Know the Medicare Eligibility Rules

Determining Your Eligibility for Medicare



Medicare eligibility is relatively straight forward. Determining your eligibility for Medicare and learning how to apply for Medicare is vital to assure you get all the benefits you're entitled to for the taxes you have paid into the system.

medicare eligibility

If you have worked for an employer for at least forty quarters in your life, which is equivalent to 10 years, you are eligible to receive Medicare benefits when you turn 65. There are a few additional details which are explained below, but basically if you have worked the required number of yours, you are eligible for Medicare.


Basic Medicare Eligibility - If Over Age 65

Medicare Part A is usually free for people who meet the following conditions and who are over the age of 65. The best time to apply for Medicare is 3 months prior to your 65 birthday. At that point you will also be eligible for Medicare Part B, but in most cases you will have to pay a premium.

Eligibility for Medicare depends on the following conditions. Number 1, being a US citizen or permanent resident, is required for all persons to receive Medicare benefits. You must, after that, meet only one of the other conditions.

  1. You must be a citizen or permanent resident of the United States of America
  2. You already get retirement benefits from either Social Security or Railroad Retirement Board (RRB)
  3. You or your spouse worked at least 10 years in Medicare covered employment
  4. If you were self employed, you paid your self employment tax, which covers Medicare and Social Security
  5. You or your spouse worked in a Medicare covered government job.
  6. You are eligible for Social Security Retirement or Railroad Retirement benefits but have not yet applied for them.

The age of official, full retirement for Social Security has been changed for some people, depending on the year you were born, from age 65 to age 67. However, the Medicare edibility age has remained at age 65.

If you are still working at the age of 65 and are not receiving full social security benefits, you will have to contact Social Security to apply for Medicare coverage. You will not be notified by them.

Your Medicare Eligibility - If Under Age 65.

There are a few exceptions to the rules above. These exceptions were put into place to help protect those people that could no longer work and needed to begin their Medicare eligibility earlier than their 65 birthday.

Some of you under age 65 may have eligibility for Medicare if you are US citizens or permanent residents and you have any of the following conditions or circumstances:

  1. You have been receiving either Social Security Disability Benefits or Railroad Retirement Disability Benefits for over 2 years, officially 24 months.
  2. You have a diagnosis of End Stage Renal Disease which is permanent kidney failure requiring transplant or dialysis. Under this provision, you are eligible to receive Medicare benefits within 3 months of your first dialysis treatment, regardless of whether you have applied or are receiving Social Security Disability Income.
  3. You have been diagnosed with Amytropic Lateral Sclerosis (ALS) also known as Lou Gerhig's Disease. In this circumstance, you are eligible to receive Medicare benefits the same month you first receive Social Security Disability Income.

If you have been receiving Medicare benefits under the age of 65 and your condition improves, or you receive a kidney transplant, you may lose you Medicare benefits. If this is your case, or if you suspect it may be in the future, it is best to contact a Social Security representative to explore your options.



Understanding your Medicare eligibility is important to make sure you get your benefits when you deserve them. It is also important to apply for Medicare when you first become eligible, as it will affect the price you have to pay for Medicare Part B costs if you delay your application.

If you are still working at the age of 65, even if you still have insurance through your employer, you should still sign up for Medicare Part A at least. Your part A Medicare Benefits may help offset the costs of hospitalizations that your primary insurance does not cover.

If you have any questions on when you should sign up for either Part A or Part B coverage, contact if Social Security at 1-800-772-1213 or contact me personally and I will assist you in determining what your best course of action will be.






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