Medicare Eligibility

Medicare eligibility criteria include:

  • Your age
  • How many years you or your spouse has worked and paid Medicare taxes
  • Whether or not you have a disability
  • Whether you live in the U.S. or not
  • Whether you got group health benefits through your, your spouse’s, or your family member’s current employer

To determine if you’re eligible for Medicare and what your Initial Enrollment Period is, we recommend using the free tool provided by Medicare.gov called the Eligibility Calculator.

You may also contact Social Security (1-800-772-1213) to find out if you’re eligible for Part A and/or Part B. If you have benefits from the Railroad Retirement Board, we recommend calling them to check your eligibility: 1-877-772-5772

In essence, if you aren’t getting Social Security or Railroad Retirement Board benefits, you’re eligible to sign up for Medicare 3 months before your 65th birthday, the month of your 65th birthday, and 3 months after your 65th birthday.

You will most likely be automatically signed up for Medicare Part A, which is premium-free. However, you do need to actively sign up for Medicare Part B if you choose to do so. You may do this by contacting the Social Security office or by applying online at socialsecurity.gov/retirement.

If you don’t sign up for Medicare during the Initial Enrollment Period, you can only sign up during the General Enrollment Period, which is from January 1-March 31 each year. Your Part B coverage would start July 1, and you will pay a late enrollment penalty for not enrolling in Part B when you were first able to do so.

Eligibility for Medicare After Age 65

If you are still working after the age of 65 and have group insurance through your employer, it’s a great idea to speak with an agent to compare your current insurance against the costs and coverage of Medicare. You have the option of continuing your current group insurance or switching to Medicare.

Even after your Initial Enrollment Period ends, you will be granted a Special Enrollment Period if your group coverage gets dropped.

However, certain types of health insurance are not considered coverage based on your employment, so when that coverage ends, it’s not considered a Special Enrollment Period. In this case, you would be responsible for late enrollment penalties.

Health insurances that are not considered coverage based on current employment are:

  • COBRA
  • Retiree health plans
  • Individual health coverage (Ex: through the Health Insurance Marketplace)

Medicare Eligibility for Spouses

If you or your spouse is still working past the age of 65 and you have insurance through that employer or union, you might be able to delay signing up for Medicare B without dealing with a late enrollment penalty. Find out if you should switch to Medicare to continue with your employer coverage.

If you haven’t worked at least 10 years in which you’ve paid Medicare taxes, but your spouse has, you’re still eligible for Medicare.

For example, stay-at-home-moms are eligible for Medicare even if they haven’t worked and paid Medicare taxes. As long as their husbands have, they may enroll during their Initial Enrollment Period.

Medicare Eligibility by State

Part of the huge headache surrounding Medicare is that it’s a federally regulated program, but each state has its own mandates. However, the one saving grace is that Medicare Eligibility is the same in Kansas as it is in Utah (and every other state).

In fact, the Eligibility Calculator on the Medicare.gov website does not ask you for your state at all – it just asks if you live in the U.S. or one of its territories.