If you’re nearing your 65th birthday, you may have a lot of questions about Medicare, and it helps to know when you can enroll and when your coverage will begin.
Generally, Americans aged 65 or older are eligible for Medicare. Most people under 65 are not eligible for Medicare, but there are exceptions. If you have a qualifying disability, amyotrophic lateral sclerosis (ALS), or End-Stage Renal Disease (ESRD) you are eligible before you turn 65.
Don’t worry—you don’t have to figure out the eligibility rules on your own. We’ll give you a breakdown of who’s eligible for Medicare and the age, disability, and residency rules that determine eligibility.
We know health insurance can be a bit of a maze. If you need any help navigating it, give us a call. Our licensed Medicare Advisors answer questions, offer support, and compare plans to help you get the best coverage for your needs. And our assistance is always free.
Key takeaways:
Most people become eligible for Medicare at 65 years old, but a qualifying disability, ALS, or ESRD can open eligibility earlier.
Being eligible for Medicare doesn’t guarantee free coverage—while most people get Part A for free, few people pay nothing for Part B.
Citizens and certain lawful permanent residents can qualify for Medicare, though the exact rules depend on age, disability or benefit entitlement, and immigration or residency status.
Requirements for Medicare eligibility
Most people become eligible for Medicare on the first day of the month they turn 65. However, if the person’s birthday falls on the first day of the month, eligibility starts the previous month. It’s worth noting that you can enroll in Medicare three months before your eligibility begins to ensure your coverage begins on time.
Some people are eligible for Medicare before age 65: people with certain disabilities, ALS, or ESRD.
Here’s a quick overview of these situations:
Age 65 or older: You’re eligible if you meet the applicable citizenship and residency rules.
Disability benefit entitlement: You’re eligible if you’re under 65 and have received Social Security disability insurance (SSDI) or Railroad Retirement Board disability benefits for 24 months.
ALS: You qualify for Medicare in the first month you are entitled to Social Security or Railroad Retirement Board disability benefits.
ESRD: You’re eligible if you have permanent kidney failure requiring regular dialysis or a kidney transplant and meet the program’s work or benefits-related conditions.
When to enroll in Medicare
If you’re eligible for Medicare due to age, you can apply for Medicare during your Initial Enrollment Period, which is the seven-month window that starts three months before your birthday, includes your birthday month, and ends three months after it.
People who have received Social Security benefits for at least four months before turning 65 are automatically enrolled in Original Medicare (Part A and Part B). Medigap, Medicare Advantage, and Part D prescription drug coverage are separate options that you can consider and enroll in on your own.
If you or your spouse are still receiving employer-sponsored coverage, you may be able to delay Part B enrollment without penalty. If your employer has 20 or more employees, you’re eligible for the Medicare Part B Special Enrollment Period. This period starts the month employment or employer-provided coverage ends (whichever happens first) and lasts for eight months.
Qualifications for Medicare eligibility under age 65
How someone qualifies for Medicare before 65 usually comes down to one of three situations:
Social Security disability benefits (SSDI): Someone receiving SSDI is generally enrolled in Medicare automatically after 24 months of receiving benefits. Your Medicare card should arrive in the mail a few months ahead of your coverage start date. If you want to enroll in Medigap, Medicare Advantage, or Part D, you will have to do that on your own or with help from a Medicare agent.
ALS: People with ALS have no 24-month wait. Medicare coverage begins as soon as their disability benefits start.
ESRD: For individuals with ESRD, coverage usually starts on the first day of the fourth month of regular dialysis. It may start in the first month if the person begins a qualifying home dialysis training program, or according to separate timing rules for a kidney transplant. Unlike SSDI or ALS, enrollment based on ESRD isn’t automatic. You’ll need to apply for Medicare through Social Security.
If you qualify for Medicare before 65, your Part A and Part B provide the same coverage as they do for people who are over 65. However, enrollment timing, coordination with other insurance, and Medicare eligibility timelines differ. You should also review your Medicare coverage again when you turn 65 because your coverage options can change.
Keep in mind that federal law doesn’t require insurers to offer Medigap to enrollees under 65. If a Medigap policy is something you’re interested in, check your state’s plan availability or talk to one of our Medicare Advisors to understand your options.
How does residency affect Medicare eligibility?
Citizenship and residency determine whether you can get Medicare. US citizens and certain lawfully present noncitizens qualify if they meet the applicable age, disability, benefit-entitlement, and enrollment rules.
A lawfully admitted permanent resident may typically buy Part A and/or Part B at age 65 after living continuously in the US for at least five years. Federal legislation enacted in 2025 narrowed the immigration categories that may qualify for Medicare. Because the effective rules and transition provisions are complex, if immigration-related eligibility is part of your situation, we suggest speaking with the Social Security Administration or a licensed Medicare Advisor.
Get help understanding Medicare eligibility and next steps
If you age into Medicare as a US citizen, eligibility is pretty simple. But if you’re eligible due to a disability or are a noncitizen, Medicare eligibility can be a bit confusing. And once you’re enrolled in Medicare, understanding the different coverage options and comparing different plans can feel like a maze.
It’s a personal journey, so you deserve personalized advice. That’s why we’re here. Give us a call at 855-900-2427 or book an appointment to get free help. We’ll guide you through the details to figure out when you qualify, whether enrolling now is right for you, and how your Medicare coverage options stack up against your healthcare needs. Our Advisors are happy to assist—with no cost and no obligation to you.
FAQ
What’s the Medicare eligibility age?
Most people are eligible for Medicare at age 65. However, some people are eligible before age 65 due to having a qualifying disability, ALS, or ESRD.
What do I pay for Medicare coverage?
What you pay for Medicare coverage varies based on your specific coverage, income, and eligibility for financial assistance. For Original Medicare, 99% of people receive premium-free Part A and pay the standard Part B premium. If you enroll in Medicare Advantage, Medigap, or Part D, you will also pay any premiums associated with those plans.
Some Medicare Advantage plans offer a Part B giveback benefit, which reduces your Part B premium. People who qualify for Medicaid or a Medicare Savings Program may also pay less for Original Medicare and Part D. People with higher incomes, however, may pay more for Part B and Part D through the income-related monthly adjustment amount (IRMAA).
Sources:
Centers for Medicare & Medicaid Services. (2026, March 10). Original Medicare (Part A and B) eligibility and enrollment. https://www.cms.gov/medicare/enrollment-renewal/original-part-a-b
Medicare.gov. (n.d.). Costs. https://www.medicare.gov/basics/costs/medicare-costs
Medicare.gov. (n.d.). End-Stage Renal Disease (ESRD). https://www.medicare.gov/basics/end-stage-renal-disease
Medicare.gov. (n.d.). How do I sign up for Medicare? https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare
Medicare.gov. (n.d.). When can I sign up for Medicare? https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-can-i-sign-up-for-medicare
Medicare.gov. (n.d.). When does Medicare coverage start? https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start
Social Security Administration. (2026). Medicare (Publication No. 05-10043). https://www.ssa.gov/pubs/EN-05-10043.pdf
