Eligibility Requirements for Medicare

Before applying for Medicare, it is important to have a good understanding of the eligibility requirements for the program.

Researching the different ways you may qualify for coverage may save you time and money. In addition, you may not realize that you are already eligible for this insurance. Note that not every Medicare customer is 65 years of age or older. Knowing how you qualify may simplify the application process and will give you a better idea of what to expect.

The two main eligibility groups are senior citizens and individuals with permanent disabilities. In effect, the criteria for each group is different. Regardless of whether an applicant is over the age minimum or has a qualifying disability, he or she must also be a U.S. citizen or a legal resident.

If an applicant is a legal resident, he or she must have lived in the U.S. for a certain number of years. Discover more about Medicare eligibility requirements with our informative research.

Applying for Medicare as a U.S. Citizen or Legal Resident

If you are a U.S. citizen, you automatically meet the citizenship requirements for Medicare. You may be required to submit proof of citizenship in the form of a birth certificate or U.S. passport.

If you are a legal resident, you must have lived in the U.S. for a minimum of five consecutive years. You will be required to submit proof of your legal presence, such as a certificate of naturalization or an alien registration receipt card, more commonly known as a green card.

Residency Status for Medicare

You must be currently living in the U.S. and have a permanent address in order to receive Medicare benefits, regardless of whether you are a U.S. citizen or a legal resident. If you move outside the country, you may not receive Medicare health coverage and these benefits will not transfer to your new country of residence.

You may need to purchase international insurance instead. If you choose to move back into the United States, you may reapply for Medicare, though you must still meet all other eligibility requirements.

How to Qualify for Medicare as a Senior Citizen

Given that Medicare was established in 1965 in order to provide senior citizens with healthcare coverage, most Medicare recipients are elderly adults. To qualify as a senior citizen, an applicant must be 65 years of age or older.

Most applicants apply around their 65th birthdays because this is when their initial enrollment periods are in place. The initial enrollment period begins three months before an applicant’s birthday and ends three months after.

If you do not apply during this period, you must wait until the general enrollment period occurs, which happens on a yearly basis. You may be eligible for a special enrollment period depending on your current circumstances.

In addition to the age requirement, you must be eligible for Social Security (SS) benefits, Railroad Retirement Board (RRB) benefits or both. Note that you do not need to be actively receiving benefits from SS or the RRB in order to qualify.

Thus, you may continue to work after you reach 65 years of age and may retire later in life. Keep in mind that your Medicare premium may cost more if you are still working when you apply for coverage.

How to Qualify for Medicare as a Person with a Disability

As Medicare was expanded in 1972 to cover people with permanent disabilities, many present-day recipients are below 65 years of age. These enrollees must still meet certain requirements in order to receive health insurance under this national program.

In general, an applicant with a disability will automatically qualify for Medicare if he or she has received benefits from SS or RRB for a minimum of 24 months. Employees of federal, state or local governments who are disabled and receive SS or RRB benefits may also be eligible. Generally, these employees must have held a disabled status for a minimum of 29 months.

There are certain circumstances in which you are not required to wait 24 or 29 months to receive Medicare coverage as a person with a disability. For example, you may receive Medicare benefits within your first month of eligibility for SS or RRB benefits if you have amyotrophic lateral sclerosis (ALS), often referred to as Lou Gehrig’s disease.

How to Qualify for Medicare as a Person with End-Stage Renal Disease (ESRD)

There are a few other circumstances in which you may qualify for Medicare benefits without having to wait for a minimum of 24 months. As an example, you may be eligible for immediate coverage if you need regular dialysis treatments, require a kidney transplant or have recently had a kidney transplant.

However, certain other criteria must apply to your situation as well, including the following:

  • You are currently receiving benefits from SS or the RRB, or you are eligible for these benefits. This means that you have worked a certain amount of hours at a salaried job that earns Social Security points, or you have worked a certain number of hours for a railroad employer.
  • You have worked a certain amount of tax quarters as a government employee.
  • You are the spouse or dependent child of someone who qualifies for SS or RRB benefits or already receives benefits.

If you meet one or more of these requirements, your Medicare coverage may begin on the third month of your dialysis, the first month of dialysis if you are working on self-dialysis training, the first month of a kidney transplant or two months before your kidney transplant if you are hospitalized during those months.

Other Ways to Qualify for Medicare

If you are a disabled widow or widower, are 50 years of age or older, receive SS benefits and have yet to apply for disability benefits, for this reason, you may be eligible for Medicare. You may also be eligible if you have a dependent child or spouse with permanent kidney failure or your spouse worked for a railroad employer.

If you had Medicare Part B once before but dropped coverage, you are also allowed to reapply in order to receive coverage again. Be sure to contact the Social Security Administration (SSA) or Medicare if you are unsure of whether you qualify.