People are generally eligible for Medicare at age 65 if they meet Medicare’s citizenship or residency requirements. Some people qualify before 65 because of a disability, ALS, or End-Stage Renal Disease (ESRD). The next step is determining whether you’ll be enrolled automatically or need to sign up yourself.
Who is eligible for Medicare?
Medicare is federal health insurance for people 65 or older who meet the program’s citizenship or residency rules. Medicare also allows earlier eligibility for certain people under 65.
| Who may qualify | General rule |
|---|---|
| People age 65 or older | Usually eligible if they meet citizenship or residency requirements |
| People under 65 with a disability | Generally eligible after 24 months of qualifying Social Security disability benefits; qualifying Railroad Retirement Board disability benefits may also establish eligibility |
| People with ALS | Can get Medicare automatically the same month Social Security disability benefits start |
| People with ESRD | May qualify earlier under ESRD-specific Medicare rules |
Citizenship and residency rules
Medicare says you must meet its citizenship or lawful presence rules to get Part A and Part B or to join a Medicare health or drug plan. If that part of your eligibility is unclear, it is important to verify it directly before you apply.
Will Medicare enroll you automatically?
Sometimes. If you begin getting Social Security or Railroad Retirement Board retirement benefits at least 4 months before turning 65, Medicare says you’ll generally get Part A and Part B automatically when you turn 65.
If you are not taking those benefits yet, you usually need to contact Social Security when you are ready to sign up. Medicare eligibility does not always mean automatic enrollment.
When can eligible people sign up?
For most people turning 65, the first enrollment opportunity is the 7-month Initial Enrollment Period. It usually starts 3 months before the month you turn 65 and ends 3 months after that month.
Medicare also notes that there can be risks to signing up late, including gaps in coverage or late enrollment penalties, unless you qualify for a Special Enrollment Period.
What if you are still working?
Being eligible for Medicare and needing to enroll right away are not always the same thing. If you or your spouse have qualifying job-based group health coverage from current employment, you may be able to delay Part B and use a Special Enrollment Period later.
That Special Enrollment Period generally ends 8 months after the employment ends or the group health plan coverage ends, whichever happens first. COBRA does not count as group health plan coverage for this rule.
What coverage can eligible people choose?
Once you are enrolled in Medicare, you generally choose how to receive your coverage.
- Original Medicare: Part A and Part B
- Medicare Advantage: an alternative offered by private plans that includes Part A and Part B and usually Part D
- Part D: prescription drug coverage through a standalone drug plan or a Medicare Advantage plan with drug coverage
To join a Medicare Advantage plan, you need both Part A and Part B.
Checklist: how to tell if you may be Medicare eligible
- Are you age 65 or older?
- If under 65, do you receive disability benefits, have ALS, or have ESRD?
- Do you meet Medicare’s citizenship or residency requirements?
- Are you already getting Social Security or Railroad Retirement Board benefits?
- Do you have current job-based group health coverage that may affect when to take Part B?
- Do you need both Part A and Part B for a Medicare Advantage plan you are considering?
FAQ
Can someone under 65 be eligible for Medicare?
Yes. Medicare says some people under 65 qualify because of disability, ALS, or ESRD.
Does Medicare eligibility mean I am enrolled automatically?
No. Some people are enrolled automatically, while others must sign up through Social Security.
If I am still working, can I delay Part B?
Possibly, but the rule depends on qualifying active-employment group coverage. It should be verified before delaying enrollment.
Confirm enrollment rather than assuming it
Automatic Part B enrollment does not apply in Puerto Rico or outside the United States. Check the effective dates on your Medicare notice. Your eligibility decision and enrollment are handled by Social Security or the Railroad Retirement Board, as applicable; an insurance agent cannot approve federal Medicare eligibility.
Related coverage questions
- How to Enroll in Medicare: Steps, Timing and Where to Get Help
- How to Verify Your Medicare Coverage and Plan Enrollment
- When Does Medicare Start? Effective Dates for Parts A and B