Who Qualifies for Medicare? The Tests and the Steps

The short answer

In short: Who qualifies for Medicare? Most people at 65, if they are US citizens or green card holders of five years. Some under 65 qualify through disability, ALS or kidney failure.

If you are checking this for your mother or father, you have probably already found the first snag. "Eligible" and "free" are not the same word. Almost everyone who is eligible gets Part A without a premium. Part B has a monthly premium for everyone. Where the work record is thin, Part A can cost money too.

Once the card arrives, someone still has to book the first appointments and chase the referrals. If that someone is you, Navigate Care explains how a navigator can take that on, and what it may cost, on its what you will pay page.

Now the tests themselves.

Who qualifies for Medicare: the three tests

There are three questions, and they get asked in this order.

1. Are you 65 or older, or do you have a qualifying disability or condition? That decides which door you use.
2. Are you a US citizen or a lawful permanent resident? AARP says that at 65 you are eligible if you are a citizen, or a green card holder who has lived continuously in the US for at least five years.
3. How much have you, or a spouse, worked? This doesn't decide whether you can get Medicare. It decides what Part A costs.

Social Security runs the enrolment. Medicare.gov says getting Medicare is your choice. Nobody is signed up against their will.

If your parent is not a citizen, the picture can be more particular than this post can cover. Other lawful immigrant categories exist, and the rules for them can change. Ask Social Security, or a free SHIP counsellor (the State Health Insurance Assistance Program in your state), before assuming either way.

Door one: turning 65

For most families this is the only door. Your parent turns 65, is a citizen or a long-term green card holder, and has worked. That is the whole test.

The part that trips people up is whether they have to do anything. Medicare.gov says you get Medicare automatically at 65 "as long as you start getting Social Security benefits at least 4 months before you turn 65." If your parent is already collecting Social Security retirement benefits, check the mail for a card. If they are still working, or have not claimed benefits, they apply. Our guide on how to apply for Medicare covers the seven-month window, the penalty and the three ways to apply.

Being eligible at 65 does not mean everything starts at 65. Part B is a separate sign-up with its own premium. In 2026 the standard Part B premium is $202.90 a month, with a $283 deductible, according to Medicare.gov. Our Medicare Part B guide goes through what that buys.

Work credits and the premium-free Part A

This is the test families miss, because nobody mentions it until a bill shows up.

Premium-free Part A is based on work. AARP describes it as 40 quarters, or 10 years, of work paying Medicare taxes. Your own record counts. So can a spouse's, if you have been married at least a year and your spouse is eligible for Social Security, according to AARP. The same page covers a former spouse.

If the record falls short, you can usually still get Part A. You buy it. Medicare.gov lists the 2026 price as $311 or $565 a month, depending on how long you or your spouse worked and paid Medicare taxes. AARP puts the split at 30 to 39 quarters for $311 and 29 or fewer for $565.

Part A cost in 2026, by work record

Source: Medicare.gov, Medicare costs, AARP

Notice what this means in practice. A parent who spent years raising children at home is not shut out. They may be covered through a spouse's record. If neither has the credits, they pay for Part A, and that is a good moment to ask about help with the cost, which is further down.

We don't give tax or financial advice, and your parent's earnings record is theirs. Social Security can tell you how many quarters are on it.

Door two: under 65

You can get Medicare younger. Three routes are common.

Disability. You need Social Security or Railroad Retirement Board disability benefits. Medicare.gov says you get Part A and Part B "after you get disability benefits for 24 months." AARP adds that you have to have been entitled to those payments for at least 24 months beforehand. The wait is real. It is the reason someone on disability for a year and a half still has no Medicare card.

ALS. ALS, also called Lou Gehrig's disease, is the exception to that wait. AARP says people with ALS don't have to wait 24 months. Medicare.gov says that if you have ALS and are already getting disability benefits, you should already have Parts A and B.

Kidney failure. Medicare.gov says you can get Medicare with end-stage renal disease (ESRD) at any age if your kidneys no longer work and you need regular dialysis or have had a transplant. There is a work or benefit condition as well, which can be met through your own record or a spouse's or parent's. For someone on dialysis, coverage usually starts on the first day of the fourth month of treatment. Our post on Medicaid vs Medicare touches on this route too.

The ways in, side by side

Source: Medicare.gov, how to sign up, Medicare.gov, ESRD, AARP

When someone doesn't qualify yet

It happens more than people expect. A parent who moved to the US late in life. A person two years into a disability claim. A spouse who is younger than 65 and wants coverage because the other spouse has Medicare. None of that is a failing. The rules are built on records and dates, and people's lives don't line up neatly with them.

What to do depends on which test failed.

If the problem is age, there is nothing to apply for yet. SHIP can talk through what coverage exists in the meantime.

If the problem is residency, Social Security can tell you the exact date the five years is met. Write that date down.

If the problem is work credits, ask Social Security whether a spouse's record applies. If it doesn't, buying Part A is the route.

If the problem is cost, there is help. A state Medicare Savings Program can pay some or all of the Medicare premium for people on a low income. For 2026, the monthly income limits run from $1,350 for a single person ($1,824 married) at the QMB level up to $1,816 single ($2,455 married) at the QI level, with resource limits of $9,950 single and $14,910 for a couple. Those are our own published figures, and states can count income differently. Our guide on Medicare Savings Programs and Extra Help goes through how to apply.

If the question is about full Medicaid, which tests income and assets and is run by your state, it is a different programme. Medicaid vs Medicare explains the split.

The steps, in order

Here is the order that works, whether it is you or your parent.

1. Write down the date of birth and the date Medicare could start. For age-based Medicare, that is the 65th birthday. The enrolment window is seven months around it.
2. Check the Social Security status. Is your parent already collecting retirement benefits, and did they start at least four months before turning 65? If yes, a card should arrive on its own.
3. Confirm citizenship or residency. Citizens, yes. Green card holders, five continuous years. Anyone else, ask Social Security first.
4. Count the work record. Ask Social Security how many quarters your parent has, and whether a spouse's record helps.
5. Choose how to apply. Online through Social Security is described by Medicare.gov as the easiest and fastest. You can also call 1-800-772-1213 (TTY 1-800-325-0778) or visit a local office. Railroad workers call the Railroad Retirement Board at 1-877-772-5772.
6. Decide on Part B. If your parent is still covered by a current job, whether to take it now is worth a call to HR or SHIP first.
7. Keep the card and the Medicare Number safe. Then look at Advantage, Part D and Medigap. Our Medicare parts explained guide is the place to start.

Where a navigator comes in

A navigator doesn't decide who qualifies, and doesn't replace SHIP. SHIP is free and is the right first call on eligibility and plan choice.

What a navigator does is the work after enrolment: booking the first visits, confirming referrals, tracking what happens after a hospital stay. Medicare doesn't automatically cover navigation. Eligibility depends on a qualifying condition or need and a provider visit. For many patients with supplemental coverage the cost is usually $0, and we confirm your cost before you start. Our compare page sets out how navigators differ from other kinds of help.