Medicare Eligibility: Do You Qualify?

Adults age 65 and older, and those in certain situations, can enroll in Medicare

Dena Bunis and Kimberly Lankford,

AARP

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En español

Published December 05, 2022

/ Updated July 26, 2024

woman in front of a blue background with a medicare card

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Key takeaways

The law signed in 1965 still applies.
Eligibility rules are based on citizenship, age and disability.
Workers pay into the program to accumulate credits but also pay premiums.
Expect prescription, Medigap premium or Medicare Advantage expenses.

For nearly 60 years, Medicare has provided health insurance for Americans 65 and older as well as people with disabilities. More than 67 million are now enrolled.

More commonly known as original Medicare or traditional Medicare, the program refers to the first two parts of Medicare, Part A and Part B, included in a bill President Lyndon B. Johnson signed into law in 1965.

Part A helps pay for inpatient stays in hospitals and skilled nursing facilities, some home care and some end-of-life hospice care.
Part B covers doctors’ services, diagnostic screenings, lab tests, outpatient care, preventive services, plus some medical equipment and transportation.

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Medicare’s not automatic. Just because you’re 65 doesn’t mean you qualify for Medicare. You also must meet one of these three criteria:

A U.S. citizen.
A person lawfully present in the U.S. who has paid or whose spouse paid Medicare payroll taxes for at least 40 quarters, or 10 years total.
Lawfully present refers to someone, such as a green card holder with permission to live and work permanently in the U.S. or someone with temporary protected status from a country that the U.S. has designated unsafe to return to. Lawful residents can qualify based on their spouse's work history if they've been married for at least one year and their spouse is at least 62.
A permanent legal resident, also known as a green card holder, can also qualify for Medicare without 40 work credits if that person lives continuously in the U.S. for at least five years before applying. If you or your spouse lived on and off in the U.S. but accumulated the required 40 credits, you don’t need to meet the five-year residency requirement. If you’re a U.S. citizen or a green card holder and neither you nor your spouse has earned 40 work credits, to receive Part A benefits you must pay monthly premiums.

It starts at age 65 for most. You can sign up for Medicare during your seven-month initial enrollment period, which runs for the three months before and after the month you turn 65. Unless you qualify earlier because of a disability, the earliest your coverage can start is the first of the month you turn 65 or the start of the previous month if your birthday is on the first.

Who qualifies for Medicare before age 65?

About 10.5 percent of Medicare beneficiaries are younger than 65 and receive Medicare because of a disability or specific medical condition. You’re eligible if you meet any of the following criteria:

You are entitled to Social Security disability benefits for at least 24 months.

You receive a disability pension from the Railroad Retirement Board and meet certain conditions.

You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS), which qualifies you immediately.

You experience permanent kidney failure requiring regular dialysis or a kidney transplant. To be eligible for Medicare for this reason, you or your spouse must also have paid Social Security taxes for a specified number of years based on your age. Dependent children can also qualify based on their parents’ work records.

What if you don’t have enough work credits?

If you don’t qualify for Medicare on your own or through your spouse’s work record, but you’re a U.S. citizen or have been a legal resident for at least five years, you can still get full Medicare benefits at age 65 or older. You’ll just pay extra.

Part A premiums are calculated based on the years you’ve worked and paid Medicare taxes. The longer you work, the more work credits you earn. You earn work credits based on your income; the amount of income it takes to earn a credit changes each year.

Most people receive Part A free because they or their spouses have worked and paid Medicare taxes for at least 40 calendar quarters. If you or your spouse haven’t paid Medicare payroll taxes for 10 years, the following premiums for Medicare Part A apply in 2024:

$505 a month, fewer than 30 quarters.
$278 a month, 30 to 39 quarters.

If you continue working until you reach 40 credits, you will no longer pay these premiums.

Part B premiums don’t depend on the number of quarters of Medicare taxes paid. But you may pay more based on your income. In 2024, you’ll pay:

$174.70 a month.
$69.90 to $419.30 a month additional for high earners.

What other decisions and costs will I face?

1. If you get Part A for free, you can choose whether to sign up for Part B. You won’t need Part B while you or your spouse are still working and have employer health insurance, but you must enroll within eight months of losing that job-related coverage or you could face a late enrollment penalty.

2. If you have Medicare Part A or Part B, you also can sign up for Part D prescription coverage. Private companies that Medicare approves sell these policies. You pay separate premiums based on the Part D plan you choose.

3. If you have Part A and Part B, you can sign up for a Medicare supplement policy. More commonly known as Medigap, this insurance can help pay original Medicare’s deductibles, copayments and other out-of-pocket costs.

Or you can opt for a Medicare Advantage plan, also known as Medicare Part C, that provides health and drug coverage from a private insurance company. You need to have Part A and Part B to sign up for a Medicare Advantage plan. Some plans charge monthly premiums in addition to your Part B premiums — and Part A premiums if you aren’t eligible for free coverage.

Editor’s note: Patricia Barry contributed to this story, which has been updated with 2024 information.

Do I Qualify for Medicare?

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Dena Bunis covered Medicare, health care, health policy and Congress. She also wrote the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.