Medicare Age Requirements: When Are You Eligible?
Most people qualify for Medicare coverage when they turn 65 years old. You may also be eligible if you are younger than age 65 and have a qualifying disability.
Who Qualifies for Medicare Coverage?
You qualify to apply for Medicare coverage if you fall within one of these two groups of individuals:
- You are age 65 (or you are turning 65 in the next three months – more on that below)
- You are under age 65 and have a qualifying disability
Medicare Eligibility at Age 65
The large majority of Medicare recipients become eligible for coverage when they turn 65 years of age. However, these two requirements are also necessary in order to qualify for Medicare coverage:
- 1. You must be a United States citizen or a legal permanent resident who has lived in the country for a minimum of five years. Providing a valid social security number or proof of residency satisfies this requirement.
- 2. You or your spouse must have worked and paid taxes for enough years to earn your place in the Medicare program. This requirement works out to roughly ten years. (Hint: if your work history qualifies you to receive Social Security or railroad retirement benefits, you should also qualify for Original Medicare.)
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Quick tip:
If you want your Medicare coverage to begin as soon as you turn 65, enroll during the three months prior to your birthday month. Your Medicare health plan will begin the first day of your birthday month.
Medicare Eligibility Due to Disability (Under Age 65)
You also qualify for Medicare if you are under the age of 65 and meet any of the following conditions:
- you have received disability benefits from the Socal Security Administration (SSA) for at least 24 months (those months don’t need to be consecutive).
- you have received disability benefits from the Railroad Retirement Board (RRB). Note: there are other requirements involved to satisfy this condition.
- you have been diagnosed with end-stage renal disease (ESRD) / permanent kidney failure requiring dialysis or a kidney transplant (and you or your spouse have met the work requirements of payment into the Medicare system).
- you have been diagnosed with Lou Gehrig’s Disease (amyotrophic lateral sclerosis). Medicare eligibility is immediate under this condition.
Once you have verified that you are eligible for Medicare coverage (or will be soon), it is important to understand the various parts of Medicare, what they cover, and when you become eligible for each.
Medicare Part A: Eligibility & Coverage
When Do You Qualify for Medicare Part A?
You become eligible for Medicare Part A when you turn 65 years old, or meet the disability requirements listed above.
What Does Medicare Part A Cover?
- Inpatient hospital care
- Skilled nursing facility care
- Inpatient skilled nursing home care (excludes custodial or long-term care)
- Hospice care
- Home health care
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Important:
If you or your spouse have paid Medicare taxes for the required 10 years, you will likely qualify for “premium-free” Part A. This means you may acquire Medicare Part A free of charge. (If you do not qualify under these circumstances, you may still be able to purchase Part A at a premium – subject to other requirements.)
Medicare Part B: Eligibility & Coverage
When Do You Qualify for Medicare Part B?
You become eligible for Medicare Part B when you turn 65 years old, or meet the disability requirements listed above.
What Does Medicare Part B Cover?
- Doctor visits
- Emergency room services
- Laboratory work
- Preventative health visits
- Imaging and diagnostic services
- Outpatient services beyond those listed here
Medicare Part C: Eligibility & Coverage
Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans (Part C) are purchased from a private insurance company and replace your Medicare Part A (hospital coverage), Part B (outpatient coverage), and usually include prescription drug coverage (Part D).
When Do You Qualify for Medicare Part C?
You become eligible for Medicare Part B when you turn 65 years old, or meet the disability requirements listed above. You must be enrolled in Part A and Part B in order to purchase a Part C (or Medicare Advantage) plan.
What Does Medicare Part C Cover?
- All services covered under Part A
- All services covered under Part B
- Prescription drugs (in most cases; varies by insurance carrier and plan)
- May offer wellness programs, dental care, vision care, and hearing care (varies by insurance carrier and plan)
Medicare Part D: Eligibility & Coverage
Medicare Part D can be purchased as a stand-alone policy from a private insurance company, or it may be bundled into a Medicare Advantage (Part C) plan (which replaces your Part A, Part B, and Part D coverage).
When Do You Qualify for Medicare Part D?
You become eligible for Medicare Part D when you turn 65 years old, or meet the disability requirements listed above. You must also be enrolled in Medicare Part A and Part B to enroll in Part D.
What Does Medicare Part D Cover?
- Outpatient prescription drugs
When Can I Enroll in Medicare?
Your Medicare enrollment period depends on your situation:
- Initial Enrollment Period (IEP): This is a seven-month window surrounding your 65th birthday (three months before, the month of, and three months after).
- Special Enrollment Period (SEP): If you’re still working and covered under an employer-sponsored health plan, you may qualify for an SEP to sign up later without penalties.
- General Enrollment Period (GEP): If you miss your IEP, you can sign up between January 1 and March 31 each year, though you may face late enrollment penalties.
Medicare Parts and Age Requirements
Understanding the different parts of Medicare can help clarify your eligibility:
- Medicare Part A (Hospital Insurance): Usually premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years.
- Medicare Part B (Medical Insurance): Available at age 65, but requires a monthly premium.
- Medicare Part C (Medicare Advantage): A private insurance alternative to Original Medicare, available once you’re eligible for Parts A and B.
- Medicare Part D (Prescription Drug Coverage): Available at 65 or earlier if you qualify due to disability.
Medicare Age Chart for Eligibility
| Age | Eligibility |
|---|---|
| Under 65 | Only if you have a qualifying disability, ESRD, or ALS |
| 65 | Standard eligibility for Medicare |
| 66+ | Eligible if you haven’t already enrolled |
The age at which you qualify for Medicare is primarily 65, but early eligibility is possible under specific circumstances. Knowing your enrollment periods and coverage options ensures you get the benefits you need without unnecessary penalties.
If you’re nearing 65, it’s a good idea to start researching your Medicare options and preparing for enrollment to avoid coverage gaps.
For more details on Medicare eligibility and enrollment, visit the official Medicare website or speak with a licensed Medicare specialist.
How Can I Check My Medicare Eligibility?
You can check your Medicare eligibility in a few simple ways, depending on whether you’re close to turning 65, have a disability, or have a qualifying medical condition. Here’s how:
1. Check Online Through the Medicare Website
You can verify your eligibility through Medicare’s official website:
- Visit Medicare.gov
- Click on “Sign Up / Change Plans”
- Select “Check Eligibility & Premiums” to determine if you qualify for premium-free Part A and when you can enroll.
2. Use the Social Security Administration (SSA) Website
Since Medicare eligibility is tied to your work history and Social Security benefits, you can also check through Social Security:
- Go to SSA.gov
- Log in or create a my Social Security account
- Click on “Medicare” to see your eligibility status and estimated premium costs
3. Call Medicare or Social Security
- Medicare Customer Service: 1-800-MEDICARE (1-800-633-4227)
- Social Security Office: 1-800-772-1213 (for Medicare eligibility and enrollment questions)
4. Check Your Work History
If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you’ll likely qualify for premium-free Part A. If you’re unsure, Social Security can provide your work credit history.
Why Are You Forced to Get Medicare at 65?
You’re not technically forced to get Medicare at 65, but there are strong incentives to enroll on time to avoid penalties and ensure you have adequate health coverage. Here’s why many people feel obligated to sign up at 65:
1. You May Lose Employer Coverage
- If you work for a small employer (fewer than 20 employees), Medicare becomes your primary insurance at 65, and your employer’s plan may no longer cover you.
- Larger employers (20+ employees) must continue coverage, but they may require you to sign up for Medicare Part A and/or Part B.
2. Avoiding Late Enrollment Penalties
- If you don’t sign up for Medicare Part B when first eligible and don’t have other creditable coverage, you’ll face a lifetime late enrollment penalty—an increase in your premium by 10% for every 12-month period you delay enrollment.
- Medicare Part D (drug coverage) also has a penalty if you don’t enroll when first eligible and don’t have creditable coverage.
3. Social Security & Automatic Enrollment
- If you’re already receiving Social Security benefits at 65, you are automatically enrolled in Medicare Part A and Part B.
- If you decline Part B, you must have other creditable coverage or risk penalties later.
4. Medicare is a Requirement for Some Retiree Benefits
- Some retiree health plans require you to enroll in Medicare Parts A & B before they cover additional costs.
- COBRA or Marketplace plans do not count as creditable coverage for delaying Medicare.
5. Premium-Free Part A is a No-Brainer for Most
- If you or your spouse worked at least 10 years (40 quarters) and paid Medicare taxes, Part A (hospital insurance) is free—so most people enroll to take advantage of it.
Can You Delay Medicare?
Yes, you can delay Medicare enrollment without penalties if you:
- Have active employer coverage through a company with 20 or more employees.
- Plan to keep working and want to stay on your employer’s health plan.
- Are covered by your spouse’s employer plan (with a large employer).
In this case, you can delay Part B (and Part D) until you retire or lose coverage and qualify for a Special Enrollment Period (SEP).
What is The Social Security 10 Year Rule?
The Social Security 10-year rule refers to the requirement that individuals must have worked and paid into Social Security for at least 10 years (40 quarters) to qualify for certain benefits, including Medicare and Social Security retirement benefits.
How the 10-Year Rule Works
- You earn “credits” based on your work history and earnings.
- Each year, you can earn up to 4 credits (one per quarter).
- To qualify for Social Security retirement benefits and premium-free Medicare Part A, you must have at least 40 credits (10 years of work).
What Benefits Require the 10-Year Rule?
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Social Security Retirement Benefits
- You can start collecting benefits as early as age 62 (at a reduced rate) or at full retirement age (67 for most people born after 1960).
- The more credits you earn, the higher your monthly benefit.
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Premium-Free Medicare Part A
- If you or your spouse worked for at least 10 years, you qualify for free Medicare Part A (hospital insurance) at age 65.
- If you haven’t worked for 10 years, you may buy Part A, but it can cost up to $518/month in 2025.
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Survivor Benefits for Spouses
- A spouse or dependent can qualify for Social Security survivor benefits if the deceased worker had at least 10 years of work credits.
Exceptions to the 10-Year Rule
- If you don’t meet the 10-year work requirement, you can still qualify for Medicare through a spouse who has earned 40 credits.
- If you’re disabled, you may qualify for Social Security Disability Insurance (SSDI) with fewer credits, depending on your age when you became disabled.
What Happens If You Haven’t Worked 10 Years?
If you haven’t met the 10-year rule, you may:
- Not qualify for Social Security retirement benefits but may still be eligible for Supplemental Security Income (SSI) if you have limited income and resources.
- Have to pay for Medicare Part A if you don’t qualify through a spouse.
What Are the Three Requirements for Medicare?
To qualify for Medicare, you generally need to meet three main requirements:
1. Age or Medical Condition Requirement
You must fall into one of these categories:
- Be at least 65 years old
- Be under 65 but have a qualifying disability (you must have received Social Security Disability Insurance (SSDI) for at least 24 months)
- Have End-Stage Renal Disease (ESRD) (kidney failure requiring dialysis or a transplant) or Amyotrophic Lateral Sclerosis (ALS) (automatically qualify with no waiting period)
2. U.S. Citizenship or Lawful Residency
You must be:
- A U.S. citizen OR
- A lawful permanent resident (green card holder) who has lived in the U.S. for at least five consecutive years
3. Work History or Payment of Medicare Taxes
- To get premium-free Part A, you or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters) in the U.S.
- If you don’t meet the 40-quarter requirement, you may still qualify for Medicare but will have to pay a monthly premium for Part A.
Can I Get Medicare if I Never Worked But My Husband Did?
Yes, you can qualify for Medicare even if you never worked, as long as your husband (or spouse) worked and paid Medicare taxes for at least 10 years (40 quarters). Here’s how it works:
Medicare Eligibility Through a Spouse
- If your spouse is at least 62 years old and has worked at least 10 years (40 quarters) paying Medicare taxes, you qualify for premium-free Medicare Part A at age 65.
- You must be at least 65 years old to enroll based on your spouse’s work history.
- If your spouse is already receiving Social Security or eligible for it, you can qualify for Medicare based on their record.
If Your Spouse is Younger Than 62
- If your husband (or wife) has not yet turned 62, you may need to wait until they reach 62 before you qualify for premium-free Part A.
- You can still purchase Medicare Part A (hospital insurance) if you don’t want to wait, but it could cost up to $518/month in 2025.
Do You Still Need to Pay for Medicare?
- Medicare Part A (Hospital Insurance): Free if your spouse qualifies.
- Medicare Part B (Medical Insurance): You’ll still need to pay a monthly premium for Part B ($185.00 in 2025, but higher if your income is above a certain level).
- Medicare Part D (Prescription Drugs): Not included automatically—you must enroll separately.
If You Are Divorced or Widowed
- Divorced: You can still qualify for Medicare based on your ex-spouse’s work record if:
- Your marriage lasted at least 10 years.
- You are currently unmarried.
- Your ex-spouse is at least 62 and eligible for Social Security.
- Widowed: You can qualify for Medicare at 65 based on your deceased spouse’s work history, as long as they worked and paid Medicare taxes.
Does Everyone Pay $170 a Month for Medicare?
Not everyone pays $170 per month for Medicare, but many people do pay a standard premium for Medicare Part B (Medical Insurance). The actual amount you pay depends on your income, the year of enrollment, and any applicable adjustments.
Medicare Part B Premiums for 2025
- The standard Part B premium in 2025 is $185.00 per month (it was $174.70 in 2024).
- Higher-income individuals pay more due to the Income-Related Monthly Adjustment Amount (IRMAA).
Who Pays More? (IRMAA Adjustments)
If your modified adjusted gross income (MAGI) is above certain thresholds, you’ll pay more than the standard premium. Here’s a breakdown:
| Individual Income (MAGI) | Married Couple Income (MAGI) | Part B Premium (2025) |
|---|---|---|
| $106,000 or less | $212,000 or less | $185.00 |
| $106,000 – $133,000 | $212,000 – $266,000 | $259.00 |
| $133,000 – $167,000 | $266,000 – $334,000 | $370.00 |
| $167,000 – $200,000 | $334,000 – $400,000 | $480.90 |
| $200,000 – $500,000 | $400,000 – $750,000 | $591.90 |
| Above $500,000 | Above $750,000 | $628.90 |
Do You Have to Pay for Medicare Part A?
Most people get Medicare Part A (Hospital Insurance) for free if they or their spouse worked and paid Medicare taxes for at least 10 years. If you don’t qualify for premium-free Part A, you could pay up to $518/month in 2025.
Other Medicare Costs to Consider
- Medicare Advantage (Part C): Costs vary by plan.
- Medicare Part D (Prescription Drug Plans): Costs depend on the plan and income.
- Medigap (Supplemental Insurance): Premiums vary based on coverage and location.
Ways to Lower Your Medicare Costs
- Medicare Savings Programs (MSP): Help low-income individuals with Part B premiums.
- Extra Help Program: Assists with prescription drug costs.
What Are The 6 Things Medicare Doesn't Cover?
Medicare covers many essential healthcare services, but there are six key things it does not cover:
1. Long-Term Care (Custodial Care)
- Medicare does not cover long-term nursing home care or assisted living.
- It only covers short-term skilled nursing facility stays after a hospital stay.
- If you need help with daily living activities (bathing, dressing, eating), you’ll need Medicaid, long-term care insurance, or personal savings.
2. Dental Care
- Routine dental exams, cleanings, fillings, dentures, and extractions are not covered.
- Medicare Advantage (Part C) may include dental benefits.
- If you need major dental work, you’ll likely need separate dental insurance.
3. Vision Care
- Original Medicare does not cover routine eye exams, glasses, or contact lenses.
- It does cover eye exams for diabetics and some conditions like glaucoma and cataracts.
- Medicare Advantage (Part C) often includes vision coverage.
4. Hearing Aids & Exams
- Medicare does not cover hearing aids, fittings, or routine hearing exams.
- Some Medicare Advantage plans offer hearing benefits.
5. Prescription Drugs (Without Part D)
- Original Medicare (Parts A & B) does not cover most outpatient prescription drugs.
- To get drug coverage, you need to enroll in Medicare Part D or Medicare Advantage with drug coverage.
6. Cosmetic Surgery
- Medicare does not cover elective cosmetic procedures (e.g., facelifts, Botox, or tummy tucks).
- It may cover procedures if deemed medically necessary, such as reconstructive surgery after an accident or mastectomy.
Other Services Not Covered
- Routine foot care (unless medically necessary for diabetes or other conditions)
- Over-the-counter medications & vitamins
- Acupuncture (except for chronic lower back pain)
- Medical care outside the U.S. (except in very limited situations)
If you need coverage for these services, you may want to consider Medicare Advantage (Part C), Medigap (Supplemental Insurance), or private insurance plans.
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Article Resources
- Medicare Eligibility & Enrollment
- Initial Enrollment Period for Medicare
- How to Enroll in Medicare
- Late Enrollment Penalties for Medicare
