There are many layers to the federal Medicare program. Let us help you figure out where to begin. We'll break down Medicare into manageable pieces, so you know if you qualify for Medicare coverage, what coverage is available in your area, and how to get enrolled in a plan that fits your needs.

When am I eligible?

There are certain eligibility requirements for Medicare coverage. Use this page as a guide to understanding if you qualify for Medicare benefits.

65 and over - Most people qualify for Medicare at age 65. You should be eligible for Medicare at the age of 65 if:

  1. You are a U.S. citizen or legal resident, and
  2. You have resided in the United States for a minimum of five years
  3. Worked at least 10 years in Medicare-covered employment

If the above applies to you and you have had Social Security deductions taken from your payroll, chances are that you will automatically receive a Medicare card in the mail just prior to becoming eligible, showing benefits for both Part A (hospital care) and Part B (medical care). Part B is optional, can be declined, and requires that a premium be paid on a monthly basis for participation.

You may have to apply if:

  1. You have not applied for Social Security or Railroad Retirement benefits
  2. You were employed by the government
  3. You have kidney disease.

Under 65 - Generally speaking, if you are under age 65, you will qualify for Medicare if:

  1. You have End Stage Renal Disease (ESRD), or
  2. You have received Social Security Disability Income (SSDI) payments for 24 months (or 1 month for ALS/Lou Gehrig's Disease)

Medicare Parts A and B will not cover all of your medical costs. Specific items, such as prescription drugs, premiums, co-pays and many more, are considered out-of-pocket costs, unless you have additional insurance. There are options to buy additional coverage from private insurance companies that fill in these "gaps". There are three different types of these plans: Medigap, Part D, and Medicare Advantage Plans.

Here is a more comprehensive list of services and expenses that Medicare Parts A and B do not cover:

  • acupuncture
  • deductibles, coinsurance, or copayments for certain health care services
  • dental care and dentures (with a few exceptions)
  • cosmetic surgery
  • chiropractic services
  • custodial care (e.g. help with bathing, dressing, using the bathroom, and eating) at home or in a nursing home
  • eye refractions
  • health care during travel outside of the United States (with a few exceptions)
  • hearing aids and hearing exams for the purpose of fitting a hearing aid
  • hearing tests (other than for fitting a hearing aid) that haven't been ordered by your doctor
  • laboratory test for screening purposes
  • long-term care, such as custodial care in a nursing home
  • orthopedic shoes (with a few exceptions)
  • prescription drugs - most prescription drugs are covered under Medicare Part D
  • routine foot care such as cutting of corns or calluses (with a few exceptions)
  • routine eye care and most eyeglasses
  • routine or yearly physical exams (Part B will cover a physical exam within the first six months)
  • screening tests and screening laboratory tests except those explicitly approved by Medicare
  • shots (vaccinations) except as approved by Medicare.
  • some diabetic supplies (such as syringes or insulin unless the insulin is used with an insulin pump or you join a Medicare Prescription Drug Plan)