Medicare & Medicare Supplement (Medigap) Eligibility Requirements



To be eligible in Medicare, the following measures must comply:

  • Aged 65 and older
    Diagnosed with end-stage renal disease (ESRD – permanent kidney failure requiring dialysis or transplant)
  • Receiving disability benefits from the Social Security Administration or the Railroad
    Retirement Board. Generally, you’re eligible for Medicare after receiving disability benefits for 24 months in a row.
  • Diagnosed with Lou Gehrig’s disease (ALS).

You don't have to pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working for at least 10 years, or 40 quarters.

The cost of Medicare Part B, on the other hand, varies depending on the year you enroll your level of income

Your Part B premium will be deducted automatically from your Social Security benefit payment if you get benefits from one of these:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

If you don’t get these benefit payments, you have to pay for it. Depending on your income level, this Part B Premium can vary.

Medicare provides only basic health insurance coverage. It does not cover 100% of all hospital and medical expenses you might have. Medicare only covers 80% of most medical services under Medicare Part B. You will have to pay 20% of the cost, and there is no maximum on what that 20% can be. It also has large co-payments and deductibles for hospitalizations, etc. that comes out-of-pocket before it kicks in. Original Medicare (Part A & Part B) doesn’t cover certain benefits like routine vision and dental, prescription drugs, or overseas emergency health coverage. Due to these reasons, most people on Medicare will procure additional supplementary health care to cover any additional expenses.

If you are on Medicare, you might be eligible for a Medicare Supplement (Medigap). Though this also depends on your age and health status.

You’ll need to meet the definition of disability based on Social Security and have worked long enough under SSA-covered employment to qualify for benefits. In general, Social Security defines disability as being unable to do the work you used to do because of a condition that is expected to last at least a year or result in your death. You must also be unable to do other work, even with accommodations. If you are under age 65 with a disability there are no federal requirements for insurance companies to offer you Medicare supplement coverage.

You will be guaranteed coverage if you are within the first 6 months of getting your Medicare Part B. If you are losing previous credible health insurance and any other type of guaranteed issue situation you can also be guaranteed coverage.

Although most states offer the same 10 Medicare Supplement insurance plans, the specific plans available in your location may vary, since insurance companies aren’t required to sell every plan.

Situations may differ from state-to-state. It is quite important to speak with a Medicare specialist at (855) 230-0801 who can explain and help you understand the various options available to you. You can also fill out our instant online quote form to see what options are available to you.