Medicare eligibility: who gets it and how to apply

If you’re turning 65 or dealing with a disability, you’ve probably heard the word Medicare. But knowing whether you qualify and what to do next can feel confusing. This guide breaks down the basics, so you can figure out if you’re eligible and get covered without the hassle.

Who qualifies for Medicare?

Medicare is a federal health program for three main groups:

  • People 65 or older. Age is the simplest trigger – once you hit 65 you’re automatically eligible.
  • Those under 65 with a disability. If you’ve received Social Security Disability Insurance (SSDI) for at least 24 months, you can enroll.
  • People with End‑Stage Renal Disease (ESRD) or ALS. Kidney failure or Lou Gehrig’s disease qualifies you right away, no waiting period.

Citizens, permanent residents, and eligible non‑citizens can all sign up. If you’re not a U.S. citizen but have a valid work visa, you may still qualify if you’ve paid Medicare taxes for at least 10 years.

Understanding Medicare parts and enrollment periods

Medicare isn’t one single plan – it’s split into parts that cover different services:

  • Part A (Hospital Insurance). Most people get this for free if they or a spouse paid Medicare taxes while working.
  • Part B (Medical Insurance). Covers doctor visits, outpatient care, and some preventive services. You pay a monthly premium.
  • Part C (Medicare Advantage). Private plans that bundle A, B, and often prescription drug coverage (Part D) into one plan.
  • Part D (Prescription Drugs). Stand‑alone drug coverage if you keep original Medicare.

The key dates are:

  • Initial Enrollment Period (IEP). The 7‑month window that starts three months before you turn 65, includes your birth month, and ends three months after.
  • General Enrollment Period (GEP). If you miss the IEP, you can sign up Jan 1‑Mar 31 each year, but coverage starts July 1 and you may pay a late‑enrollment penalty.
  • Special Enrollment Period (SEP). Available if you’re covered by employer insurance when you turn 65 or lose other creditable coverage.

To avoid gaps, apply online at socialsecurity.gov/medicare during your IEP or use the phone line if you need help.

When you apply, have these items ready: your Social Security number, birth certificate, recent tax return (for income‑based plans), and details of any current health coverage.

Most people only need Parts A and B, but if you take several prescriptions, adding Part D can save money. If you prefer one plan with extra perks like dental or vision, check Medicare Advantage options in your area.

Remember, you can change your plan during the Annual Election Period (Oct 15‑Dec 7) for the next year. Review your costs and coverage each year – premiums, co‑pays, and networks can shift.

Bottom line: If you’re 65 or older, have a qualifying disability, or live with ESRD/ALS, you’re likely eligible. Start the sign‑up process early, keep your documents handy, and compare plan details to find the best fit for your health and budget.

Is Medicare Part A Really Free at 65? Everything You Need to Know
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June

Is Medicare Part A Really Free at 65? Everything You Need to Know

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