Medicare: Eligibility, Costs, How to Enroll

What Is Medicare?

Medicare is the federal health insurance program for people age 65 and older. It also covers younger people with certain disabilities and anyone with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease). The Centers for Medicare & Medicaid Services (CMS) runs the program under the U.S. Department of Health and Human Services.

About 65 million Americans are enrolled in Medicare. The program has four parts. Part A covers hospital stays and inpatient care. Part B covers doctor visits, outpatient services, and medical equipment. Part C (Medicare Advantage) is an alternative way to get Parts A and B through private insurers, often with extra benefits. Part D covers prescription drugs.

Medicare is not free. Most people pay no premium for Part A because they or a spouse paid Medicare taxes for at least 10 years (40 quarters). Part B has a standard monthly premium of $202.90 in 2026. Part D premiums vary by plan. Unlike Medicaid, Medicare is not based on income for basic enrollment. However, low-income enrollees can get help paying premiums and costs through Medicare Savings Programs and the Extra Help program.

You can check whether you or a family member may qualify for Medicare and related programs using our free eligibility screener.

Who Qualifies for Medicare?

Medicare eligibility is based on age, disability status, or specific medical conditions. Income does not determine whether you can enroll. Here are the main paths to coverage.

Age 65 and Older

If you are 65 or older and a U.S. citizen or permanent resident who has lived in the United States for at least five continuous years, you qualify for Medicare. Most people are automatically enrolled in Parts A and B when they turn 65 if they are already receiving Social Security benefits. If you are not receiving Social Security, you need to sign up during your Initial Enrollment Period.

Under 65 with a Disability

People under 65 who receive Social Security Disability Insurance (SSDI) benefits become eligible for Medicare after a 24-month waiting period. The clock starts from the date you first receive SSDI payments. After 24 months, you are automatically enrolled in Parts A and B.

End-Stage Renal Disease (ESRD)

If you have permanent kidney failure requiring dialysis or a kidney transplant, you can qualify for Medicare at any age. Coverage typically begins the fourth month of dialysis treatments, though it can start sooner if you receive training for home dialysis or get a transplant.

ALS (Lou Gehrig's Disease)

People diagnosed with ALS qualify for Medicare as soon as they begin receiving SSDI benefits. There is no 24-month waiting period for ALS patients.

Part A Premium Eligibility

Source: CMS 2026 Medicare Parts A & B Premiums and Deductibles, November 2025.

About 99% of Medicare beneficiaries pay nothing for Part A. If you or your spouse worked and paid Medicare taxes for at least 10 years, Part A is premium-free. People with fewer work quarters can still enroll by paying a monthly premium.

Our free screener checks Medicare eligibility along with Medicaid, SNAP, and other programs in about five minutes.

How Much Does Medicare Cost?

Medicare costs include premiums, deductibles, and coinsurance. The amounts change every year. Here are the 2026 numbers.

Part A Costs (Hospital Insurance)

Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.

Source: CMS 2026 Medicare Parts A & B Premiums and Deductibles.

You pay the $1,736 deductible once per benefit period, not once per year. A benefit period starts when you are admitted to a hospital and ends 60 days after you are discharged. If you are readmitted after 60 days, a new benefit period begins and you pay the deductible again.

Part B Costs (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health care.

Source: CMS 2026 Medicare Parts A & B Premiums and Deductibles.

Higher-income enrollees pay more for Part B. If your modified adjusted gross income is above $106,000 (single) or $212,000 (married filing jointly), you pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium. The total can range from $244.60 to $618.80 per month depending on your income bracket.

Part C Costs (Medicare Advantage)

Medicare Advantage plans are offered by private insurance companies approved by Medicare. Costs vary by plan and location. Many plans charge $0 in extra premiums beyond the Part B premium. Some include dental, vision, hearing, and prescription drug coverage. You still pay your Part B premium when enrolled in a Medicare Advantage plan.

Part D Costs (Prescription Drugs)

Part D plans are also offered by private insurers. The average basic premium is about $46 per month in 2026, though plans vary widely. Starting in 2025, all Part D plans have an annual out-of-pocket spending cap. For 2026, that cap is $2,100. Once you spend that amount on covered drugs, your plan pays 100% for the rest of the year.

The Part D deductible for 2026 is $615 or less, depending on your plan. Many plans have no deductible for generic drugs.

Source: Medicare.gov Part D Costs.

Extra Help for Low-Income Enrollees

If you have limited income and resources, the Extra Help (Low-Income Subsidy) program can pay most of your Part D costs. To qualify, your annual income must be below $22,590 for an individual or $30,660 for a married couple in 2026, and your resources must be below $17,220 (individual) or $34,360 (couple). You can apply at ssa.gov or by calling Social Security at 1-800-772-1213.

Medicare Savings Programs through your state Medicaid office can also help pay your Part A and Part B premiums, deductibles, and coinsurance. Check your state benefits page or use our free screener to see if you qualify.

How to Enroll in Medicare

Enrollment depends on your situation. Some people are enrolled automatically. Others must sign up during specific windows.

Step 1: Check your eligibility

Use our free eligibility screener or review the requirements above. If you are turning 65, plan ahead. Your Initial Enrollment Period begins three months before your 65th birthday month.

Step 2: Understand your enrollment period

Initial Enrollment Period (IEP): A seven-month window that starts three months before the month you turn 65, includes your birthday month, and ends three months after. This is the best time to enroll to avoid penalties and gaps in coverage.

General Enrollment Period (GEP): January 1 through March 31 each year. If you missed your IEP, you can sign up during this window. Coverage starts July 1. You may owe a late enrollment penalty.

Special Enrollment Period (SEP): If you delayed enrollment because you had coverage through an employer (your own or a spouse's), you get an eight-month SEP starting when the employment or coverage ends. No penalty applies if you enroll during this window.

Open Enrollment for Medicare Advantage and Part D: October 15 through December 7 each year. During this period, you can switch between Original Medicare and Medicare Advantage, join or drop a Part D plan, or change plans.

Step 3: Gather your documents

You will need:

• Social Security number
• Date of birth
• Proof of U.S. citizenship or lawful residency
• Information about current health insurance (if any)
• Employer information (if enrolling during a Special Enrollment Period)

Step 4: Submit your enrollment

Online: Visit Medicare.gov or SSA.gov to sign up for Parts A and B. You can enroll in Part C and Part D plans at Medicare.gov/plan-compare.

Phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) to enroll in Parts A and B. Call 1-800-MEDICARE (1-800-633-4227) for help choosing Part C or Part D plans.

In person: Visit your local Social Security office. Find your nearest office at ssa.gov/locator.

Step 5: Get free counseling through SHIP

Every state has a State Health Insurance Assistance Program (SHIP) that offers free, unbiased Medicare counseling. Trained counselors can help you compare plans, understand your costs, and make enrollment decisions. In California, the program is called HICAP (1-800-434-0222). In Texas, it is called HICAP (1-800-252-9240). In New York, it is called HIICAP (1-800-701-0501). Find your state's SHIP program through shiphelp.org or your state benefits page.

Medicare and Other Programs

Many Medicare enrollees also qualify for other federal and state benefits. If you are on Medicare, you may want to check these programs:

• Medicaid: Low-income Medicare enrollees may qualify for Medicaid too. "Dual eligible" beneficiaries get help with Medicare premiums and cost-sharing. Each state sets its own Medicaid income limits.
• SNAP (Food Stamps): Seniors on Medicare with limited income often qualify for SNAP. A single person can qualify with gross income below $1,696 per month.
• SSI: If you are 65 or older with limited income and resources, Supplemental Security Income provides monthly cash payments. SSI recipients in most states automatically qualify for Medicaid.
• LIHEAP: The Low Income Home Energy Assistance Program helps pay heating and cooling bills. Many Medicare enrollees on fixed incomes qualify.
• ACA Marketplace: If you are under 65 and waiting for Medicare eligibility, the ACA marketplace provides health insurance options with premium subsidies based on income.

Our free screener checks Medicare and all of these programs at once.

Frequently Asked Questions

When should I sign up for Medicare?

Sign up during your Initial Enrollment Period, which begins three months before you turn 65 and lasts seven months total. If you are already receiving Social Security benefits at age 65, you will be automatically enrolled. If you have employer coverage, you can delay enrollment without penalty and use the Special Enrollment Period when that coverage ends.

Is Medicare free?

Part A is free for most people because they paid Medicare taxes during their working years. Part B costs $202.90 per month in 2026. Part D premiums vary by plan. You also pay deductibles and coinsurance when you use services. Low-income enrollees may qualify for programs that cover these costs.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare includes Part A (hospital) and Part B (medical) run directly by the federal government. You can see any doctor who accepts Medicare. Medicare Advantage (Part C) bundles Parts A and B through a private insurer, often adding drug coverage, dental, and vision. Advantage plans usually require you to use network providers but may have lower out-of-pocket costs.

What does Medicare not cover?

Original Medicare does not cover dental care, vision exams for glasses, hearing aids, long-term custodial care, or care outside the United States. Some Medicare Advantage plans include dental, vision, and hearing benefits. You can also buy separate supplemental (Medigap) policies to cover gaps in Original Medicare.

What happens if I miss my enrollment period?

If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you must wait for the General Enrollment Period (January through March). Your Part B premium will increase by 10% for each full 12-month period you could have enrolled but did not. This penalty lasts as long as you have Part B. Part D has a similar late enrollment penalty.

Can I have Medicare and Medicaid at the same time?

Yes. About 12 million Americans are "dual eligible" for both programs. Medicaid can help pay your Medicare premiums, deductibles, and copays. It also covers services Medicare does not, like long-term care and dental. Contact your state Medicaid office or use our free screener to check if you qualify.

How do I choose between Medicare plans?

Start with the free Medicare Plan Finder at Medicare.gov. Enter your zip code and current prescriptions to compare plans in your area. You can also call 1-800-MEDICARE or contact your state's SHIP program for free, personalized counseling.

Does Medicare cover prescription drugs?

Original Medicare (Parts A and B) does not cover most outpatient prescription drugs. You need to enroll in a Part D plan or a Medicare Advantage plan that includes drug coverage. In 2026, Part D plans cap your annual out-of-pocket drug spending at $2,100. After reaching that limit, your plan pays 100% of covered drug costs for the rest of the year.