Determining Your Medicare Plans Eligibility and Who Qualifies

Chris Antrim, Health, Life & Medicare Insurance Broker • March 12, 2024

Determining If You Meet The Criteria To Get Eligible For Medicare Health Plans

Normally, you’re qualified for Medicare Plans coverage if you’re people age 65 or older, younger people with disabilities, or people with chronic diseases.


These are usually the situations before you get qualified for Medicare, even though you are at least one of the following, Medicare doesn’t automatically qualify you.


To determine if you’re eligible for Medicare coverage, in this article we’re going to discuss the requirement you must meet certain criteria in order to apply for coverage.

Who’s Eligible For Medicare

To find out more about your Medicare eligibility and health plans, you can visit medicare.gov they offer eligibility tools you use to see if you’re qualified for any Medicare plans.


  • Medicare Eligibility For Part A & Part B

To get qualified for Original Medicare you must be a U.S. citizen or a permanent legal resident for at least 5-five continuous years. You must meet at least one of these requirements to get Medicare eligibility:


A. Must be age 65 or older and eligible for Social Security

You may get automatically enrolled in Part A when you reach age 65 and already qualify from Social Security. In addition, you may automatically qualify for Part A and Part B if you’re already receiving benefits from Social Security or the Railroad Retirement Board (BRB), starting the first day of the month you turn 65.


B. Must be disabled and receive disability benefits

Another situation you may get automatically enrolled in Original Medicare: when you have a permanent disability which you receive disability benefits from Social Security for at least 24 months. Or certain disability benefits from the BRB for also 24 months.


C. Have an End-stage Renal disease or permanent kidney failure

Usually, if you have a chronic disease that requires dialysis treatment or kidney transplant, you need to sign up for Medicare as your enrollment isn’t automatic.


D. Have Lou Gehrig’s disease

You’ll be eligible for Medicare and will automatically enroll in Medicare Part A & Part B if you are diagnosed with Amyotrophic Lateral Sclerosis or ALS on the first day of the month you start receiving disability benefits. Unlike other disabilities that wait 24 months to get eligible for Medicare.


  • Medicare Eligibility For Part C

Medicare Advantage plan or Part C is an alternative way to get Medicare Part A and Part B. You can also purchase Part C through private insurance. To be eligible for Medicare Advantage, you must reside within the service area and must be enrolled in Original Medicare.


Medicare Part C is optional, there is no penalty for not signing up. But you must have Part a and Part B to get Part C and especially live within the service area.


  • Medicare Eligibility For Part D

Part D covers prescription drugs, and like Part C it is available through private insurance that is approved by Medicare. To be qualified for enrollment in a prescription drug plan you must have Medicare Part A and B and live within the service area. Medicare Part D is a stand-alone plan if you have Original Medicare or a Medicare Advantage plan that comes with prescription drugs.


  • Medicare Supplements

Medicare Supplements or Medigap is also available at private insurance companies. To be eligible for Medigap you must enroll in Original Medicare Part A and B because Medigap doesn’t work with Medicare part C or Medicare Advantage plan. And you must also consider the service area of where you're living.


Age Consideration When Applying For Medicare Plans

When it comes to getting Medicare, age is a very important factor. Medicare is a government health insurance program for people who are 65 years old or older, but there are some exceptions. In this section, we'll discuss the age requirements for getting Medicare.


At What Age Can You Apply for Medicare?

Most of the time, you can sign up for Medicare when you turn 65. The first time you can sign up is three months before you turn 65 and three months after. If you miss your original enrollment period, you can sign up during the general enrollment period, which runs from January 1 to March 31 every year.


If you have a certain disability, you might be able to get Medicare before you turn 65. No matter how old you are, you may be eligible for Medicare if you have Lou Gehrig's disease (ALS) or if you get disability payments from Social Security for 24 months.


Why Age is Important When Applying for Medicare?

When registering for Medicare, age is a big factor because the program is mostly for people over 65. The age limit makes sure that the program can cover people who are most likely to need it as they get older and need more medical care.


Also, signing up for Medicare at the right age can help you avoid fines for signing up late. You may have to pay a penalty for the rest of your life if you don't sign up for Medicare during your initial enrollment time and don't have other coverage that is comparable.


How To Apply For Medicare Plans

Medicare is a federal health insurance program that provides coverage for people who are aged 65 and over, those with certain disabilities, and those with end-stage renal disease. If you're eligible, applying for Medicare can seem overwhelming, but it doesn't have to be. In this article, we'll guide you through the process of how to apply for Medicare.


  1. Determine Your Eligibility. The first step in applying for Medicare is to determine your eligibility. Most people are eligible for Medicare when they turn 65 years old, but you may also qualify if you have a disability or end-stage renal disease. You can check your eligibility status by using the Medicare eligibility tool on the Medicare website.
  2. Choose Your Coverage. Once you've determined your eligibility, the next step is to choose your coverage. There are four parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). You can choose to enroll in Original Medicare (Part A and Part B), or you can enroll in a Medicare Advantage plan (Part C), which combines Parts A and B with additional benefits.
  3. Enroll in Medicare. You can enroll in Medicare online, by phone, or in-person. To enroll online, go to the Social Security website and follow the instructions for applying for Medicare. You can also enroll by phone by calling Social Security at 1-800-772-1213. If you prefer to enroll in person, you can visit your local Social Security office.
  4. Understand Enrollment Periods. It's important to understand the enrollment periods for Medicare. You can enroll in Medicare during your initial enrollment period, which is a seven-month period that starts three months before your 65th birthday and ends three months after your birthday. If you miss your initial enrollment period, you can enroll during the general enrollment period, which is from January 1 to March 31 each year.
  5. Submit Your Application. Once you've chosen your coverage and determined your enrollment period, it's time to submit your application. If you're applying online, you can submit your application electronically. If you're applying by phone, the representative will guide you through the application process. If you're applying in person, the Social Security representative will help you complete your application.


Applying For Medicare Plans with Chris Antrim Insurance

Comparing your Medicare plans into different companies will help you determine the expected monthly premiums and what are the best deals for your needs and situations. You can also ask our Insurance & Medicare Broker Chris Antrim, he can help you stretch out your options about your Medicare health plans.

Thank You For Reading!

For More Medicare Health Plan, Visit Idaho Medicare Plans Page.
aca insurance in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 20, 2025
Moving to Boise or the Treasure Valley? Learn how to update your ACA coverage, verify networks (St. Luke’s/St. Al’s), and avoid losing insurance.
boise health insurance open enrollment
By Chris Antrim, CLTC - Boise Health & Life Agency October 20, 2025
Missed the ACA deadline? Boise residents can still get coverage through Special Enrollment, HealthShare, or short-term plans. Learn how.
health insurance in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 20, 2025
Idaho ACA subsidy guide—see income limits, household examples, and tax tips to lower your premium. Quick local calculator and help.
health insurance in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 19, 2025
Lost coverage, moved, or had a life event? Learn Idaho’s ACA Special Enrollment Period rules, required proof, and how to avoid a gap in Boise.
health insurance open enrollment in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 19, 2025
Boise ACA open enrollment runs November–January. Learn dates, documents, and steps to enroll or renew your Marketplace health plan with local expert help.
healthshare plan in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 19, 2025
Unsubsidized ACA premiums high? See how Impact and One Health Share can lower monthly costs for Boise families—plus trade-offs to know first.
health insurance in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 18, 2025
Boise residents: compare ACA plans, short-term coverage, HealthShares, and DPC combos. See which option lowers costs without losing key protections.
health insurance plan for 63 years old in boise
By Chris Antrim, CLTC - Boise Health & Life Agency October 18, 2025
Boise pre-Medicare guide: compare ACA plans, networks, RX, out-of-pocket caps, and the glidepath to Medicare. Local, doctor-by-doctor checks.
health insurance for self-employed
By Chris Antrim, CLTC - Boise Health & Life Agency October 18, 2025
Boise entrepreneurs: compare Impact Health Sharing and One Health Share to ACA. Lower monthly costs, flexible provider choice, quick starts. Local support.
boise hsa plan
By Chris Antrim, CLTC - Boise Health & Life Agency October 17, 2025
Boise HSA-eligible ACA plans explained. See how to lower taxes, compare networks (St. Luke’s/St. Al’s), and model real costs. Local expert help.