Who is Eligible for Medicare?

The Medicare public insurance program in the United States is administered by the Centers for Medicare & Medicaid Services and is designed to provide certain individuals with affordable, reliable health care. The system provides insurance coverage to roughly 45 million Americans, 38 million of whom are senior citizens over the age of 65. Medicare eligibility is not restricted to senior citizens however; in fact not even all senior citizens are eligible for Medicare.

The simplest category of Medicare eligible individuals includes most senior citizens. Any individual 65 years of age or older who is a United States citizen and paid into the Medicare system through their payroll taxes is Medicare eligible. Married individuals who did not pay into the system through taxes are still eligible as long as their spouse paid their taxes. Any individual in this group is eligible for Medicare Part A and Part B, and won’t pay any monthly premium for their Part A services. All Medicare eligible individuals pay a premium for Part B.

Individuals 65 years of age or older who did not pay into the Medicare system, either themselves or through a spouse, are still Medicare eligible but must pay a monthly premium to receive Part A coverage as well as Part B coverage.

There are gray areas in between the above listed groups of individuals. Individuals who are 65 years of age or older, but only paid into Medicare through taxes for less than 10 years, are still eligible for Medicare but must pay a monthly premium for Part A. Individuals in this group will pay less of a premium than those who never paid into the Medicare system.

Certain groups of individuals born outside of the United States can be eligible for Medicare coverage. No illegal aliens are allowed to collect Medicare benefits. Those who are legal aliens in the United States and have lived in the country for at least five years continuously may be Medicare eligible but need to contact a local Medicare office for specific eligibility information as it can vary from person to person.

In addition to senior citizens, there are certain groups of individuals under the age of 65 who are Medicare eligible. Any individual who is suffering from End Stage Renal Disease (kidney failure) and is in need of dialysis or a kidney transplant is eligible for Medicare coverage. Also, individuals who are suffering from Lou Gehrig’s Disease (also known as ALS) are eligible for Medicare coverage. For these individuals, there is no waiting period; they become Medicare eligible as soon as they are diagnosed with their disease.

Other individuals who are under the age of 65 but not suffering from ESRD or ALS can also be Medicare eligible. Those who are receiving Social Security disability benefits due to an illness or disability are eligible to receive Medicare but there is a two year waiting period.

The Medicare program provides eligible individuals with many benefits despite some drawbacks. Many individuals with Medicare will pay little or no out of pocket costs while on the program. However, those in need of greater medical attention while covered by Medicare may face high out of pocket costs to cover services Medicare does not always pay for. That being said, the out of pocket costs most face pale in comparison to the bills they would face without the assistance of Medicare.