If you’re nearing age 65, you may be wondering about your Medicare eligibility. Like any health insurance program, there are rules and requirements you must meet to participate. Here’s an overview of the key Medicare eligibility rules.

Who Is Eligible for Medicare: Basic Rules

Medicare eligibility rules and requirements are basic for most people:

  • You must be 65 or older
  • You must be a permanent U.S. resident or citizen
  • If you are younger than 65, you may qualify if you have certain disabilities or end-stage renal disease

Medicare Parts A and B Eligibility

Original Medicare Parts A and B eligibility requirements are simple for most people. You must be:

  • Age 65 or older and eligible to receive Social Security benefits*
  • Age 65 or older and a spouse or widow/widower of someone eligible for Social Security benefits
  • Younger than 65 and have ESRD (end-stage renal disease, which is permanent kidney failure treated with dialysis or a transplant) or ALS
  • Younger than 65 and have received Social Security disability benefits for at least 24 months

*If you started receiving a Social Security check before your 65th birthday, or you receive Railroad Retirement benefits, you're automatically enrolled in Part A and B. If you don't receive Social Security payments, contact the Social Security Administration at 1.800.772.1213 to enroll in Medicare or ask questions about your eligibility.

If you meet the eligibility requirements above, you are generally eligible to enroll in Original Medicare. Your enrollment period lasts seven months and includes:

  • Three months before your 65th birthday
  • The month you turn 65
  • The three months after your birthday (for a total of 7 months)

You must contact the Social Security Administration to enroll.

If you meet any of the criteria on the list above, you are also eligible for Part B, which covers doctor services. Part B is a voluntary program with a monthly premium. You can decline Part B coverage when you first enroll in Medicare, but you may be subject to a penalty if you don’t enroll in Part B. You will not need to pay a late enrollment penalty as long as you meet certain conditions that let you sign up for Part B during a Special Enrollment Period.

Medicare Part C (Medicare Advantage) Eligibility

To be eligible for Part C (Medicare Advantage) plans, people ages 65 and older or with qualifying disabilities must:

  • Be eligible for both Medicare Part A and Part B
  • Pay the Medicare Part B premium
  • Live in the plan's service area

Part D Eligibility

Anyone who is entitled to Part A or enrolled in Part B is eligible for a prescription drug plan. Our Medical Mutual Medicare Advantage Plans include Part D coverage.

Medicare Supplement Insurance Eligibility

To be eligible for Medicare Supplement insurance, you must:

  • Be a permanent resident of and reside in the plan’s state for at least six months of each calendar year
  • Be age 65 or older
  • Be enrolled in both Medicare Part A and Part B
  • Continue to pay your Part B premium

Learn more about Medical Mutual Medicare Plans by visiting our Plans section.

Have a Question? We Can Help!

Speak with a Medical Mutual licensed insurance agent or call your insurance agent.

Call 1-866-406-8777 (TTY 711 for hearing impaired)

Mon.-Fri. 8 a.m. to 8 p.m.

Page last updated on 3/26/2018
H4497_H6723_WS_2016_Jun15 CMS Approved
C1757-MCS R1/16