Medicare Eligibility

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 in order to participate. We’re here to help you understand the key Medicare eligibility rules.

Who is eligible for Medicare?

Medicare eligibility rules and requirements are basic and apply for almost everyone:

• 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

When you sign up for Medicare, your spouse and dependents will not be covered by your Medicare plan. Medicare doesn't include family coverage and each person must individually meet the eligibility requirements.

What if I am planning to work past age 65?

Even if you plan to keep working past age 65 or are covered under your spouse's employer-sponsored health coverage, you’ll still need to consider Medicare. Do not assume you can delay signing up with Medicare because you have other medical insurance. Only group health plans sponsored by an employer with 20 or more employees lets you delay your Medicare enrollment. Other health coverage and COBRA coverage is not acceptable. We encourage you to contact us to learn more.

What if I have End-Stage Renal Disease (ESRD) and want Medicare?

If you have ESRD, you can join a Medicare plan during the Open Enrollment (October 15 – December 7) or during a qualifying event.

Medicare Parts A and B Eligibility

Many people are automatically enrolled in Original Medicare Parts A and B once they become eligible, but some people will need to enroll on their own*. 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 amyotrophic lateral sclerosis (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 (TTY 1-800-325-0778) or visit a local Social Security office to enroll in Original Medicare or ask questions about your eligibility.

Medicare Part C (Medicare Advantage) Eligibility

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

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

Medicare Part D (Prescription Drug Plans) 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. 

There may be a penalty if you delay enrolling in Part D when you are first eligible. If you have equal or better coverage from another source, such as a retirement plan, you will not be subject to the penalty.

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 

You cannot be enrolled in both a Medicare Advantage and Medicare Supplement Insurance plan at the same time.

Next Step: When to Enroll