Learn about the age-related and disability-related requirements for Medicare eligibility.
While people know that the federal Medicare program is for older individuals, it’s challenging to find detailed information about age eligibility and what will happen if you don’t apply at the right time.
Enrolling once you become eligible is essential if you want to avoid penalties and start using your Medicare benefits without any hassles.
This article will help you learn about age eligibility, other requirements for Medicare, why it’s important to enroll on time, and how you can get the best coverage.
Medicare Part A deals with hospital care, inpatient care, and types of other care such as hospice care.
Medicare Part B covers general medical expenses, outpatient care, preventive screenings, tests, and certain medical equipment costs.
Medicare Part D relates to self-administered prescription drugs, such as blood pressure tablets, diabetic medication, and pain tablets.
Medicare Eligibility - Whether or not you qualify for Medicare based on age or disability.
Age-eligibility - This is if you are eligible for Medicare based on your age.
Disability-eligibility - This is if you qualify for Medicare based on a disability.
Medicare Enrollment - Joining Original Medicare or a Medicare Advantage plan.
Enrollment Period - Specific times when you can or should enroll in Medicare.
Before we go into the age eligibility requirements, let’s cover the general conditions for you to be eligible for Medicare.
To qualify for Medicare, you must be a U.S. citizen or a permanent legal resident for at least five years.
You will not be eligible for Medicare if you have recently moved to the United States or are undocumented.
You must reside in a U.S. state or territory if you would like to receive Medicare benefits. Medicare will not cover treatment in foreign countries.
Have a question about Medicare eligibility? Reach out PolicyScout’s trained consultants on 1-888-912-2132 or email Help@PolicyScout.com for assistance with your Medicare questions.
The federal Medicare program is aimed at people who are 65 and older. If you meet the other requirements listed above and are at least 65, you can join Part A and B.
If you are about to turn 65, you are eligible to enroll three months before the month of your 65th birthday.
For example, if you turn 65 in June you become eligible for Medicare from March (three months before).
You can also wait up to three months after your birthday month to enroll without any penalties.
For example, if your birthday is in July you can enroll until October of that year.
This seven-month window, three months before and three months after your birthday month, is known as your Initial Enrollment Period.
If you haven’t contributed towards the program through Medicare taxes and don’t qualify for premium-free Medicare Part A, you can still join Medicare.
However, you will have to pay a monthly premium to join Medicare Part A, which is usually free for people who have paid Medicare taxes.
You qualify for Medicare coverage at age 65 or older—even if you decide to join when you turn 80, 90, or 100. However, you might have to pay a Late Enrollment Penalty.
For Medicare Part A - This will be a 10% increase in your monthly premiums, and you will have to pay it for double the length of time you were not enrolled.
For example, if you enroll at the age of 70 (five years after becoming eligible), you will have to pay a Late Enrollment Penalty for ten years.
For Medicare Part B - Your Late Enrollment Penalty will be 10% of the standard monthly premium multiplied by the number of 12 month periods you didn’t enroll. You will have to pay this penalty while you have Medicare Part B health insurance.
For example, if you didn’t enroll for two years you would have to pay a 20% penalty, and if you didn’t enroll for four years you would have to pay a 40% penalty.
Initial Enrollment Period - This will be your first time enrolling in Medicare. You will have a seven-month window (three months before and after the month of your 65th birthday).
General Enrollment Period - This enrollment period starts on January 1st and ends on March 31st each year. You may have to pay a penalty if you have missed your Initial Enrollment Period. Your Medicare coverage will begin on July 1st in the year you enroll.
Special Enrollment Period - If you qualify for a Special Enrollment Period, you will be allowed to enroll in Medicare up to 8 months after your current health insurance coverage ends.
To find out which enrollment period is best for you or if you qualify for a Special Enrollment Period, speak to a PolicyScout consultant today.
Countrywide Percentage of Age-based Eligibility for Medicare in 2019
This map produced by the Kaiser Family Foundation shows that most people become Medicare-eligible because of age. Between 2013 and 2019, around 83-85% of Medicare beneficiaries were over 65.
As seen in the graphic above, the majority of people qualify for Medicare based on their age. But a large portion, around 15-17% of all Medicare enrollees, are eligible based on disability or a terminal condition.
You will be eligible to join Medicare at any age if:
- You are receiving Social Security Disability Benefits or Insurance.
- You are receiving Railroad Retirement Board benefits for a disability.- Are diagnosed with ALS (Lou Gehrig’s Disease).
- Have End-Stage Renal Disease (ESRD).
Similar to the Social Security Administration, The RRB is an independent government agency that administers retirement benefits for railroad workers in the U.S.
If you are younger than 65 and eligible for Social Security Disability Insurance (SSDI) or receiving disability benefits, you are also eligible for Medicare health insurance.
Once you qualify for SSDI there is a 24-month waiting period before you can get Medicare health insurance cover, except if you have ALS or ESRD.
After 24 months, you will be able to enroll like age-eligible Medicare beneficiaries during your Initial Enrollment Period and the General Enrollment Period.
Some disabilities and conditions that are covered by Social Security Disability Insurance include:
End-stage Renal Disease (ESRD), also known as end-stage kidney disease, renal failure, or kidney failure, is a life-threatening condition that affects nearly 800,000 people in the U.S.
If you suffer from ESRD, you will be eligible for premium-free Medicare if your kidneys no longer work, if you have had a kidney transplant, or if you require regular dialysis.
You will also need to make sure that:
You have worked the required amount of time under Social Security, the RRB, or as a government employee.
You are eligible or currently receiving Social Security or RRB benefits.
If you don’t meet these requirements, you might still be eligible:
If you are married and your spouse meets one of the requirements listed above.
If you are a dependent child and one of your parents meets one of the requirements listed above.
If you meet these requirements, you will not have to wait 24 months before qualifying for Medicare health insurance.
You’ll also get retrospective benefits for 12 months, meaning that approved costs will be covered 12 months before your enrollment date.
ALS, or Lou Gehrig’s Disease, is a progressive nervous system disease that Medicare covers. If you are diagnosed with ALS and apply for SSDI, you will become eligible for Medicare regardless of your age.
There is a five-month waiting period before you will be able to enroll as a Medicare beneficiary. This is much shorter than the normal 24-month SSDI period because of the rapid progression of ALS.
Medicare Advantage Plans, Medicare Supplement Insurance Plans, and Part D Plans (prescription drug coverage) are health care insurance plans offered by private health insurance companies.
The age requirements for Medicare Advantage, Medicare Supplement Insurance, and Part D Plans are exactly the same as Original Medicare.
You will have to enroll in Original Medicare before signing up for a private Medicare insurance plan.
If you’re struggling to make sense of Medicare or need assistance finding the right provider in your area, PolicyScout can assist. Contact us on 1-888-912-2132 to speak with one of our trained Medicare consultants.
Most People Don’t Compare Medicare Plans When Choosing a Provider
We understand why people don’t compare their plan options. Finding the best provider for your individual needs can be stressful and time-consuming. Choosing PolicyScout as your trusted Medicare partner can make the process a lot easier.
If you are under the age of 65 but qualify for Medicare because of a disability or illness, some Medicare Advantage, Medicare Supplement Insurance, and Part D (Prescription Drug Coverage) Plans might not offer health insurance to you.
For example, if you have ESRD or ALS you can join a Medicare Advantage plan. But you may not be able to get a Medicare Supplement Insurance Plan until you are 65.
Some Medicare insurance companies offer Special Needs Plans (SNPs) designed to provide benefits and care for specific conditions.
It’s always best to check with providers to see what specific plans they can offer you if you suffer from a disability or illness.
If you’d like to learn more about your coverage options and Medicare, visit our Medicare Hub. We have a host of resources to help you navigate your way through Medicare and make informed decisions about your health cover.
If you’d rather speak to someone, one of our agents is ready to assist you with your Medicare questions. Our experience and knowledge make us a trusted choice for hundreds of Americans looking for Medicare advice and help.
Contact PolicyScout on 1-888-912-2132 to learn more about Medicare Advantage, Medicare Supplement Insurance plans, or Part D plans in your area.