Who is Covered Under Medicare?
Summary: To qualify for Medicare, you must be a U.S citizen or permanent resident for at least five years in a row and be age 65 or older. You can also qualify for Medicare before turning 65 if you qualify by disability.
Medicare coverage: what is Medicare?
Traditional Medicare means Part A and Part B. Part A is hospital insurance, and Part B is medical insurance. To qualify for Medicare, you must:
- Be a U.S. citizen or a permanent resident of the United States for at least five years in a row.
- Fall into one of these categories:
- Be age 65 or older, or
- Qualify by disability as described later in this article
Medicare coverage at 65
If you’re age 65 or older, and you meet the requirements above, you typically qualify for Medicare. Not only that – in many cases, you’re automatically enrolled in traditional Medicare, Part A and Part B.
Typically, you get enrolled automatically if you’re already getting Social Security or Railroad Retirement Board retirement benefits when you turn 65.
If you’re not automatically enrolled, you can sign up during your Medicare Initial Enrollment Period (IEP). Your IEP generally begins three months before the month you turn 65 and continues for three months after that month. It lasts seven months in all.
Medicare coverage for a disability
If you have a disability, you may be eligible to enroll in Medicare before the age of 65. You’re automatically enrolled once you have received Social Security or Railroad Retirement Board disability payments for 24 months in most cases.
If you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you may qualify for Medicare coverage as soon as you are eligible for the disability benefits mentioned above. You will typically be enrolled in Medicare Part A and Part B automatically the same month you start getting disability benefits.
Medicare coverage when you have ESRD
People with end-stage renal disease (ESRD) might also qualify for Medicare coverage before age 65. You must have ESRD. That is, you have had a kidney transplant, or you need dialysis regularly. Also:
- You’ve worked for enough time to qualify for Social Security or Railroad Retirement Board (RRB) benefits.
- You are eligible for Social Security or Railroad Retirement Board (RRB) benefits, or you’re already getting them.
- You’re the spouse or dependent child of someone who meets either of the above requirements.
If you qualify for Medicare coverage younger than age 65 because of ESRD, you generally need to sign up. That is – you’re not automatically enrolled. Contact the Social Security Administration or the RRB to sign up or to get more information.
- Call at Social Security 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7 am to 7 pm, in all U.S. time zones.
- If you work(ed) for a railroad, call the Railroad Retirement Board at 1-877-772-5772. TTY users call 1-312-751-4701. Monday through Friday, 9 am to 3:30 pm, in all U.S. time zones.
Medicare coverage: who’s eligible for Medicare Part C and Part D?
You may be able to get your Medicare Part A and Part B benefits through Medicare Part C (Medicare Advantage). You’re generally eligible for Medicare Part C if:
- You have Medicare Part A and Part B
- You live within the plan’s service area
Please note that you might not qualify for Medicare Part C if you have ESRD. However, you might be able to enroll in a Medicare Special Needs Plan.
Medicare Part D is prescription drug coverage. Many Medicare Advantage plans already include this coverage. But if you decided not to sign up for a Medicare Advantage plan, you can still sign up for a stand-alone Medicare prescription drug plan (PDP). You’re generally eligible for a stand-alone Medicare PDP if:
- You have Medicare Part A or Part B
- You live within the plan’s service area
Once you are eligible to sign up for Medicare, trying to choose the right plan for you can feel overwhelming. Our plan comparison tool makes the job much easier. Enter your zip code in the box on this page and follow the prompts to compare Medicare plans in your area.