Medicare Eligibility

Medicare is available to United States citizens and legal residents who have lived in the United States for at least 5 years in a row. Medicare is individual insurance. It doesn't cover spouses or dependents. You may become eligible to receive Medicare benefits based on any one of the following.

I am Turning Age 65 or am Older than Age 65

I am Receiving Social Security Disability (SSDI) Benefits

Recipients of Social Security disability benefits will be automatically enrolled into Medicare after 24 months.

Here’s what you need to know:

  1. You’ll be automatically enrolled in Original Medicare (Parts A and B). Your Medicare card will arrive in the mail a few weeks before your eligibility date.
  2. Your coverage starts the first day of the month you receive your 25th disability check.
  3. You still have an Initial Enrollment Period (IEP) when you may make decisions about your Medicare coverage.

Your IEP is 7 months long. It includes your 25th month of disability, the 3 months before and 3 months after.

I Have End Stage Renal Disease (ESRD) / Amyotrophic Lateral Sclerosis (ALS)

Medicare Coverage and ALS

If you have been diagnosed as having Amyotrophic Lateral Sclerosis (ALS) you will be automatically enrolled in Original Medicare, the month your Social Security disability benefits begin. Its best to apply for Medicare benefits as soon as you have been diagnosed, since a waiting period may need to be satisfied first.

You still have the right to make Medicare coverage choices, such as adding Medicare Part D prescription drug coverage or choosing a Medicare Advantage plan.

Medicare Coverage and ESRD

You may get Medicare benefits at any age if you have ESRD and one of the following applies :

  1. You are eligible for Medicare based on your work record.
  2. You are already getting Social Security or Railroad Retirement Board benefits, or you are eligible for benefits.
  3. Your spouse or parent meets one of the above requirements.

Medicare coverage starts the fourth month you receive dialysis treatments.

Medicare coverage could start the first month you receive treatments if all of these apply:

  1. You attend a home dialysis training program provided by a Medicare-certified training facility.
  2. Your doctor expects you to complete the training and be able to do your own dialysis treatments.
  3. You maintain regular dialysis treatments throughout the usual required waiting period.

You must enroll in Original Medicare Parts A and B yourself. Once you have both Part A and Part B, you may make other Medicare coverage choices, such as adding Medicare Part D prescription drug coverage or choosing a Medicare Advantage plan.

If you are 65 or older, or disabled, and are already enrolled in Part A, you may enroll in Part B without penalty if you are approved for Medicare based on ESRD. You may also have an existing Part B late enrollment penalty removed.