Who is eligible for Medicare in 2025?

Seniors 65 and older are eligible for Medicare, and some younger individuals may also be eligible if they have certain disabilities or medical conditions.

You can sign up for Medicare three months before your 65th birthday, though if you already get Social Security or Railroad Retirement benefits, you’ll be enrolled automatically.

People with end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) qualify for Medicare at any age. Keep reading for a Medicare eligibility check and to see what you need to apply.

Medicare Eligibility Requirements

Call (855) 634-0435 now to connect with a licensed insurance agent who can walk you through Medicare plan options.

You can also enter your ZIP code to compare affordable Medicare plans in your area.

Medicare Eligibility Requirements

You must meet Medicare eligibility criteria to get coverage, such as being 65 or older or having certain disabilities or qualifying health conditions.

Once you turn 65, you can sign up for Medicare during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday.

You will not be able to access Medicare benefits until your IEP starts, but you can begin comparing health insurance plans online to prepare for enrollment.

If you aren’t eligible for Social Security or retirement benefits, you may still qualify for Medicare through your spouse’s work history if they paid Medicare taxes.

If neither of you meet those requirements, you can still enroll, but you’ll pay higher premiums.

It’s important to understand your eligibility and enrollment period to avoid penalties and ensure you get the coverage you need when you need it.

How to Get Medicare Before You Turn 65

A common question readers ask is, “Can I get Medicare at 55?”

No, Medicare eligibility is determined primarily by age, and coverage begins once you turn 65.

Key Medicare Terms to Know

Learn More: Expert Guide to Medicare

So, what disabilities qualify for Medicare under 65?

You may be eligible for Medicare before 65 if you’ve been diagnosed with end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS).

If you have ALS, you’re automatically enrolled in Medicare the same month your disability benefits begin.

For ESRD, you can qualify based on dialysis or a kidney transplant, and the timing depends on your treatment plan.

What Medicare Covers

Medicare covers hospital stays, doctor visits, medical equipment, prescriptions, and more, depending on your plan.

You can get coverage through Original Medicare (Parts A and B) or a Medicare Advantage plan, and you can also add Part D for prescription drug coverage.

Original Medicare consists of two parts that cover different types of care:

• Medicare Part A, or hospital insurance, covers inpatient hospital care, skilled nursing care, hospice, and home health.
• Medicare Part B, or medical insurance, covers outpatient care, doctor visits, preventive services, and medical equipment.

Medicare Part C, also known as Medicare Advantage, has the same eligibility requirements as Original Medicare but bundles hospital, medical and often prescription drug coverage into one plan with an annual out-of-pocket limit.

Medicare Part D covers prescription drug costs, so you may be wondering, “Who is eligible for Medicare Part D?”

Seniors are eligible to sign up for Part D as soon as they turn 65 during their IEP. Original Medicare (Parts A and B) doesn’t include prescription drug coverage, so you must buy Part D to pay for your medications.

Fortunately, many Medicare Advantage plans bundle Part D with Parts A and B for one monthly premium.

HMO and PPO are the most popular plans with beneficiaries. PFFS plans are more common among beneficiaries with few healthcare needs and who can afford high out-of-pocket costs. SNPS are only available to beneficiaries on Medicaid.

Compare Medicare Advantage vs. Original Medicare plans before you turn 65 to find out what coverage you need.

Learn More: Medicare Coverage & Eligibility

How Much Does Medicare Cost?

If you’re wondering how much Medicare costs, premiums vary based on the plan you choose, your income, your work history, and the amount you’ve paid in Medicare taxes.

You’ll also have other expenses, such as deductibles, copayments, and coinsurance, depending on your Medicare plan.

Medicare Costs by Plan Type

Medicare includes four parts, each covering different types of services.

Original Medicare combines Part A and Part B to cover inpatient hospital stays and outpatient medical care.

Costs for Original Medicare are set by the federal government each year.

Optional coverages such as Part D prescription drug plans or Medigap are available to lower out-of-pocket expenses. Many people also choose Medicare Advantage, or Part C, as an alternative to Original Medicare.

Medicare Costs: Copay, Coinsurance, & Premiums

These plans, along with Part D and Medigap policies, are offered through private insurers approved by Medicare.

Medigap (Medicare Supplement Insurance) is also sold by private companies and helps pay some of the out-of-pocket costs not covered by Original Medicare.

Premiums

Medicare Part A is premium-free for most people who’ve worked at least 10 years and paid Medicare taxes.

If you don’t meet the requirement, you’ll pay $278 or $505 monthly for Part A, depending on how long you or your spouse worked and paid Medicare taxes.

Medicare Savings Programs: Monthly Income Limits

As of 2025, the standard Medicare Part B premium is $185 per month, but people with higher incomes may pay mo re based on income-related adjustments.

Medicare Part D and Advantage plan costs vary since they’re offered by Medicare-approved private insurers.

Deductibles

Each part of Medicare has a deductible, or what you pay out of pocket before your coverage begins. In 2025, the Medicare Part A deductible is $1,676 per benefit period for hospital stays, while the Part B deductible is $257 per year.

Medicare Parts C and D have their own deductibles that vary by provider. Compare deductible amounts for Medicare Parts A, B, C, & D here.

Copayments & Coinsurance

Copayments are fixed amounts you pay for covered services or prescriptions. For instance, Part A has set copays based on the length of your inpatient hospital stay, usually nothing for the first 60 days, then a daily fee after that.

If you’re enrolled in a Medicare Advantage plan, you might also have copays for doctor visits, emergency care, or hospital stays.

Medicare Parts A-D & Medigap: Copay & Coinsurance

Coinsurance refers to the cost you’re responsible for paying after meeting your deductible. It’s an important factor in understanding your total Medicare expenses, as it directly affects what you’ll pay out of pocket for ongoing care.

You’ll typically pay 20% coinsurance for most Part B services, including outpatient care, diagnostic tests, and medical equipment, while Medicare covers the remaining 80%.

Many Medigap plans help pay these coinsurance expenses, reducing your out-of-pocket costs and making your healthcare spending more predictable.

We recommend comparing local Medicare insurance providers online before you turn 65 to find the plan you need. Enter your ZIP code to start comparing Medicare costs near you.

When and How to Enroll in Medicare

You can apply for Medicare online, by phone, or at a local Social Security office when you qualify, usually when you turn 65, during specific enrollment periods, or automatically if you already get Social Security or Railroad Retirement Board benefits.

Enrolling on time is important so you can avoid late penalties and coverage delays.

Learn More: How to Sign up for Medicare

The Initial Enrollment Period (IEP) lasts for seven months, running three months before your 65th birthday to three months after. If you already collect Social Security benefits, you’ll get Medicare Parts A and B automatically.

Medicare Enrollment Periods: Dates & Options

If you’re still employed and have coverage through your employer, you can delay Part B enrollment without facing penalties.

Once your job or coverage ends, you can sign up during the eight-month Special Enrollment Period (SEP).

After enrolling in Parts A and B, you can add Medicare Advantage (Part C) or Part D prescription coverage.

You can switch or adjust Medicare Advantage plans during the Annual Enrollment Period (AEP) from October 15 to December 7, or during the Open Enrollment Period (OEP) from January 1 to March 31.

See if You Qualify for Medicare Today

Medicare provides essential health coverage primarily for seniors age 65 and older.

Some individuals under 65 may also qualify due to certain disabilities or medical conditions, such as End-Stage Renal Disease or Lou Gehrig’s disease (ALS).

Who is eligible for Medicare? Your Medicare eligibility depends on your age, citizenship, and Social Security status.

You can sign up for Medicare during the Initial Enrollment Period (IEP), which begins three months before your 65th birthday.

To qualify for Medicare, you must meet these criteria:

• Age: You must be at least 65 years old, unless you have a qualifying disease or disability.
• Citizenship: You must be a U.S. citizen or have lived in the country for at least five years before enrolling.
• Social Security: You must be eligible for Social Security or Railroad Retirement Board benefits.

To qualify for enrollment, you must be a U.S. citizen or have lived in the United States for at least five years, and either you or your spouse must have paid Medicare taxes during that period.

Confused about Medicare? Call (855) 634-0435 to speak directly with a licensed insurance agent and get the answers you need.

You can also compare Medicare insurance companies online to see if you’re eligible and price plans available near you.