to avoid future penalties and high medication costs.

Expert Guidance

Need help understanding your Medicare options? Our team of experts can guide you through your choices and help you select the right supplemental plan. Reach out to us today for clarity and peace of mind!