What are the Medicare eligibility requirements?

Here’s a simple checklist to help you see if you're eligible for Medicare.

Are you a U.S. citizen or a legal permanent resident who has lived in the U.S. for at least five continuous years?

• Yes: Continue.

• No: You are likely not eligible at this time.

Do you meet one of the following criteria?

• You are 65 or older.

  • Most people become eligible for Medicare Part A (hospital insurance) at age 65 if they (or their spouse) have worked and paid Medicare taxes for at least 10 years.

• You are under 65 and have a disability.

  • You must have received Social Security Disability Insurance (SSDI) benefits for at least 24 months.

• You have end-stage renal disease (ESRD), requiring dialysis or a kidney transplant.

• You have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.

If you answered "yes" to the first question and checked at least one of the boxes under the second, you are likely eligible for Medicare.

When can I get Medicare if I was born in 1960-1965?

If you were born between 1960 and 1965, you are either currently approaching or have recently reached your Medicare eligibility window. While the "Full Retirement Age" for Social Security has shifted to 67 for this age group, the eligibility age for Medicare remains 65. 

Medicare Eligibility Age Chart

How and When to Enroll in Medicare

Your Initial Enrollment Period (IEP)

This is the first time an eligible person can enroll in Medicare Part A and Medicare Part B. This timeline begins three months before the month of a person’s 65th birthday and continues through the three months following a person’s 65th birthday.

Automatic vs. Active Enrollment

In some cases, enrollment is automatic. If you collect Social Security or Railroad Retirement Board benefits when you turn 65, or if you’re Medicare-eligible at any age due to a disability or medical condition, you’ll generally be automatically enrolled in Original Medicare, which includes:

• Part A: Coverage for hospital expenses

• Part B: Coverage for healthcare expenses

In other cases, individuals must actively enroll. If you’re not currently receiving Social Security benefits or Railroad Retirement Board benefits when you turn 65, you must complete the formal enrollment process.

Other Key Enrollment Periods

If you miss your IEP window, you may be able to sign up during the General Enrollment Period (GEP), which runs from January 1 to March 31 each year, but this may result in a late enrollment penalty. 

Current beneficiaries can make changes to their coverage during the Annual Enrollment Period (AEP), from October 15 to December 7, which allows for switching between Original Medicare and Medicare Advantage plans or changing prescription drug plans. In addition, a Special Enrollment Period (SEP) may be available if you experience a specific life event, such as moving out of your plan’s service area or losing your health insurance.

Your Turning 65 Medicare Checklist

Once you understand your Initial Enrollment Period (IEP) dates, it’s time to take action. Use this streamlined three-step guide to ensure you don’t miss important deadlines or leave gaps in your coverage:

1. Confirm your Initial Enrollment Period dates.

2. Enroll in Part A and Part B via Social Security.

3. Compare Medicare Advantage and Supplement plans to understand your options for covering the remaining 20% of your healthcare costs.

Don’t navigate your enrollment alone. Ensure you’re fully prepared for this milestone by downloading our today. This comprehensive guide breaks down every deadline and decision you need to make for a stress-free transition to Medicare.

The Cost of Medicare Explained

Medicare Part A (Hospital Insurance) Costs

In many cases, Medicare Part A is premium-free. This includes:

• If you are 65 or older and you worked and paid Medicare taxes for at least 10 years (or you’re a government employee who is Medicare-covered).

• If you are receiving retirement benefits from Social Security or the Railroad Retirement Board (or you’re eligible but haven’t yet applied).
  
  

Medicare Part B (Medical Insurance) Costs

Everyone pays a monthly premium for Medicare Part B. The amount is either deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t qualify for any of these, you’ll receive a bill every three months directly from Medicare.

Dual Eligibility (Medicare and Medicaid)

If you have a limited income, you may be dually eligible for both Medicare and Medicaid, which can eliminate most premiums and out-of-pocket costs. Those who qualify often have access to Dual Special Needs plans (D-SNPs)—specialized Medicare Advantage plans that offer extra benefits, like credits for groceries or over-the-counter health items. Our licensed SelectQuote agents can quickly check your eligibility for these programs and help you maximize your available coverage.

Filling the Gaps: Beyond Original Medicare

Original Medicare typically only covers 80% of Part B costs, leaving you responsible for the remaining 20% in coinsurance, deductibles, and copays. To manage these expenses, most beneficiaries choose one of two options:

• Medicare Advantage (Part C) provides an alternative by bundling Parts A and B. Some plans may include prescription drug coverage as well as additional routine benefits like dental, vision, and hearing.

• Medicare Supplement (Medigap) works alongside Original Medicare to cover the "gaps" in coverage, specifically the 20% coinsurance and other out-of-pocket costs.
  

Working Past 65 and Your Medicare Options

Many people worry that remaining employed past age 65 will automatically trigger late-enrollment penalties, but this isn't necessarily true. Whether you face a penalty depends entirely on the size of your employer and whether your current health coverage is considered "creditable" by Medicare. 

Be sure to check with your employer before your 65th birthday and before your IEP period to confirm the company’s requirements, as some employers require you to enroll in Original Medicare (Part A and Part B) at age 65. You may have the option of only enrolling in Part A (which is free for most people and provides hospital coverage) in addition to your employer’s healthcare plan.

Is Medicare mandatory at 65?

While Medicare is not technically mandatory, your decision to delay it depends on the size of your employer. If you or your spouse is still working and the company has 20 or more employees, your group health coverage is considered "primary," meaning you can safely delay Part B without facing late-enrollment penalties. However, if the employer has fewer than 20 employees, Medicare becomes the primary payer at age 65. In this case, you must enroll in Medicare to avoid significant coverage gaps and lifelong premium penalties. 

Learn More: Is it mandatory to sign up for Medicare at 65?

Find the Right Medicare Coverage for You

With over 40 years of experience and over 60 million people served, SelectQuote is here to help you understand the ins and outs of Medicare enrollment. In just minutes, our licensed insurance agents can compare Medicare Advantage plan options that may be available in your area, helping you understand the fine print so you can feel confident in your coverage choices. The service is free, and there’s no obligation to enroll.