Medicare is the federal health insurance program for Americans age 65 and older, plus certain younger people with qualifying disabilities or medical conditions. As of 2026, more than 67 million Americans are enrolled. If you are approaching 65 or have a disability, understanding whether you qualify and what coverage you can get is one of the most important financial decisions you will make.
Quick Answer: Most people qualify for Medicare at age 65 if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters). Younger adults can qualify through Social Security Disability Insurance (SSDI) after 24 months of benefits, or immediately if they have ALS or end-stage renal disease. Part A (hospital) is free for most people; Part B (medical) costs $202.90 per month in 2026 per CMS.gov.
Who Qualifies for Medicare in 2026?
Medicare eligibility in 2026 falls into three main pathways: age, disability, and specific medical conditions.
Pathway 1: Age 65 and Older
You qualify for Medicare at 65 if you meet one of these citizenship and residency requirements:
- You are a U.S. citizen, OR
- You are a lawful permanent resident (green card holder) who has lived in the U.S. continuously for at least 5 years
You also need to meet a work history requirement to receive premium-free Part A (hospital insurance):
- You paid Medicare payroll taxes for at least 40 quarters (10 years), OR
- Your current or former spouse paid Medicare payroll taxes for at least 40 quarters
If you have 30 to 39 quarters of work history, you can still enroll in Part A but pay a reduced premium of $311 per month in 2026. Fewer than 30 quarters means a full premium of $565 per month in 2026. Everyone who qualifies by age can enroll in Part B regardless of work history, though a monthly premium applies.
Pathway 2: Disability (Under 65)
People under 65 can qualify for Medicare after receiving Social Security Disability Insurance (SSDI) benefits for 24 consecutive months. The 24-month waiting period begins the first month you receive SSDI cash payments.
Key facts for the disability pathway:
- You must have a qualifying disability as determined by the Social Security Administration
- Medicare enrollment is automatic after the 24-month waiting period
- You receive the same Parts A and B coverage as a person 65 and older
- If you stop receiving disability benefits, Medicare coverage can continue for a limited period
Pathway 3: ALS or End-Stage Renal Disease (Any Age)
Two medical conditions eliminate the age requirement entirely:
- ALS (Lou Gehrig's Disease): Medicare coverage begins the same month you start receiving SSDI disability benefits. There is no 24-month waiting period.
- End-Stage Renal Disease (ESRD): If you have permanent kidney failure requiring dialysis or a kidney transplant, you qualify for Medicare regardless of age. Coverage generally starts the fourth month of dialysis treatment (or sooner in certain situations).
What Are the Four Parts of Medicare?
Medicare is divided into four parts, each covering different services. Understanding what each part covers helps you choose the right combination for your needs.
Medicare Part A: Hospital Insurance
Part A covers inpatient care. In 2026, the specific services include:
- Inpatient hospital stays
- Skilled nursing facility (SNF) care following a hospital stay of at least 3 days
- Hospice care
- Some home health services
2026 Part A Costs:
| Cost Type | 2026 Amount |
|---|
| Premium (most people) | $0 (premium-free with 40+ quarters) |
| Premium (30-39 quarters) | $311/month |
| Premium (under 30 quarters) | $565/month |
| Hospital deductible per benefit period | $1,736 |
| Hospital coinsurance days 61-90 | $434/day |
| Hospital coinsurance lifetime reserve days | $868/day |
Source: CMS.gov 2026 Medicare Parts A and B Premiums and Deductibles
Medicare Part B: Medical Insurance
Part B covers outpatient and preventive care:
- Doctor visits and specialist consultations
- Outpatient hospital services
- Preventive screenings (mammograms, colonoscopies, diabetes screening, annual wellness visits)
- Durable medical equipment (wheelchairs, walkers, oxygen equipment)
- Mental health services
- Some home health services
- Ambulance services
2026 Part B Costs:
| Cost Type | 2026 Amount |
|---|
| Standard monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% of Medicare-approved amount |
Higher-income enrollees pay an Income-Related Monthly Adjustment Amount (IRMAA) surcharge on top of the standard premium. In 2026, IRMAA applies to individuals with income above $109,000 (or $218,000 for joint filers), with surcharges ranging from $81.20 to $487.00 per month.
Medicare Part C: Medicare Advantage
Medicare Advantage (Part C) is offered by private insurance companies approved by Medicare. Instead of using Original Medicare (Parts A and B), you get all your Medicare benefits through a private plan.
Key features:
- Must cover at least the same services as Original Medicare Parts A and B
- Most plans also include Part D prescription drug coverage
- Many plans offer additional benefits not covered by Original Medicare: routine dental, vision, hearing aids, fitness programs
- Average Medicare Advantage premium in 2026 is $14.00 per month (down from $16.40 in 2025), though costs vary widely by plan and location
Medicare Advantage plans include HMOs, PPOs, and Special Needs Plans (SNPs) for people with specific conditions or circumstances.
Medicare Part D: Prescription Drug Coverage
Part D covers outpatient prescription drugs. You can get it as a standalone plan (added to Original Medicare) or bundled within a Medicare Advantage plan.
2026 Part D Key Numbers:
| Item | 2026 Amount |
|---|
| Average stand-alone plan premium | $34.50/month |
| Maximum annual deductible | $615 |
| Annual out-of-pocket cap | $2,100 |
The $2,100 out-of-pocket cap is new for 2026, up from $2,000 in 2025, thanks to the Inflation Reduction Act changes. Once you hit this cap, your plan covers 100% of covered drug costs for the rest of the year.
Medicare vs. Medicaid: Key Differences
These two programs share a similar name but serve different populations and purposes.
| Feature | Medicare | Medicaid |
|---|
| Who it serves | Age 65+, certain disabilities, ALS, ESRD | Low-income individuals and families |
| Income requirement | None (age/disability based) | Income must be at or below threshold |
| Federal or state? | Primarily federal | Federal-state partnership |
| Cost | Premiums + deductibles | Usually low or no cost |
| Can you have both? | Yes (dual eligibility) | Yes (dual eligibility) |
Some people qualify for both programs at the same time. These "dual eligibles" receive Medicare as primary coverage and Medicaid helps pay for costs Medicare does not cover, including some premiums, deductibles, and long-term care. To check if you qualify for either or both programs, use the CoveredUSA eligibility screener.
Medicare Savings Programs (For Lower-Income Enrollees)
If you are enrolled in Medicare but have limited income and resources, you may qualify for a Medicare Savings Program (MSP) through your state's Medicaid agency. These programs help pay some or all of your Medicare costs.
The four types of Medicare Savings Programs in 2026:
| Program | What It Pays |
|---|
| Qualified Medicare Beneficiary (QMB) | Part A and Part B premiums, deductibles, and coinsurance |
| Specified Low-Income Medicare Beneficiary (SLMB) | Part B premium only |
| Qualifying Individual (QI) | Part B premium only |
| Qualified Disabled and Working Individual (QDWI) | Part A premium only (for disabled working people) |
Income limits for MSPs vary by state. Contact your state Medicaid office or visit medicare.gov to check current limits in your state.
How to Apply for Medicare in 2026
Enrollment Windows
Initial Enrollment Period (IEP): A 7-month window centered around your 65th birthday. It opens 3 months before the month you turn 65 and closes 3 months after. Enrolling in the first 3 months means coverage starts on the first day of your birthday month.
General Enrollment Period (GEP): January 1 through March 31 each year. For people who missed their IEP. Coverage starts the first of the month after you enroll. Late enrollment penalties may apply.
Special Enrollment Period (SEP): Available if you or your spouse had qualifying employer coverage when you turned 65. You have an 8-month window to enroll after that coverage ends without a late penalty.
Annual Election Period (AEP): October 15 through December 7 each year. This is when you can switch between Original Medicare and Medicare Advantage, or change your Part D plan. Changes take effect January 1.
Medicare Advantage Open Enrollment Period: January 1 through March 31. If you are already in a Medicare Advantage plan, you can switch to another MA plan or return to Original Medicare during this window.
Application Steps
- Confirm your eligibility. Check your age, work history, and disability status against the criteria above. If unsure, the CoveredUSA screener can confirm your eligibility in about 2 minutes.
- Choose your enrollment method. You can apply online at ssa.gov, call 1-800-772-1213, or visit your local Social Security office.
- Apply during your IEP. If you are already receiving Social Security or Railroad Retirement Board benefits at 65, you are automatically enrolled in Parts A and B. Otherwise, you must actively enroll.
- Decide on additional coverage. After enrolling in Parts A and B, decide whether to add a standalone Part D drug plan, enroll in Medicare Advantage (Part C), or buy a Medigap supplemental policy.
- Complete your drug plan selection. If you choose Original Medicare, compare Part D drug plans at medicare.gov/plan-compare.
- Confirm your enrollment. You will receive a red, white, and blue Medicare card in the mail within 30 days.
- Review annually. Each fall during the AEP, compare your current plan against available options in case a better plan is available in your area for the upcoming year.
Documents Needed
- Social Security number
- Proof of age (birth certificate or passport)
- Proof of U.S. citizenship or lawful permanent residence
- Work history records (W-2s or Social Security earnings statement)
- If applying for a SEP: documentation of prior qualifying employer coverage (letter from employer or insurer)
Common Reasons Applications Are Delayed or Denied
- Insufficient work history (fewer than 40 quarters) to qualify for premium-free Part A
- Not meeting the 5-year continuous residency requirement (for permanent residents)
- Applying outside an enrollment window without a qualifying SEP
- Missing or incorrect documentation of disability status (for disability pathway applicants)
- Submitting incorrect or inconsistent personal identification information
Late Enrollment Penalties
Missing your enrollment window without qualifying employer coverage triggers permanent monthly penalties that last as long as you have Medicare:
- Part B late penalty: 10% added to the standard premium for every 12-month period you were eligible but did not enroll. On the 2026 standard premium of $202.90, one year late adds roughly $20.29 per month permanently.
- Part D late penalty: 1% of the national base beneficiary premium multiplied by the number of full months you went without creditable drug coverage. This amount is added to your monthly Part D premium permanently.
There is no late enrollment penalty for Part A if you qualify for premium-free Part A.
Check Your Medicare Eligibility Now
If you are approaching 65, have a disability, or are not sure which programs you qualify for, the CoveredUSA screener walks you through your options in about 2 minutes. It covers Medicare, Medicaid, Medicare Savings Programs, and ACA marketplace plans, and it is free and confidential.
Check your eligibility now at CoveredUSA, it takes 2 minutes.
Frequently Asked Questions
What age do you qualify for Medicare?
The standard Medicare eligibility age is 65. There is no maximum age. People under 65 can qualify through Social Security Disability Insurance after 24 months of receiving benefits, or immediately if they have ALS or end-stage renal disease.
Do you have to be a U.S. citizen to get Medicare?
No, but you must meet residency requirements. U.S. citizens qualify automatically. Lawful permanent residents (green card holders) can qualify after 5 years of continuous U.S. residency. As of 2025, changes to immigration law narrowed eligibility so that some categories of lawfully present non-citizens (such as those with Temporary Protected Status) are no longer eligible. See KFF.org for current immigration-specific guidance.
Is Medicare free?
Part A is free for most people who have at least 40 quarters of Medicare payroll tax work history. Part B charges a monthly premium of $202.90 in 2026. Part D (drug coverage) and Medicare Advantage plans also charge premiums that vary by plan. Lower-income enrollees may qualify for Medicare Savings Programs that pay some or all of these costs.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare (Parts A and B) is managed directly by the federal government. You can use any provider that accepts Medicare, and you pay a percentage of each covered service. Medicare Advantage is private insurance approved by Medicare. It usually bundles Parts A, B, and D into one plan, often with extra benefits like dental and vision, but typically limits you to a network of providers.
Can you have both Medicare and Medicaid at the same time?
Yes. People who qualify for both are called dual eligibles. Medicaid acts as secondary coverage and can help pay Medicare premiums, deductibles, and cost-sharing. Income and asset limits for dual eligibility are determined by your state. The CoveredUSA screener can check both programs at once.
What happens if I miss my Medicare Initial Enrollment Period?
If you miss your IEP without qualifying employer coverage, you can enroll during the General Enrollment Period (January 1 through March 31 each year), but late enrollment penalties will apply to Part B and Part D premiums permanently. If you had qualifying employer coverage when you turned 65, a Special Enrollment Period lets you sign up within 8 months of that coverage ending without penalty.
How do I apply for Medicare?
You can apply online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security Administration office. If you are already receiving Social Security retirement benefits, enrollment in Parts A and B is automatic when you turn 65.
What does Medicare not cover?
Original Medicare does not cover routine dental care, eyeglasses, hearing aids, long-term custodial care, or most care received outside the United States. Some Medicare Advantage plans cover dental, vision, and hearing as supplemental benefits. Medigap (Medicare Supplement) policies can help cover cost-sharing like deductibles and coinsurance, but they do not add new service categories.
