How To Know If You Qualify For Medicare

In the United States, there are several health insurance options. One option you have is to apply for government health insurance which is called Medicare. The Medicare program was established in 1966. At that time, the Social Security Administration (SSA) was responsible for providing funds to qualifying individuals for medical assistance. 

Today, that duty falls under the jurisdiction of the Department of Health and Human Services (HHS), which includes a division specifically for that purpose called the Centers for Medicare and Medicaid Services. You must meet Medicare eligibility requirements to receive Medicare benefits. Those requirements and other aspects of Medicare enrollment are outlined below.

Permanent Legal Residency or Citizenship
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Medicare eligibility is only available to legal residents of the United States. To qualify, you must present proof of United States citizenship or permanent legal residency. Such proof may include:

  • A United States Territory or State Birth Certificate
  • Proof of U.S. Naturalization
  • Foreign Proof of Birth and Parental U.S. Citizenship Proof for One or Both Parents
  • Proof of Lawful Temporary Residency
  • A Non-Immigrant Visa
  • A Green Card
  • Certain Other Qualifying Immigration Status Proof

It is a common rumor that you must work for a minimum of 10 years to apply for Medicare. That is typically true if you want free Medicare Part A coverage. However, the work status of your spouse may also qualify you for free coverage. Additionally, you may still qualify for other forms of Medicare or for Medicare Part A for a paid premium, despite your work status.

Medicare qualification occurs automatically when you reach 65 years of age if you are a legal citizen or resident. However, you must still apply to receive the benefits. You may do so beginning up to three months prior to turning 65. Your coverage begins after your application is approved.

Medicare enrollment is also based on disability status. Certain conditions entitle you to Medicare Part A or Medicare Part B coverage. Those conditions are:

  • End Stage Renal Disease (ESRD) – You could qualify for Medicare with ESRD if you worked for at least 40 quarters or 10 years prior to becoming disabled. You must apply for coverage through the SSA.
  • Amyotrophic Lateral Sclerosis (ALS) – ALS is also called Lou Gehrig’s Disease. Medicare Part B and Medicare Part A coverage are automatically provided to you when you request disability benefits if you have ALS.
  • Certain Other Long-Term Disabilities – If you collect disability benefits from the SSA or Railroad Retirement Board for more than two years (24 months), you automatically qualify for Medicare. You will receive your Medicare card in the mail prior to your 24th month. However, your benefits will not automatically activate until the 25th month begins.

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