Who is Eligible for Medicare in 2023? People Who Fit One of These 12 Criteria

Medical care is a top expense for many seniors, especially as they get older and experience more physical ailments related to aging. It's important to find ways to keep more money in your wallet as costs can add up quickly.

To take care of both your physical and financial health in retirement, it’s essential to learn more about your health care options, starting with understanding whether or not you’re eligible for Medicare.

Below, we’ll quickly review what Medicare is before diving into the ins and outs of who does and doesn’t qualify.

Medicare is the government-sponsored health care program for American adults age 65 and older. While it's not free, it helps to lower the financial stress of those in retirement. 

More than half of all working Americans get health care through their jobs, and nearly everyone pays the Medicare tax throughout their working years.

Once you leave the workforce, your health care needs don’t stop. That’s when you can begin to use the Medicare coverage you’ve contributed to for many years. So who is eligible for Medicare?

While Medicare is intended to support retirees, it doesn’t kick in based on when you leave the workforce. Instead, Medicare is only available to American workers age 65 and older. 

In other words, even if you retire earlier than age 65, you won’t qualify for Medicare until your 65th birthday — although you can apply three months before that magic birthday.

Legal U.S. citizens qualify for Medicare, including those who were born in the United States and immigrants who became naturalized citizens.

Some permanent legal residents (otherwise known as lawful permanent residents or green card holders) are also eligible for Medicare, but only if they’ve lived in the U.S. for at least five years.

Green card holders who didn’t work, are older than 65, and are married to a qualifying lawful permanent resident typically also qualify for Medicare.

If you’ve paid into the Social Security program and are eligible for benefits, you’re almost certainly eligible for Medicare benefits as well.

In fact, if you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Part A and Part B when you turn 65. 

If you wait to receive Social Security until age 66 or older, you will need to apply for Medicare three months before your 65th birthday,

U.S. railroad workers have their own retirement fund system separate from Social Security. However, those receiving railroad retirement benefits are also eligible to receive Medicare starting on their 65th birthdays.

Not all government workers pay Social Security wages, including teachers in certain states as well as federal employees hired before 1983. 

Whether or not federal employees pay Social Security taxes, though, they’re eligible for Medicare from age 65 onward.

Non-working spouses of working individuals who qualify for Medicare will also receive Medicare coverage once they turn 65. 

This is true of non-working spouses whose partners paid Social Security wages, but it’s also true of the non-working spouses of workers covered by federal retirement benefits plans other than Social Security.

In some cases, Americans can qualify for Medicare even if they aren’t 65 yet. For instance, if you’ve been on Social Security Disability Insurance (SSDI) for at least 24 months, you can claim Medicare benefits. 

In some cases, the 24 months don’t have to be consecutive. If you’ve had SSDI benefits for 24 total months, you likely qualify for Medicare.

If you worked for the railroad and have received disability pension benefits for 24 total months, you can qualify for Medicare regardless of your age.

Amyotrophic lateral sclerosis (ALS) is a rare, extremely costly disease that progresses rapidly. Individuals who are diagnosed with ALS often require fast, extensive intervention and thorough disability accommodations to maintain their quality of life and live independently for as long as possible.

Because ALS is so rare, costly, and aggressive, individuals diagnosed with ALS can immediately apply for Social Security Disability Insurance, which instantly qualifies them for Medicare benefits as well.

Unlike other SSDI recipients, those with ALS don’t need to wait 24 months to start their Medicare coverage. However, it’s important to be aware that you only qualify for Social Security Disability Insurance if you worked long enough to earn a certain amount of Social Security work credits.

End-stage renal disease, or permanent kidney failure, typically requires individuals to either receive a kidney transplant or undergo long-term dialysis treatments. 

Dialysis and kidney transplants are both extremely expensive and can have a massive impact on your quality of life, so those with permanent kidney failure typically qualify for SSDI and Medicare regardless of age.

The same Social Security work credit requirements apply to ESRD as well to ALS. Again, the younger you are, the fewer work credits you need to qualify for benefits.

If you’re a stay-at-home spouse who is diagnosed with ALS or permanent kidney failure, you can qualify for Medicare earlier than age 65 as long as your working spouse is eligible for Medicare. 

This also applies to non-working spouses of federal and railroad workers who qualify for Medicare but not Social Security.

Ideally, SSDI and Medicare benefits will help households where anyone suffers from ALS or ESRD stay in good financial shape, regardless of whether or not the individual with the diagnosis worked outside the home.

Medicare can be hard to understand, starting with whether or not you qualify. 

Once you know you’re eligible for Medicare, make sure you sign up as soon as your initial enrollment period starts three months before you turn 65.

While Medicare can help eliminate some financial stress, it won't likely take care of all your health care costs. It's important to know what you'll pay so you can plan ahead and cover the rest of your monthly retirement costs.