At What Age Are You Eligible For Medicare?

Many people wonder how old do you have to be to enroll in Medicare? Most people are eligible for Medicare at age 65, but there are some exceptions which allow for earlier enrollment into Medicare, such as having a qualifying disability like End-Stage Renal Disease (ESRD), ALS (Lou Gehrig's Disease) or other qualifying diseases.

By understanding Medicare Eligibility ages and conditions, it allows you to plan for your future, as well as ensure you have a smooth transition into the Medicare program. 

Medicare Eligibility by Age (Medicare Eligibility Age Chart):

Knowing when you'll be eligible to enroll in Medicare based on what year you were born will help you prepare for your Medicare enrollment period, as well as help you prevent any late enrollment penalties. 

Nearly 90% of the almost 70 million American's enrolled in Medicare are eligible based on their age (65 or older), rather than a qualifying disability. If you are under the age of 65, but have a qualifying disability, you may be able to enroll in Medicare earlier than age 65, and you should look into a Special Needs Plan and learn more about enrolling in Medicare with a disability.

Medicare Eligibility Chart by Birth Year:

Other Medicare Eligibility Criteria Outside of Age

Although, most Medicare Enrollees are eligible based on being aged 65 or older, there are additional eligibility criteria which may allow those under age 65 to enroll in Medicare.

You may be eligible for Medicare if you meet at least one of the following criteria:

• Being Aged 65 or Older.
• Living with End-Stage Renal Disease (ESRD): If you are living with End-Stage Renal Disease, you are eligible for Medicare.
• Living With Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's Disease): If you are living with Amyotrophic Lateral Sclerosis, you are eligible for Medicare.
• Actively Receiving Social Security Disability Insurance (SSDI): If you have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you are eligible for Medicare. Learn more about which disabilities qualify for these benefits.

Most enrollees are eligible based on their age, but nearly 10% of Medicare enrollees are eligible based on some additional criteria outside of their age. 

Learn More About The Medicare Enrollment Process

Enrolling in Medicare isn't always as simple as you might assume. By learning more about what the actual Medicare enrollment process looks like may help you enroll smoothly, and avoid any penalties or lapses in coverage.

Will I Be Automatically Enrolled Into Medicare?

As you're getting closer to age 65 or other eligibility criteria, it's important to know if you'll be enrolled automatically, or if you will have to enroll yourself.

• If you are already receiving Social Security or Railroad Board benefits for at least 4 months before being eligible for Medicare, you are automatically enrolled in Medicare Part A and Medicare Part B at age 65. You will receive a "Welcome to Medicare" kit in the mail about 3 months before turning 65, which will help you decline enrollment in Medicare Part A and/or Medicare Part B if you don't want to be automatically enrolled.
• If you are not currently receiving Social Security or Railroad Board benefits, you are not automatically enrolled in Medicare at age 65.

How to Enroll in Medicare

If you are ready to enroll into Medicare, you will have access to signup during your Initial Enrollment Period (IEP). Your IEP is a 7-month window that beings 3 months before your 65th birthday, including your birth month, and extends 3 months after your birth month. 

If your birthday is August 20th, your IEP would begin May 20th and would end November 20th.

You are able to enroll in Medicare Part A and Medicare Part B online, by phone or in person. 

Note: You'll likely need the following documents during this process:

• Social Security Number
• Birth Certificate
• Current Health Insurance Information
• Medicaid Number (If you have one)

Medicare vs. Medicare Advantage

Medicare Part A and Medicare Part B (also known as Original Medicare) is offered by the government and is designed to provide hospital insurance (Medicare Part A) and medicare insurance (Medicare Part B) for seniors and other eligible enrollees.

Medicare Advantage plans are health plans offered by private insurance companies contracted with Medicare, to offer plans that bundle Medicare Part A and Medicare Part B (often times Medicare Part D (Prescription Drugs) together, while often offering additional coverage, which allows you to pick a plan that has all the coverage and benefits that work for you and your situation.

In order to be eligible for Medicare Advantage plans, you must be eligible for Original Medicare. You cannot have a Medicare Advantage Plan without being eligible for Original Medicare.

• Original Medicare (Medicare Part A and Medicare Part B) = Run by the Federal Government to Provide Hospital Insurance and Medical Insurance.
• Medicare Advantage = Run by Private Carriers and Bundle Medicare Part A and Medicare Part B Together While Often Offering Additional Benefits and Coverage Options:

Example Additional Benefits Offered by Medicare Advantage Plans:

• Prescription Drug Coverage
• Grocery Benefits
• Out-of-Pocket Maximums
• Gym Memberships or Benefits

Every Medicare Advantage Plan Is Different, These Are Only Examples of What They Might Offer.

Final Thoughts

Medicare can be confusing, but it can be beneficial in planning out your longterm health. Understanding how your age impacts your Medicare eligibility will help you understand when you may be eligible for Medicare, and help to prevent and lapse in coverage or penalties.