Medicare Eligibility: Do You Qualify?

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.