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Fact Checked

What Are the Qualifications for Medicare?

Kenneth W. Michael Wills
Kenneth W. Michael Wills

In the United States, Medicare is a hybrid public and private insurance program administered by the federal government, designed to help offset some major medical expenses for certain populations with higher risk of incurring such medical expenditures. Those who might qualify for the Medicare program are citizens and residents age 65 or older or those younger than 65 suffering from a disability, kidney failure or Lou Gehrig’s disease. Qualifications for Medicare are varied, however, depending on the applicant’s situation and the eligible category in which he or she is applying. One consistent prerequisite is that the applicant or the applicant’s spouse is required to have paid into the program for at least 10 years, either through an employer, or directly if self-employed.

Residents and citizens who are 65 or older and have contributed to the Medicare program for 10 years meet qualifications for Medicare if they meet one or more criteria. These criteria include the following: recipient of or are qualified to receive social security benefits; recipient of or are qualified to receive railroad retirement benefits; applicant has a husband or wife who is eligible or an applicant who is the parent of a deceased child who was fully-insured. Oftentimes, however, applicants who do not meet the aforementioned criteria in this category may still apply for Medicare, but instead will pay a monthly premium for the coverage.

A patient with kidney failure may qualify for Medicare if they can demonstrate that they are on dialysis.
A patient with kidney failure may qualify for Medicare if they can demonstrate that they are on dialysis.

Potential applicants yet to reach the age of 65 may still qualify due to extenuating circumstances. If an applicant has received social security disability benefits for a period exceeding 24 months, he or she is likely to meet the qualifications for Medicare due to a disability. Railroad workers receiving disability pensions may also qualify as well as those receiving social security benefits due to Lou Gehrig’s disease, regardless of the period receiving such benefits. Children and widows over the age of 50 may also qualify in the event their parents or spouses worked for the government long enough to pay into the Medicare program. Those suffering from permanent kidney failure are potentially eligible as well; though they will need to demonstrate the need for a kidney transplant or show that they receive dialysis regularly to maintain kidney function as well as qualify in one of the aforementioned categories before applying.

Most seniors over age 65 in the United States qualify for Medicare.
Most seniors over age 65 in the United States qualify for Medicare.

Qualifying only gets the applicant Part A of Medicare, which is the hospital insurance. Applicants meeting qualifications for Medicare Part A are automatically qualified for Part B, which is the medical insurance, but must pay a premium for the coverage. Premium amounts for this portion of the coverage are determined by the applicant’s income. Once an applicant has both Part A and B, he or she can the purchase a Medicare Advantage Plan — the Part C — from a private insurer authorized by Medicare to administer such policies. Having all three parts also allows the beneficiary to participate in Part D, which is the prescription drug portion of Medicare, whereby the beneficiary will pay premiums to prescription drug coverage.

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    • A patient with kidney failure may qualify for Medicare if they can demonstrate that they are on dialysis.
      By: Tyler Olson
      A patient with kidney failure may qualify for Medicare if they can demonstrate that they are on dialysis.
    • Most seniors over age 65 in the United States qualify for Medicare.
      By: Monkey Business
      Most seniors over age 65 in the United States qualify for Medicare.
    • Those nearing the age of 65 and seeking Medicare coverage can enroll online or at their nearest Social Security office.
      By: zimmytws
      Those nearing the age of 65 and seeking Medicare coverage can enroll online or at their nearest Social Security office.