Medicare Eligibility

Posted: July 07, 2022

There are four scenarios that make you eligible. Medicare is used most by seniors ages 65 years and older or by individuals with disabilities. However, there are other less common scenarios that may qualify you for this government discounted health insurance coverage including people with end stage renal disease.

Who qualifies for Medicare?

• Seniors ages 65 and over*
• Disabled adults*
• Disabled children under 20*
• Disabled children over 20*

* For additional eligibility criteria, see below. 

1. Seniors Ages 65 and Over (Most Common Scenario)

If you are 65 or older, you most likely will be eligible for Medicare. You must also have 10+ years of work history either from yourself or from your spouse working. And, you must be lawfully present in the United States. You must have a long-term presence in the country. Tourist visits do not count toward eligibility. However, you are eligible if you have a green card or a work permit that has allowed you to gain 10+ years of work history. 

What if I’m 65+, but I haven’t worked in the United States for 10 or more years?

If you do not have the 10+ years of work history, you may be able to get government discounted health insurance through Covered California. Click here to view Covered California Rates. Be aware that to qualify for Covered California, individuals sixty-five and over must meet the following criteria:

• Lawful presence
• Have not worked 10+ years in the US

 

2. Individuals with Disabilities (2nd Most Common Scenario)

You are eligible for Medicare if you have received social security disability for 24 months or longer. In order to meet these criteria, you also must be lawfully present in the United States and have a long-term presence. Tourist visits do not make you eligible, but you may be eligible if you have a green card or a work permit. 



3. End Stage Renal Disease 

Individuals of any age who have end stage renal disease (ESRD) often are eligible for Medicare. All of the following must be true. Your kidneys are no longer working. You require regular kidney dialysis, or you have had a kidney transplant. 

Also, one of the following must be true: 

• You have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
• You are already getting or are eligible for Social Security or Railroad Retirement benefits
• You’re the spouse or dependent child of a person who meets either of the requirements listed above

4. Disabled Child (over 20)
Unmarried disabled children over age 20 may be eligible for Medicare. They must have received social security disability for 24 months or more. They must have developed the disability prior to age 22. And, they must have at least 1 parent who receives or is eligible for social security retirement benefits.