In most circumstances, the eligibility age for Medicare is 65 years old. However, people with certain medical conditions may be eligible for coverage at a younger age.
Medicare is a government-sponsored health insurance program that includes hospital and medical coverage.
Most people with Medicare coverage are 65 years or older. However, there are many younger individuals living with medical conditions or disabilities who may be eligible for a Medicare plan.
There are various types of Medicare plans, each with differing coverage and costs.
This article explains how and when someone becomes eligible for Medicare benefits, including considerations that relate to age and health conditions.
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A person usually reaches eligibility for Medicare at 65 years of age. Medicare has been available for people ages 65 years old and over in the United States since 1965. This is the year the Medicare program was signed into law, giving older adults health coverage and financial security.
Over time, legislation has increased coverage for those with certain medical conditions who have not yet reached the age of 65 years.
According to KFF, an independent source for health policy research, news, and polling, 58 million people in the United States enrolled in Medicare Parts A and B in 2021.
The Center for Medicare Advocacy notes that while 8.4% of the United States general population are individuals under the age of 65 years with disabilities, that percentage nearly doubles among those who have Medicare.
The Congressional Budget Office (CBO) has studied the feasibility and potential cost savings of increasing the age of Medicare qualification from 65 to 67 years. In 2013, the CBO issued a report that estimated that doing so would decrease the federal budget deficit by $19 billion across 7 years.
However, the current eligibility age remains 65 years.
Read more about Medicare enrollment.
Some people can qualify for Medicare coverage when they are younger than 65. This includes:
- people with certain disabilities who have received Social Security Disability Insurance (SSDI) for 24 months
- people with end stage renal disease (ESRD)
- people with amyotrophic lateral sclerosis (ALS)
Disabilities
Individuals who receive SSDI may be eligible for Medicare before they turn 65 years old. The Social Security Administration (SSA) has specific qualifications for a person to qualify for SSDI.
These qualifications include:
- have earned at least 40 work credits in jobs that pay social security tax
- younger workers may qualify with fewer credits
- have a medical condition that meets the SSA’s definition of disability
- the condition is severe enough to keep a person from performing work-related activities for at least 12 months
The SSA defines a disability when a person meets the following criteria:
- a medical condition causes a person to no longer be able to work at the substantial gainful activity (SGA) level
- a person cannot continue the work they were doing or adjust to other work due to a medical condition
- the condition is expected to last at least 1 year or result in death
A person can become eligible for Medicare once they have received SSDI for 24 months. Once a person meets the 24-month requirement, they will gain automatic enrollment into Medicare Part A and Part B.
Learn more about Medicare and disability.
ESRD
ESRD is the final stage of chronic kidney disease. People with ESRD
Typically, Medicare benefits begin in the fourth month of dialysis when healthcare professionals administer this treatment in a dialysis facility. However, it can begin as early as the first month if a person meets the following requirements:
- the individual takes part in a Medicare-approved home dialysis training program
- the individual begins home dialysis before the third month of dialysis
- the individual expects to finish the dialysis training and give self-dialysis treatments
Medicare coverage can also begin during the first month if an individual requires hospital admittance for a kidney transplant or for necessary treatment before the transplant.
Medicare benefits that begin on the basis of ESRD cover all medical requirements, not just those relating to ESRD.
Learn more about end-stage renal disease.
ALS
If a person has ALS, they will qualify for Medicare Part A, which is free from premiums. Individuals with ALS qualify for Medicare benefits the same month they begin to receive SSDI.
They can begin by applying for SSDI. Once they have approval for these benefits, they can then apply for Medicare coverage.
A person is eligible for Medicare Part A if they or their spouse have paid Medicare taxes for at least 40 quarters of work.
This might become more challenging when an older adult with a younger spouse did not work 40 quarters but their spouse did.
If a younger spouse worked for 40 quarters, they can qualify their partner for Medicare coverage once they reach 62 years old and the older, nonworking spouse reaches 65 years old.
If someone reaches 65 years, did not pay Medicare taxes for 40 quarters, and has a spouse under 62, they may have to pay for their Medicare Part A benefits until their qualifying spouse reaches 62 years of age.
Read more about Medicare coverage for spouses.
If a person already receives benefits from the Social Security Administration, the Administration will automatically enroll them in Medicare parts A and B.
A person does not have to be retired to receive Medicare. If they are not currently receiving Social Security benefits, they can apply for Medicare benefits as early as 3 months before their 65th birthday.
Applying for Medicare benefits as early as possible may help the Social Security office process the paperwork in time for the person’s 65th birthday.
People who apply too late may face a premium 10% higher than that of those who apply on time. This premium would apply for double the time a person has been eligible but did not apply.
A person can apply for Medicare during their birth month or up to 3 months after their birth month without having to pay penalties for Medicare coverage.
However, their benefits will not begin until the Centers for Medicare and Medicaid Services process their request.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
A person can qualify for Medicare benefits when they reach 65 years of age. The cost of these benefits depends on whether or not they or their spouse have worked at least 40 quarters and paid Medicare taxes.
Those with disabilities, end stage renal disease, or amyotrophic lateral sclerosis may qualify for Medicare benefits before this age. They qualify for Medicare benefits after they have received Social Security Disability Insurance (SSDI) for at least 24 months.