Navigating the Medicare eligibility maze: do you qualify for Medicare?

Confused about whether you’re eligible for Medicare? In this article, we break down the important factors you need to know.

Illustration of a Medicare insurance card.

Launched in 1965, Medicare is a health insurance program offered by the U.S. government. It helps cover many medical expenses, such as hospital visits and doctors appointments. While it is mostly a program for folks 65 and older, Medicare also supports certain people under 65 with qualifying disabilities or medical conditions such as end-stage renal disease (ESRD, referring to permanent kidney failure requiring dialysis or a transplant).

Medicare eligibility can be complicated, so let’s jump through the hoops together so you understand your options.

Are you 65 or older?

The big 65 is more than just a magical birthday; for many, it’s your golden ticket to Medicare eligibility. If you've been hanging your hat in the U.S. as a citizen or permanent resident for at least five consecutive years and are receiving (or eligible to receive) Social Security or Railroad Retirement benefits, you're in the club. Alternatively, if you or your spouse worked long enough in a government job where you paid Medicare taxes, you're all set.

Are you younger than 65?

Some individuals under the age of 65 can also qualify for Medicare. If you've got Social Security Disability Insurance (SSDI) in your corner for 24 months, or perhaps a disability pension from the Railroad Retirement Board, you might be eligible.

Additionally, specific conditions like Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS), or permanent kidney failure may also fast-track you into Medicare eligibility.

Other paths to Medicare eligibility

If you don’t qualify for Medicare on your own or through your spouse’s work history, but meet the U.S. citizenship and residency requirements, you can buy into Medicare when you turn 65 by paying premiums for part A.

You can also enroll in Part B by paying premiums, but if you buy part A, you’ll have to buy part B as well. And, if you’re interested in Medicare Advantage, like the kinds of plans Devoted Health offers, you’ll have to be enrolled in both A and B.

What about Medicaid?

Medicaid is a joint federal and state program and offers benefits beyond Medicare to people with limited income, such as coverage for nursing home care and personal care services. Some seniors are eligible for both Medicare and Medicaid, which is sometimes referred to as being “dual eligible”.

Medicaid eligibility differs by state, but if you qualify for both, most of your health care costs are likely covered. If this describes your situation, you can decide whether to enroll in an Original Medicare plan or a Medicare Advantage (part C) plan. Medicare Advantage plans, such as D-SNP and C-SNP plans, may make it easier for you to get the care and services you need, and also cost less overall. You can learn more about these plan types here.

When to enroll in Medicare

Once you understand your eligibility, it's important to learn how and when you can enroll in Medicare.

When you turn 65, you have a 7-month Initial Enrollment Period (IEP) to sign up for Medicare, which begins 3 months before the month you turn 65, includes your birthday month, and extends 3 months after that month. Signing up during this time helps you avoid pesky late enrollment penalties.

If you miss the IEP, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. But, it’s important to remember that late enrollment may mean higher premiums for Part B. Read more about enrollment period specifics here.

Other resources for Medicare eligibility

An easy way to verify your eligibility is to visit Medicare.gov. Or, if you prefer to speak with someone over the phone, try the Medicare hotline at 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2048.

How Devoted can help

We have licensed representatives available to help you with your questions or answer more questions about Devoted Health Medicare Advantage plans. Call us at 1-800-483-8066 (TTY 711) for personalized assistance.

You can also learn more about your Medicare options in this free Medicare Comparison Guide.