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Phone Number

(417) 633-7200

Location

Springfield, Missouri

Medicare Eligibility

There are several ways individuals can become eligible for Medicare. Age, disability, and certain diagnoses can qualify someone for Medicare. Prior to enrollment, understanding how Medicare works and which plans to enroll in will ensure you get the most value. First, you’ll need to know if you are eligible to enroll in Medicare.

Medicare Qualifications

Individuals who are 65 and older are eligible to receive Medicare benefits. They must be a U.S. citizen or a permanent resident who has lived in the U.S. for five consecutive years. The individual must have paid Medicare taxes for ten years to receive premium-free Part A. Enrollment is automatic if the individual has been receiving Social Security benefits.

Individuals who have been receiving disability benefits from Social Security for 24 months are also eligible for Medicare. Enrollment is automatic and will be effective on the 25th month of disability.

Finally, those with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease are also eligible. ALS individuals will be enrolled in Medicare automatically, but those with ESRD must enroll themselves. Individuals with either of these conditions will receive premium-free Part A regardless of tax status.

Other Medicare Eligibility Requirements

To receive premium-free Part A, an individual must have paid Medicare taxes for ten years. A spouse who has not met that requirement but who is married to someone who has will also be eligible for premium-free Part A. Those who have not met the requirement must pay a premium for Part A.

Beneficiaries with low income may be eligible for financial assistance and may also be eligible for Medicare and Medicaid.

Beneficiaries with high income may pay a higher premium for both Part B and Part D. This added premium is calculated by using the tax return from two years ago. The added premium is called the Income-Related Monthly Adjustment Amount (IRMAA).

Disability Eligibility

Individuals who have been receiving disability benefits for 24 months will be automatically enrolled in Medicare on the 25th month. In some instances, the individual does not have to wait the full 24 months.

People with ALS will be eligible for Medicare on the month that the disability benefits begin.

Disability is determined by the Social Security Administration, not the Medicare Program.

Cartoon artwork explaining Medicare and Advantage Eligibility​

Am I automatically
enrolled in Medicare when I turn 65?

If an individual has already been collecting Social Security benefits prior to age 65, they will be automatically enrolled in Original Medicare, unless they do not qualify for premium-free Part A.

Otherwise, 65-year-olds should enroll in Original Medicare during their unique Initial Enrollment Period. This begins three months before their 65th birthday.

Medicare enrollment can be delayed if the individual has other creditable health insurance. However, it is important to find out if your current coverage is “creditable.” All employers who have at least 20 employees have creditable coverage.

Medicare

Savings Program

The Medicare Savings Program will help eligible beneficiaries pay for some of their out-of-pocket expenses, like those associated with Medicare Parts A and B.

There are four Medicare Savings Programs.

QMB

Qualified Medicare Beneficiary Program

SLMB

Specified Low-Income Medicare Beneficiary Program

QI

Qualifying Individual Program

QDWI

Qualified Disabled and Working Individuals Program

If an individual qualifies for one of these programs, they will also qualify for Extra Help, which is a program that offers financial assistance for prescriptions.

Learn more about

Medicare Eligibility

If you have any questions or concerns regarding your eligibility, please contact a Missouri Medicare Advisor today.

Questions to be advised on:

The Missouri Medicare Advisor website character Nathan Mueller discussing Questions to be advised on.
Individuals at least 65 years of age, individuals who have been on disability for at least 24 months, and individuals with either ALS or ESRD are eligible for Medicare.
Unless you become eligible due to disability or you get diagnosed with ALS or ESRD, you will become eligible for Medicare at age 65.
You must be 65 to enroll in Medicare unless you qualify because of disability or because you have been diagnosed with ALS or ESRD.

You must be a legal U.S. citizen or a permanent resident for at least five years to be eligible for Medicare.

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