Medicare Eligibility: Who May Enroll in Medicare?
Who is eligible for Medicare Part A and Part B?
Medicare is government health care coverage. Medicare Part A covers hospital insurance and Medicare Part B covers medical insurance.
Only U.S. citizens and permanent legal residents of at least five continuous years are eligible for Medicare. To be eligible for Medicare, you also must either:
- Be age 65 or older OR
- Be disabled OR
- Be of any age and have end-stage renal disease (ESRD)
If you are turning 65 and are receiving Social Security or Railroad Retirement Board benefits you may be automatically enrolled in Medicare and receive your Medicare card in the mail. If you are not receiving these benefits, you will not be automatically enrolled and you can apply for Medicare through Social Security.
If you have a disability, there is generally a waiting period of two years that you are receiving Social Security benefits before you are eligible for Medicare. After this waiting period, you’re generally automatically enrolled in Medicare. There are certain conditions that could waive your Medicare eligibility waiting period.
- If you have ESRD and you’re on dialysis, Medicare coverage usually starts the first day of the fourth month of your dialysis treatment. Medicare coverage may start as early as the first month of dialysis under certain conditions. If are eligible for Medicare through ESRD, you need to sign up as your enrollment is not automatic.
- If you have ALS (Lou Gehrig’s disease) you are eligible for Medicare the first month you are entitled to Social Security or Railroad Retirement Board benefits. There is no waiting period for Medicare coverage if you have ALS.
Who is eligible for Medicare Part C (Medicare Advantage)?
Medicare Advantage is another way to get your Medicare Part A and Part B benefits from a private insurance company contracted with Medicare. Medicare Advantage plans must cover everything that Original Medicare (Part A and Part B) cover with the exception of hospice care, which is still covered by Part A. Medicare Advantage plans often offer extra coverage that Original Medicare typically doesn’t cover, such as routine dental, routine vision, prescription drug benefits and more. To be eligible for Medicare Advantage, you must:
- Already have Medicare Part A and Part B
- Live in the service area of the plan you want to enroll in (certain states and areas may have few or no Medicare Advantage plans available)
- Generally not have End-Stage Renal Disease if you haven’t had a kidney transplant (If you have ESRD you may be able to join a Special Needs Plan (SNP) if one is available in your area.)
Who is eligible for Medicare Part D (prescription drug coverage)?
Medicare Part D is coverage for prescription drugs offered by private companies contracted with Medicare. You may want Medicare Part D coverage because Original Medicare (Part A and Part B) doesn’t cover most prescription drugs you take at home. You can get Medicare Part D coverage either through a stand-alone Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage.
To be eligible for Medicare Part D you must
- Be enrolled in Medicare Part A and/or Part B
- Live in the service area of your plan
There is no exclusion for ESRD patients for stand-alone Medicare Part D plans.
Who is eligible for Medicare Supplement (Medigap)?
Medicare Supplement insurance plans can help cover costs that Original Medicare doesn’t cover, such as coinsurance, copayments, and deductibles. Like Medicare Part D plans and Medicare Advantage plans, Medicare Supplement insurance plans are offered by private insurance companies contracted with Medicare. To be eligible for Medicare Supplement you must generally:
- Be enrolled in Medicare Part A and Part B
- Live in the service area of your plan
- Be age 65 or older
Medicare Supplement is not generally available to Medicare beneficiaries under 65 who are eligible for Medicare because of a disability. Federal law doesn’t require companies to sell Medicare Supplement polices to people under 65, although some states do require insurance companies to sell to people under 65. However, if you’re under 65 and shopping for a Medicare Supplement Insurance plan, it may cost you more than if you were 65 or older.
When to enroll
Depending on the type of Medicare coverage you enroll in, there may be different enrollment periods. Generally, you can enroll when you’re first eligible for Medicare. Read about eligibility for Medicare.