Who qualifies for Medicare?

Medicare is federal health insurance that comes separated into parts that cover different services. Most of the time, when you first enroll in Medicare, you will enroll in Part A and Part B. You are eligible for Medicare Parts A and B when you are 65 years old, disabled, or meet other special qualifications. Under certain conditions, you may also qualify for Part A but be required to pay the premium.

Medicare Part A

For premium-free Medicare Part A, you must be entitled to Medicare based on your own earnings, or those of a spouse, parent or child. You also must have a specific number of Quarters of Coverage, based on your age, disability, or special qualification. You will also be required to file an application for Social Security or the Railroad Retirement Board.

If you are receiving monthly Social Security or RRB benefits, at 4 months before turning age 65 or later, you will not need to file a separate application to become entitled to premium-free Part A. You will be enrolled automatically when you turn 65.

An individual who is not receiving monthly Social Security or RRB benefits must file an application for Medicare by contacting the Social Security Administration.

Qualifying Based on Disability

An individual who has been receiving disability benefits from Social Security or RRB for 24 months becomes eligible to Medicare Part A. Disabled government employees who cannot receive Social Security or RRB benefits may become entitled to disability benefits and automatically enrolled in Part A after being disabled for 29 months.

There are also special qualifications for certain conditions or diseases.

An individual suffering from Amyotrophic Lateral Sclerosis (ALS), otherwise known as Lou Gehrig’s disease, is entitled to Part A the first month they are entitled to Social Security or RRB disability cash benefits, without a waiting period.
Social Security rules that child disability benefits do not begin earlier than age 18. Therefore, you do not become eligible for Part A from child disability benefits before you are 20 years old.
Individuals suffering from End-Stage Renal Disease (ESRD) who receive regular dialysis treatments or a kidney transplant can file an application for Part A, if one of the following conditions are met as well:
- Have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
- Are getting or are eligible for Social Security or RRB benefits
- Are the spouse or dependent child of a person who has worked the required amount of time under Social Security, the RRB, or as a government employee

Medicare Part B

Part B is a voluntary program that requires payment of a monthly premium for all parts of coverage.

Individuals who are 65 years old, or are already receiving Social Security or RRB benefits 4 months before being eligible for Medicare and residing in the United States, are automatically enrolled in both Part A and Part B. If you are enrolled automatically, you will have the choice to refuse part B coverage.

Individuals are not automatically enrolled if they are not receiving Social Security or RRB. Those who refused or terminated Part B coverage can enroll for Part B during annual or special enrollment periods. However, that if you take too long to enroll in part B, you may be charged a late fee.

Termination of Medicare Policies

If you pay a premium for Part A, you can terminate it at any time. Individuals enrolled in premium-free Part A cannot voluntarily cancel their Part A coverage. This is not permitted by law. However, there are circumstances in which your premium-free Part A coverage will end, including:

Loss of entitlement to Social Security or Railroad Retirement Board benefits
Death