Medicare Eligibility: Who Qualifies for Medicare at 65 and Under 65

Source: Medicare.gov: Get started with Medicare

This guide explains who qualifies for Medicare, at 65 and under 65, what you pay for Part A and Part B, and when coverage can start. We don't show plan prices or recommend a plan; we explain the federal rules so you can plan your next step.

Who is eligible for Medicare?

Medicare is health insurance for people 65 or older who meet citizenship or residency requirements. You may be eligible earlier if you have a disability, End-Stage Renal Disease (ESRD) or ALS (Medicare.gov).

Medicare eligibility at 65

Citizenship and residency

To enroll at 65, you must be a U.S. resident and either a U.S. citizen or a lawful permanent resident who has lived in the U.S. for 5 continuous years before the month you apply (CMS).

Part A: with or without a premium

You don't pay a Part A premium at 65 if you or your spouse (living or deceased, including a divorced spouse) get or can get Social Security or Railroad Retirement Board benefits, or worked long enough in a government job that paid Medicare taxes (Social Security). CMS says about 99% of people with Medicare don't pay a Part A premium because they have at least 40 quarters of Medicare-covered work (CMS).

If you don't qualify, you can buy Part A. In 2026, the monthly Part A premium is $311 if you or your spouse have 30 to 39 quarters of coverage, and $565 if you have fewer than 30 (CMS).

Part B: a monthly premium

Part B is voluntary and has a monthly premium. The standard Part B premium is $202.90 a month in 2026. People with higher incomes pay a set extra amount, based on the income on their tax return from 2 years earlier (CMS). See IRMAA brackets for 2027. Your income doesn't decide whether you can get Medicare; it can change what you pay for Part B and Part D.

Medicare eligibility under 65

• Social Security disability benefits: if you're under 65 and getting disability benefits from Social Security, you get Medicare automatically after 24 months of disability benefits, or when you turn 65, whichever comes first (Medicare.gov). Your Medicare card arrives about 3 months before your Medicare coverage starts.
• ALS (Lou Gehrig's disease): you get Medicare automatically the same month your Social Security disability benefits begin (Medicare.gov).
• End-Stage Renal Disease (ESRD): ESRD is permanent kidney failure that requires regular dialysis or a kidney transplant. You may be eligible at any age if you, your spouse or a parent worked long enough under Social Security, the Railroad Retirement Board or a Medicare-covered government job. You apply through Social Security (Social Security).
• Railroad Retirement Board disability: people who get a disability pension from the RRB and meet certain conditions may also qualify.

Medigap before 65: federal law doesn't require companies to sell Medigap policies to people under 65, and rules vary by state. The Utah Insurance Department can tell you what's available in Utah before 65. If you already have Part B, you'll get a Medigap Open Enrollment Period when you turn 65. See Medigap Open Enrollment Period.

When can your Medicare start?

If you get Social Security benefits before 65

If you get Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65, you're enrolled in Part A and Part B automatically, and you can choose whether to keep Part B (CMS).

If you don't

You sign up through Social Security during your Initial Enrollment Period. It lasts 7 months: it starts 3 months before the month you turn 65 and ends 3 months after (Medicare.gov).

Source: Medicare.gov: When does Medicare coverage start?

If you qualify for Part A without a premium, it starts the month you turn 65. If your birthday is on the 1st of the month, coverage starts the month before you turn 65. See how to apply for Medicare in Utah and Medicare enrollment dates.

If you're still working

If you or your spouse have health coverage from current work, you may be able to delay Part B and sign up later with a Special Enrollment Period. It lasts 8 months after the job or the group coverage ends, whichever happens first. COBRA isn't considered group health plan coverage, and COBRA or retiree coverage ending doesn't qualify you for this Special Enrollment Period (Medicare.gov). See still working at 65.

If you miss your window

If you don't sign up when you're first eligible and don't qualify for a Special Enrollment Period, you may wait for the General Enrollment Period (January 1 to March 31) and pay a Part B late enrollment penalty: an extra 10% for each full 12-month period you could have signed up but didn't, for as long as you have Part B (Medicare.gov). Try our Medicare penalty calculator.

Find when your Medicare could start

Enter your birth month and year to see your 7-month Initial Enrollment Period, or the month you started disability benefits to see when Medicare would start. The result is an example estimate based on the dates you enter.

How to check your eligibility and sign up

What eligibility means for your plan choices

Once you have Medicare, you can choose how you get your coverage:

• Original Medicare with a Medigap policy: you need Part A and Part B to buy a Medigap policy. You can apply for a Medigap policy at any time, but timing matters; see What is Medigap? and Medicare Supplement plans in Utah.
• Medicare Advantage (Part C): you need Part A and Part B and must live in the plan's service area. See What is Medicare Part C? and Medicare Advantage plans in Utah.
• Medicare drug coverage (Part D): you need Part A or Part B to join a Medicare drug plan (Medicare.gov).

To compare the two paths, see Medicare Advantage vs. Medicare Supplement or try our Original Medicare vs. Medicare Advantage comparison tool. Plan changes later happen during Medicare Open Enrollment and the Medicare Advantage Open Enrollment Period. For the bigger picture, see Medicare in Utah and turning 65 in Utah.

How our team helps

We're Boo Insurance Services, a licensed independent Medicare agency in Draper, licensed since 2014. We've helped 1,000+ Utahns with Medicare and have 170+ 5-Star Google Reviews. We meet by phone or video anywhere in Utah, help you work out your dates and answer your questions in plain language. You won't pay us a fee. Insurance companies pay us when you enroll, and that doesn't change your plan's benefits, coverage or premium. If we talk about Medicare Advantage or drug plans, Medicare rules require a short Scope of Appointment form first. You decide, with no obligation.

Frequently asked questions

Who is eligible for Medicare?

People 65 or older who meet the citizenship or residency requirements, people under 65 who have gotten Social Security disability benefits for 24 months, and people with ALS or End-Stage Renal Disease (ESRD) who meet the requirements.

Can I get Medicare before 65?

Yes, in some cases. If you get Social Security disability benefits, Medicare starts automatically after 24 months of benefits. With ALS, it starts the same month your disability benefits begin. People with ESRD may be eligible at any age.

Do I have to have worked to get Medicare?

No. Your work record, or your spouse's, decides whether you pay a Part A premium. Most people don't pay one because they or their spouse have at least 40 quarters of Medicare-covered work. In 2026, people who buy Part A pay $311 or $565 a month, depending on their work record.

Will I be enrolled in Medicare automatically?

If you get Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65, you're enrolled in Part A and Part B automatically. If not, you sign up through Social Security.

Is Medicare eligibility based on income?

No. Your income doesn't decide whether you can get Medicare, but people with higher incomes pay a set extra amount for Part B and Part D, based on their income from 2 years earlier.

Can a non-citizen get Medicare?

A lawful permanent resident who has lived in the U.S. for 5 continuous years before applying can enroll at 65, if they meet the other requirements.

When should I sign up for Medicare?

During your 7-month Initial Enrollment Period, which starts 3 months before the month you turn 65. If you sign up before your birthday month, Part B starts the month you turn 65. If you have coverage from current work, you may be able to delay Part B.

Can I buy a Medigap policy before 65?

Federal law doesn't require companies to sell Medigap policies to people under 65, and rules vary by state. The Utah Insurance Department can tell you what's available in Utah before 65. If you already have Part B, you'll get a Medigap Open Enrollment Period when you turn 65.

Serving Utah residents. We do not offer every plan available in your area. Currently we represent 9 organizations which offer 58 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Sources

• Medicare.gov, Get started with Medicare
• Medicare.gov, Which path is right for me?
• Medicare.gov, When does Medicare coverage start?
• Medicare.gov, Avoid late enrollment penalties
• CMS, Original Medicare (Part A and B) Eligibility and Enrollment
• CMS, 2026 Medicare Parts A & B Premiums and Deductibles
• Social Security, Medicare (Publication EN-05-10043)

Not connected with or endorsed by the United States government or the federal Medicare program. Fores Boo, licensed independent Medicare agent, NPN 17255694, Boo Insurance Services, 61 W 13490 S Ste 201, Draper, UT 84020.

Last updated: October 21, 2026.