Learn About the Requirements for Medicare

It is important to understand eligibility requirements for Medicare before you apply in order to know what to expect with your application process and to be aware of whether or not you may be found eligible to receive Medicare health coverage.

Medicare has different eligibility requirements for senior citizens and disabled individuals, so it is crucial that you understand the requirements for senior citizens. You should note that all Medicare recipients must live within the United States and must either be a United States citizen or have a lawful and qualifying alien status. If you are a non-citizen, you must have lived within the United States for the last five consecutive years in order to be eligible for Medicare. To learn more about the Medicare eligibility requirements for seniors, review the information that has been provided within the sections below.

Learn About Medicare’s US Citizenship Requirements

In order to be considered eligible for the Medicare health insurance program, you must either be a United States citizen or you must be a qualifying non-citizen. A qualifying non-citizen is generally a person who has been lawful and permanent resident that has been living within the United States for a minimum of five consecutive years. Those that do not meet this year requirement will not be eligible to receive Medicare benefits and must wait until they have resided legally within the United States for 5 continuous years prior to the month where a Medicare application is submitted.

Find Out About the Residency Requirements for Medicare

Medicare is only available to residents of the United States. If you choose to move to another country, you will no longer be eligible to receive Medicare health coverage and will lose benefits if you have already been receiving them. You can then reapply to Medicare once all eligibility requirements, including residency, have been met once more.

Learn About the Medicare Requirements for Senior Citizens

Medicare was originally created in 1965 to provide health insurance coverage to senior citizens throughout the United States. This is still true today, but first you must meet a few eligibility requirements that are provided to senior citizens.

To be eligible to receive Medicare health coverage, you must be at least 65 years of age. However, you can apply for Medicare during your initial enrollment period that begins three months prior to your 65th birthday. Additionally, it is worth knowing that in order to receive a premium-free Medicare Part A, you must:

  • Be 65 years of age or older; and
  • Be eligible to receive Social Security or Railroad Retirement Board (RRB) cash benefits

It is important to know that you are not required to receive Social Security benefits or Railroad Retirement Board (RRB) benefits in order to be eligible for Medicare health coverage. You have the option of retiring later and continuing to work while enrolled into Medicare. You must only be eligible for such benefits.

Your initial enrollment period will take place three months prior to your birthday, including your birthday month, and continue for three months after your birthday. Unless you qualify for a special enrollment, you will not be able to enroll into Medicare again until the annual general enrollment period.

Learn About Medicare Based Upon Disability Requirements

In 1972, the Medicare program was extended to include disabled individuals of all ages. However, disabled individuals have their own Medicare eligibility requirements that must be met in order to obtain Medicare coverage.

A disabled individual who is eligible to receive monthly Social Security or Railroad Retirement Board (RRB) benefits is considered automatically eligible for Medicare after having received disability benefits for a minimum of 24 months. If you are a disabled Federal, State or local government employee who is not eligible to receive Social Security or Railroad Retirement Board benefits, you may still be deemed eligible for Medicare after having been disabled for 29 months.

However, there are a few exceptions to this rule that you should be aware of. If you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, you will become entitled to Medicare the first month that you become entitled to Social Security or Railroad Retirement Board benefits. You do not need to participate in a waiting period, even though your eligibility is based upon disability.

Learn About Medicare and End-Stage Renal Disease (ESRD) Requirements

If you are receiving regular dialysis treatment or a kidney transplant, you may be eligible for Medicare right away. In order to be considered eligible, one of the following conditions must apply to you and your situation:

  • You have worked the required amount of time under Social Security and Railroad Retirement Board (RRB).
  • You have worked a set amount of time as a government employee.
  • You are either receiving or eligible for Social Security or Railroad Retirement Board (RRB) benefits.
  • You are the spouse or dependent child of an individual who has worked the required set amount of time as a government employee or have met Social Security or Railroad Retirement Board (RRB) time requirements.
  • You are a spouse or dependent child of a person who is receiving Social Security or Railroad Retirement Board (RRB) benefits.

So long as you meet one of least one of these eligibility requirements, your Medicare coverage can begin as early as:

  • The 3rd month in which you have received regular dialysis
  • The first moth that you begin a regular course of dialysis if you are engaged in self-dialysis training
  • The month of the kidney transplant
  • Two months prior to the month of the kidney transplant, if you are hospitalized during those months

Find Out About Other Medicare Enrollment Situations

Finally, there are some cases in which you may still be eligible to receive Medicare health coverage, even if you do not meet requirements based on your age, disability or End-Stage Renal Disease (ESRD) status. You may be eligible to receive health coverage under the Medicare program if you:

  • Are a disabled widow or widower who is at least 50 years of age that has not yet applied for disability benefits due to the fact that you are already receiving another type of Social Security benefit.
  • You are a government employee who became disabled before the age of 65.
  • You, your dependent child or your spouse has permanent kidney failure.
  • You previously had Medicare Part B, but dropped that coverage.
  • You previously turned down Medicare Part B.
  • You or your spouse has worked for the railroad industry.

You will need to contact the Social Security Administration in order to determine whether or not your circumstances regarding these extra enrollment exceptions will meet Medicare standards and eligibility requirements.

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