Eligibility

Who Qualifies for Medicare?

Christian Worstell

by Christian Worstell | Published February 18, 2021 | Reviewed by John Krahnert

In general, U.S. citizens and permanent residents who have lived in the country for more than five years qualify to receive Medicare benefits at age 65. However, people with certain disabilities or medical conditions may qualify sooner. Read on to learn more about who qualifies for Medicare and what you can expect once you enroll.

65th birthday cake

What Age Qualifies for Medicare?

Original Medicare is made up of two parts: Medicare Part A and Medicare Part B. As mentioned, you may qualify for Original Medicare when you turn 65 years old.

You may also qualify for Medicare if you:

  • Have Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease)
  • Have end stage renal disease (permanent kidney failure)
  • Have received Social Security Disability Insurance or Railroad Retirement Board disability benefits for the past 24 months

Medicare Enrollment

Some people are automatically enrolled in Medicare — others must enroll manually.  

  • If you have received Social Security Disability Insurance or Railroad Retirement Disability Benefits:
    If you have received Social Security Disability Insurance or Railroad Retirement Board disability benefits, you will be automatically enrolled in Medicare Parts A and B after 24 months of receiving disability benefits.
  • If you are 65 years old:
    If you are not receiving Social Security or Railroad Retirement disability benefits when you turn 65, you will most likely have to manually enroll in Medicare Part A and Part B. It is important to note that although Medicare Part B enrollment is optional, if you fail to sign up for Medicare Part B during your Initial Enrollment Period, you may have to pay a late enrollment penalty for as long as you have Medicare Part B.

Medicare Out-of-Pocket Expenses

Although Original Medicare provides coverage for a wide range of medical services, it leaves some out-of-pocket costs to enrollees. Medicare Supplement Insurance (Medigap) is sold by private insurance companies to help fill in some of these coverage gaps, saving you significant money in the long run.

There are currently 10 standardized Medigap plans available in most states labeled Plan A, B, C, D, F, G, L, M and N (there are differently standardized options in Minnesota, Massachusetts and Wisconsin).

Important: Plan F and Plan C are not available to beneficiaries who became eligible for Medicare on or after January 1, 2020.

Each type of Medigap plan provides a unique combination of basic benefits that help pay for Medicare deductibles, copayments, coinsurance and other expenses. Take a look at the chart below for a comparison of each Medigap plan.

Click here to view enlarged chart

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Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

A B C* D F1* G1 K2 L3 M N4
50% 75%
50% 75%
50% 75%
50% 75%
50% 75% 50%
80% 80% 80% 80% 80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

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1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,220 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

3 Plan L has an out-of-pocket yearly limit of $3,110 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

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Understanding Medicare can be difficult, especially if you aren’t sure whether or not you qualify. Our licensed agents are available to answer all your questions — from eligibility to enrollment — and can even match you with a Medicare Supplement Insurance plan that makes sense for you.

Speak with a licensed agent today at 1-800-995-4219 to discuss your Medigap plan options.

Resource Center

Compare Medigap Plans 2021

See how the 10 Medigap plans differ. Review our chart for a detailed comparison of Medicare Supplement insurance benefits and compare Medigap options where you live. Read more
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