Medicare Eligibility
Who Is Entitled to Medicare?
Medicare isn’t just for people who turn 65. There are multiple pathways to eligibility — and the rules around what you qualify for, when you must enroll, and what it costs are more nuanced than most people realize.
Not sure if you qualify — or what to do next? We’ll walk you through it.
Four Ways to Become Eligible for Medicare
Most people qualify through age, but Medicare also covers people under 65 in specific circumstances.
Age 65 or Older
The most common pathway. You’re eligible for Medicare if you are 65 or older and:
You do not need to be retired or have stopped working to qualify.
Disability (Under 65)
You qualify for Medicare before age 65 if you have received Social Security Disability Insurance (SSDI) benefits for:
This applies to any qualifying disability. The 24-month waiting period begins from your first SSDI payment, not your application date.
End-Stage Renal Disease (ESRD)
You qualify for Medicare at any age if you have permanent kidney failure requiring:
Coverage typically begins the 4th month of dialysis (or sooner in some cases). There is no 24-month waiting period for ESRD.
ALS (Lou Gehrig’s Disease)
If you are diagnosed with Amyotrophic Lateral Sclerosis (ALS), you qualify for Medicare:
ALS is the only condition with an immediate Medicare eligibility exception — there is no waiting period of any kind.
Part A: Premium-Free vs. Premium
Most people get Part A (hospital insurance) automatically and without a monthly premium — but not everyone. Your eligibility depends on your work history.
Premium-Free Part A
$0/monthYou qualify for premium-free Part A if:
This is the most common scenario. Most Americans qualify for premium-free Part A.
Premium Part A
Up to $518/month (2025)You can buy Part A if you don’t qualify for it for free:
This applies to some immigrants, people who worked in non-covered employment, and those who didn’t work long enough in the U.S.
Important: Spouse & Ex-Spouse Work History Counts
If you don’t have 40 quarters of work history, you may still qualify for premium-free Part A based on your current spouse’s or ex-spouse’s work history — as long as the marriage lasted at least 10 years and you haven’t remarried.
What Each Part of Medicare Covers
Once you’re eligible, understanding which parts of Medicare you’re entitled to — and what they cover — is the foundation for making smart coverage decisions.
Part A — Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
Most people are automatically enrolled when they turn 65 if they’re already receiving Social Security.
Part B — Medical Insurance
Covers doctor visits, outpatient care, preventive services, durable medical equipment, mental health services, and ambulance services.
You must actively enroll in Part B unless you’re auto-enrolled through Social Security. Learn about Part B enrollment →
Part C — Medicare Advantage
Private plans that bundle Part A, Part B, and usually Part D together. Many include extra benefits like dental, vision, hearing, and fitness.
Optional — you choose to enroll during specific enrollment periods. Learn about Advantage plans →
Part D — Prescription Drug Coverage
Covers prescription medications. Available as standalone plans or built into most Medicare Advantage plans.
Optional but recommended — even if you don’t take medications now. Learn about Part D →
Working Past 65: When Must You Enroll?
If you’re still working at 65 with employer health insurance, your enrollment rules depend on the size of your employer.
Employer With 20+ Employees
Employer With Fewer Than 20 Employees
Critical distinction: COBRA, retiree coverage, VA benefits, and marketplace plans do not count as employer coverage from a large employer. These do not allow you to delay Part B without penalty.
Automatic Enrollment vs. Active Enrollment
Some people are automatically enrolled in Medicare. Others must take action to avoid coverage gaps and penalties.
Automatically Enrolled
You’ll receive your Medicare card in the mail approximately 3 months before your 65th birthday. You can decline Part B if you have qualifying employer coverage.
Must Actively Enroll
Missing your enrollment window can result in permanent penalties and coverage gaps. Don’t assume enrollment happens automatically.
Common Misconceptions About Medicare Eligibility
Not Sure What You Qualify For?
A quick review can clarify your eligibility, timeline, and next steps — at no cost.
Medicare Eligibility — Frequently Asked Questions
At what age am I eligible for Medicare?
Most people become eligible at age 65. However, you can qualify before 65 if you’ve received Social Security Disability benefits for 24 months, have been diagnosed with ALS (immediate eligibility), or have End-Stage Renal Disease requiring dialysis or transplant.
Do I have to be a U.S. citizen to get Medicare?
No. You can qualify as a legal permanent resident (green card holder) who has lived in the United States continuously for at least 5 years. You must also meet the age or disability requirements and have sufficient work history (or qualify through a spouse).
My spouse worked but I didn’t. Am I still eligible?
Yes. If your spouse has at least 40 quarters (10 years) of Medicare-tax-covered work, you can qualify for premium-free Part A based on their work history. This also applies to ex-spouses if the marriage lasted at least 10 years and you haven’t remarried.
I’m still working at 65. Do I have to sign up?
It depends on your employer size. If your employer has 20 or more employees, you can delay Part B without penalty. If your employer has fewer than 20 employees, Medicare becomes primary and you should enroll during your Initial Enrollment Period to avoid permanent penalties. Learn more about Part B enrollment.
Does COBRA count as employer coverage for delaying Medicare?
No. COBRA, retiree health plans, VA benefits, TRICARE, and marketplace plans do not qualify as current employer group health coverage. None of these allow you to delay Part B enrollment without facing permanent late enrollment penalties.
What if I never worked and my spouse never worked?
You can still enroll in Medicare at age 65, but you would need to pay a premium for Part A (up to $518/month in 2025). Part B is available to all eligible individuals regardless of work history, with the standard monthly premium.
Can I get Medicare if I’m under 65 with a disability?
Yes, but there is typically a 24-month waiting period after your first Social Security Disability (SSDI) payment. Medicare coverage begins automatically in month 25. The exception is ALS, which has no waiting period, and ESRD, which has a shorter waiting period.
What is a Medicare Supplement (Medigap) plan?
A Medicare Supplement plan works alongside Original Medicare to help cover deductibles, coinsurance, and gaps. It provides nationwide provider access but requires a separate Part D plan for prescriptions. See how it compares to Medicare Advantage.
Does my location affect my Medicare plan options?
Yes. Medicare Advantage plan availability, networks, premiums, and extra benefits vary significantly by where you live. Supplement plans are standardized nationally but premiums differ by location and carrier.
Explore More Medicare Resources
Turning 65 Guide
Step-by-step guide to enrolling in Medicare.
Enrollment Deadlines
Every enrollment period with dates and rules.
Supplement vs. Advantage
Understand the two main coverage paths.
Medicare Penalties
Avoid costly permanent late enrollment penalties.
Part B Enrollment
When to sign up and how to avoid gaps.
Medicare Glossary
Every Medicare term explained in plain language.
Questions About Your Medicare Eligibility?
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