Medicare Eligibility
Check to see if you're eligible for Medicare
Typically, Medicare is available for U.S. citizen ages 65 and older. However, people with certain disabilities may be eligible at any age. Keep reading to see if and when you’ll be eligible to enroll in Medicare.
To qualify for Medicare, you must be
— A U.S. resident or a legal resident living in the U.S. for at least 5 consecutive years
— Age 65 or older
— People under 65 who have qualifying disabilities like:
— Permanent kidney failure (end-stage renal disease) requiring dialysis or a kidney transplant
— Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
Special enrollment periods for Medicare
Most people enroll in a Medicare Advantage plan during the 7 month period around their 65th birthday (3 months before, 3 months after, plus birth month). Outside of that time period, you usually have to wait for the annual enrollment period to begin on October 15th. However, you may be able to enroll in a plan through a special enrollment period if you:
— Retired after 65
— Moved and your current plan is not available in your new region
— Became a resident of a nursing home
— Need to leave your employer health plan
— Involuntarily lost prescription drug coverage
— Meet certain low-income guidelines
Eligibility for other parts of Medicare
To be eligible for other parts of Medicare, you must meet a few requirements:
- Medicare Advantage
- Prescription Drug Plan
- Medigap Plan
— You must be eligible for Medicare and already enrolled in both Part A and Part B.
— Except in certain circumstances, if you’ve been diagnosed with end stage renal disease (ESRD) at the time of enrolling, you will not be eligible for Medicare Advantage. If you are diagnosed while enrolled in a Medicare Advantage (MA) plan, you can continue to be enrolled.
— Your permanent address must be in the plan’s service area.
— You cannot be enrolled in a stand-alone Part D prescription drug plan and a Medicare Advantage plan, even if you choose a plan that doesn’t cover prescription drugs.
— You must be eligible for Medicare and already enrolled in both Part A and Part B.
— You still qualify for Part D coverage even if you’ve been diagnosed with end stage renal disease (ESRD), have amyotrophic lateral sclerosis (Lou Gehrig’s Disease) or certain disabilities.
— Your permanent address must be in the plan’s service area.
— You cannot be enrolled in a stand-alone Part D prescription drug plan and a Medicare Advantage plan at the same time, even if your Medicare Advantage plan doesn’t cover prescription drugs.
— Because Medigap Blue policies supplement your Medicare coverage, you must be eligible for Medicare and already enrolled in both Part A and Part B.
— Your permanent address must be in the plan’s service area.
— In most cases, Medicare supplement policies are “underwritten.” This means that some companies may charge more for a Medigap Blue policy or deny coverage for preexisting conditions.
— There are certain times, however, when an insurance company must sell you a Medigap Blue policy, even if you have health problems. Listed below are times that you’re guaranteed the right to buy a Medigap Blue policy:
• When you’re in your Medigap Blue open enrollment period.
• If you have a guaranteed issue right.
— In some cases it may be illegal for the insurance company to sell you a Medigap Blue policy (such as if you already have Medicaid or a Medicare Advantage Plan).
Ready to enroll?
If you meet the qualifications, then let's get started on the enrollment process.
Do you need more information on Medicare eligibility?
Contact Social Security at 800-772-1213, 24 hours a day, 7 days a week, or visit the
Social Security Administration website.