HomeHealth TipsDo you know the Medicare eligibility rules related to age?

10 months ago (04/02/22) 238 Views

Do you know the Medicare eligibility rules related to age?


Medicare is the federal government’s health insurance program for senior citizens and people with disabilities. If you’re 65 or older, you qualify for Medicare, but that doesn’t mean you automatically get it.

Once you meet certain age or other criteria for Medicare, you decide whether to enroll in the program.

Enrolling in Medicare can be a confusing process. It requires understanding some of the basics of how the program works.

This article will cover what you need to know:

What is the age of eligibility for Medicare?

The eligibility age for Medicare is 65 years old. This applies whether or not you are still working when you turn 65. You do not need to be retired to apply for Medicare.

If you have insurance through your employer at the time you apply for Medicare, Medicare will become your secondary insurance.

You can apply for Medicare:

  • up to 3 months before the month in which you turn 65
  • during the month in which you turn 65
  • up to 3 months after the month you turn 65

You have a 7-month window to sign up.

Are there exceptions to the Medicare eligibility age requirement?

There are many exceptions to the Medicare eligibility age requirement.

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If you’re under 65, but receive Social Security because you have a disability, you may be eligible for Medicare.

After 24 months of receiving Social Security due to disability, you may become eligible for Medicare.

If you have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), you are eligible for Medicare as soon as your Social Security disability benefits begin. You are not subject to the 24-month waiting period.

If you have End-Stage Renal Disease (ESRD), you are eligible for Medicare after a kidney transplant or 3 months after dialysis treatment begins.

What does it mean if the age of eligibility changes?

Legislators and elected officials sometimes discuss changing the age of eligibility for Medicare from 65 to 67.

If this were to happen, it would be a phased change.

For example, if legislation to change the eligibility requirement was passed the year you turn 65, you would still be eligible, just as you would have been if the law had not changed.

According to the Congressional Budget Office (CBO), the age requirement would most likely gradually increase by 2 months each year until the age reaches 67.

It would take several years for the age requirement criteria to come into full effect.

What are other Medicare eligibility requirements?

There are a few other Medicare eligibility criteria besides the age requirement.

  • You must be a United States citizen or lawful permanent resident who has lived in the United States for at least 5 years.
  • You or your spouse must have paid Social Security for a total of 10 years or more (or put another way, earned 40 credits) OR you must have paid Medicare tax while you or your spouse were employed by the federal government.
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Every year, the cycle for enrolling in Medicare seems similar. Below are some important deadlines to keep in mind.

  • Your 65th birthday. Initial Enrollment Period. You can apply to enroll in Medicare up to 3 months before, during the month of your 65th birthday, and 3 months after.
  • From January 1 to March 31. Annual enrollment period. If you haven’t applied for Medicare during the 7 months around your birthday, you can sign up during this time. You can also switch between Original Medicare and Medicare Advantage plans and change your Medicare Part D plan during this period. If you sign up for Medicare Part A or Part B during this time, you’ll be covered starting July 1.
  • From October 15 to December 7. The open enrollment period for people who have signed up for Medicare and want to change their plan options. Plans chosen during open enrollment are effective January 1.

What is Medicare?

Medicare is a federal health insurance program for people who are 65 years of age or older, as well as people with certain medical conditions.

Medicare is divided into different “parts”. Parts are a way of referring to different Medicare-related policies, products, and benefits.

Medicare Part A

Medicare Part A is coverage for hospital care, as well as hospice care, nursing facilities, and some home care services.

If you or your spouse paid Medicare taxes for 10 years or more, you are eligible for Medicare without any payment or premium once you turn 65.

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If you or your spouse worked for less than 10 years, you can still get Medicare Part A, but you may need to pay a premium based on the amount of time you worked.

Medicare Part B

Medicare Part B covers doctor’s care and preventive care. There is a monthly premium for Medicare Part B benefits. The premium changes annually. This is calculated based on your income.

Medicare Part C

Medicare Part C is also known as Medicare Advantage.

Medicare Part C provides all the benefits of Part A and Part B and sometimes includes additional benefits, too.

Medicare Part C requires payment of a premium. It is run by private insurance companies rather than through the federal government.

Medicare Part D

Medicare Part D helps cover the costs of prescription drugs. Medicare Part D has its premium, separate from Original Medicare. The cost of these plans varies.

Medicare Part D plans are run by private insurance companies.

Medigap Insurance

Medigap refers to private insurance plans that require a separate premium. These plans help with the costs of deductibles and copays. These plans are designed to help pay for what Original Medicare doesn’t cover.


The age of eligibility for Medicare remains 65 years old. If that were to change, it might not affect you, as the change will happen in gradual increments. Enrolling in Medicare may seem complicated, but there are many resources to help you simplify the enrollment process.


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