Who Qualifies for Medicare?

Medicare is the federal health insurance program for people age 65 and older, as well as certain individuals under 65 with qualifying conditions. 

• Age 65 or older — U.S. citizens or permanent legal residents who have lived in the U.S. for at least 5 continuous years generally qualify.
• Disability (under 65) — Individuals who have received Social Security Disability Insurance (SSDI) for 24 months automatically qualify.
• End-Stage Renal Disease (ESRD) — People of any age with permanent kidney failure requiring dialysis or a transplant may qualify.
• ALS (Lou Gehrig's disease) — Medicare eligibility begins as soon as SSDI benefits start — no 24-month waiting period.

Initial Enrollment Period (IEP)

A 7-month window surrounding your 65th birthday — 3 months before, your birthday month, and 3 months after. This is generally your best opportunity to enroll without penalties.

General Enrollment Period (GEP)

Runs January 1 – March 31 each year. For those who missed their IEP without qualifying coverage. Coverage typically begins July 1, and late penalties may apply.

Annual Election Period (AEP)

Runs October 15 – December 7 each year. You can switch Medicare Advantage or Part D plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.

Medicare Advantage Open Enrollment (MA OEP)

Runs January 1 – March 31. If you're enrolled in a Medicare Advantage plan, you can make one switch — to a different MA plan or back to Original Medicare.

Special Enrollment Periods (SEPs)

Certain life events allow you to enroll or change coverage outside standard windows, including:

• Losing employer or union health coverage
• Retiring or leaving active employment
• Moving outside your plan's service area
• Moving into or out of a care facility
• Changes in Medicaid or Extra Help (Low Income Subsidy) eligibility
• Your current plan leaving the area or significantly reducing benefits

Missing your enrollment window — without qualifying coverage in place — can result in a permanent premium increase.

Part B penalty: For each 12-month period you were eligible but didn't enroll (without qualifying employer coverage), your Part B premium may increase by 10% — permanently.

Part D penalty: If you go 63 or more consecutive days without creditable prescription drug coverage after becoming eligible, a permanent penalty is added to your monthly Part D premium.

Still working at 65? If you have coverage through an employer with 20+ employees, you may be able to delay Part B without penalty. Talk with your HR department and consider speaking with a licensed Medicare agent before making any decisions. 

*This information is for general educational purposes only and is not a substitute for personalized advice. Medicare rules and program details are subject to change. For the most current information, visit https://www.medicare.gov/providers-services/original-medicare or call 1-800-MEDICARE (1-800-633-4227). You may also contact your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling.