Am I Eligible For Medicare?

Personal Circumstances Driving Your Eligibility

There are different conditions that factor into Medicare eligibility. Here are a few circumstances in which an individual can be eligible for Medicare Part A (hospital insurance), Part B (medical insurance), Part C (private insurance), and/or Part D (prescription drug insurance).

You have turned age 65, are a citizen or permanent resident of the United States for more than five years, and you or your spouse has worked in a Medicare covered employment for ten years or more.

Typically, U.S. citizens and certain permanent residents 65 years of age and older are eligible for Medicare if you or your spouse has worked more than 40 quarters in a Medicare covered employment.

If you are already collecting your retirement benefits, you will be automatically enrolled in Medicare Parts A and B on the first day of the month you turn age 65. You should receive your Medicare card in the mail showing your Medicare eligibility and coverage about three months before your 65th birthday.

You are allowed to delay your enrollment in Medicare Part B when you are first eligible if you or your spouse is still working and have health insurance through an employer or union. However, if you delay your enrollment after you are initially eligible and do not have credible coverage, you may have to pay a penalty for late enrollment.

You’re not 65 yet, but you have been receiving disability benefits from Social Security or RRB for at least two years

You must collect Social Security disability benefits for two years before you are eligible for Medicare disability benefits. You will be eligible for Medicare on the first day of the 25th month and you will be automatically enrolled in Medicare Parts A and B.

You have Lou Gehrig’s Disease

If you have Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease), you’ll be automatically Medicare eligible and enrolled in Medicare Parts A and B on the first day of the month when you begin receiving Social Security or RRB disability benefits. Your enrollment is automatic; there is no waiting period for your coverage to begin after you are Medicare eligible.

You have End-Stage Renal Disease that requires kidney transplant or dialysis

For those who have End-Stage Renal Disease (ESRD), you are eligible for Medicare if your condition requires a kidney transplant or dialysis treatment. In order to qualify for Medicare eligibility, you would also have to either be the spouse or dependant of someone who is eligible for Social Security or RRB benefits or have to have worked long enough to receive these benefits.

If you have ESRD and require dialysis, your Medicare coverage would not begin until three months after dialysis. For example, if you began treatment in September, you would not be eligible for or covered by Medicare until December.

If your condition requires a kidney transplant, you would be eligible from the month the hospital admits you for kidney transplant or related services. Medicare coverage would begin that month or within two months. If your transplant is delayed for more than two months and you are hospitalized during this time, your Medicare eligible coverage could start two months before your transplant.

Please note that your Medicare eligibility will end 12 months after you discontinue dialysis treatment or 36 months after you have had a kidney transplant and no longer need dialysis.

You are enrolled Medicare Parts A and B and are looking for additional coverage or other coverage options

If you are enrolled in both Medicare Parts A and B, you would be eligible to enroll in Medicare Part C plans and/or Medicare Part D plans. These plans are offered by private insurance companies and come with a variety of different benefits and coverage options. Enrollment in these plans is voluntary and it is your own responsibility to select a plan and enroll once you are eligible.

After you become eligible, you must enroll for Medicare Part C and/or Medicare Part D during your Initial Enrollment Period, which begins three months before you first become eligible for Medicare Part B and lasts for seven months. You can also enroll during the Annual Enrollment Period, which lasts from October 15th to December 7th.