Medicare Eligibility Criteria :

Medicare is a federal health insurance program primarily designed for individuals aged 65 and older, but certain younger individuals may also qualify due to specific disabilities or medical conditions. Understanding who is eligible for Medicare is key to planning your healthcare coverage. Here’s a breakdown of the eligibility criteria for different groups.

1. Eligibility Based on Age

The majority of people qualify for Medicare when they turn 65. To be eligible, you must meet the following criteria:

• Age 65 or older.
• You must be a U.S. citizen or a legal permanent resident who has lived in the United States for at least five consecutive years.
• You (or your spouse) must have worked and paid Medicare taxes for at least 10 years (40 quarters).

Automatic Enrollment

If you’re already receiving Social Security or Railroad Retirement Board benefits before you turn 65, you will be automatically enrolled in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) once you reach 65.

2. Eligibility for Younger Individuals

Certain individuals under 65 can qualify for Medicare if they meet specific conditions, including:

Disability

• Receiving Social Security Disability Insurance (SSDI) for at least 24 months. After receiving SSDI for two years, you will automatically be enrolled in Medicare.

End-Stage Renal Disease (ESRD)

• Individuals of any age who suffer from permanent kidney failure (requiring dialysis or a kidney transplant) are eligible for Medicare. Enrollment can start as early as the first month of dialysis treatment under specific circumstances.

Amyotrophic Lateral Sclerosis (ALS)

• Also known as Lou Gehrig’s Disease, individuals diagnosed with ALS are automatically eligible for Medicare once they begin receiving SSDI benefits, with no waiting period.

3. Eligibility Based on Spousal Work History

If you are 65 or older but haven’t worked or paid enough Medicare taxes to qualify for premium-free Part A coverage, you may still qualify based on your spouse’s work history, provided:

• Your spouse is eligible for Social Security or Medicare benefits.
• You are currently married and your spouse is at least 62 years old, or you are a widow(er) and were married for at least 10 years to someone who qualified.

4. Medicare for Dual-Eligible Individuals

Some individuals qualify for both Medicare and Medicaid. These dual-eligible beneficiaries typically receive extra help paying for out-of-pocket Medicare costs like premiums, co-pays, and deductibles through Medicaid.

5. Special Enrollment Periods (SEPs)

Individuals who are still working and have health insurance through their employer may delay enrolling in Medicare Part B and qualify for a Special Enrollment Period. This allows them to enroll in Medicare without a penalty when they leave their job or lose their employer coverage.

Common SEPs Include:

• Losing employer-sponsored coverage after retirement.
• Moving to a new area where your current Medicare plan isn’t available.