Medicare Eligibility

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Am I eligible for Medicare?

Medicare is a federal health insurance program for people ages 65 or older. Others younger than 65 may also be eligible if they have certain disabilities or diseases, such as End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), otherwise known as Lou Gehrig's disease. Learn more about ESRD eligibility. (Please note that by clicking on this link, you will be leaving Memorial Hermann Advantage HMO website.)

Medicare Eligibility

You qualify at age 65 or older if:

  • You are a U.S. citizen or a permanent legal resident; and
  • You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits — usually having earned 40 credits from about 10 years of work — even if you are not yet receiving these benefits; or
  • You or your spouse is a government employee or retiree who has not paid into Social Security, but has paid Medicare payroll taxes while working.

You qualify under age 65 if:

  • You are a U.S. citizen or a permanent legal resident; and
  • You have been entitled to Social Security disability benefits for at least 24 months (which need not be consecutive); or
  • You receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
  • You have Lou Gehrig's disease (amyotrophic lateral sclerosis), which qualifies you immediately; or
  • You have permanent kidney failure requiring regular dialysis or a kidney transplant — and you or your spouse has paid Social Security taxes for a certain length of time, depending on your age.

The government makes it easy to confirm if you’re eligible for Medicare. Visit www.medicare.gov to see if you qualify. (Please note that by clicking on this link, you will be leaving Memorial Hermann Advantage HMO website.)

When you first get Medicare

If you are turning 65 or fall into one of the under 65 qualifications, you are eligible to enroll in Medicare as part of the Initial Coverage Enrollment Period (ICEP).

The ICEP is a 7-month period that begins 3 months before the month a person turns 65 and ends 3 months after the person turns 65. For someone under age 65 who becomes entitled to Medicare based on disability, entitlement begins with the 25th month of disability benefit entitlement. For these individuals, the ICEP begins 3 months before the 25th month of disability benefit entitlement, includes the 25th month, and ends three months after. The ICEP for people with ESRD and ALS varies based on their situation.

Coverage begins based on when you enroll during the ICEP. If a person enrolls in the first 3 months of the ICEP, coverage begins the first month the person is eligible for Medicare. If a person enrolls in any other month of the ICEP, coverage will be delayed. Disabled individuals are automatically enrolled in Medicare Part A and Part B after they have received disability benefits from Social Security for 24 months. Most likely, if you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B. You will receive your Original Medicare benefits starting the first day of the month you turned 65. You may also enroll in a Medicare Advantage or Medicare Part D plan during your ICEP.

If you are eligible for Medicare and were not automatically enrolled in an Original Medicare plan, then you may do so by visiting www.ssa.gov, where the Social Security Administration handles the enrollment process for Medicare.


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