Medicare Coverage & Eligibility in 2025

When researching Medicare coverage and eligibility, it is important to know that signing up late for Medicare could incur late penalties for parts of Medicare.

Read on for an expert guide to Medicare that breaks down your choices, as well as how to determine your eligibility for Medicare.

Speaking to an insurance representative can help you determine your eligibility status and what Medicare plan is best. Call (855) 634-0435 to speak to a licensed insurance agent or enter your ZIP to learn more about your Medicare options.

Determine if You Meet Medicare Eligibility Requirements

Wondering how to determine eligibility for Medicare? Almost anyone over 65 years of age can sign up for Medicare insurance.

While most Medicare-eligible customers must be over age 65, there are certain exceptions for those younger than 65 who have qualifying disabilities or medical conditions.

While 85% of Medicare enrollees are over age 65, 13% are under age 65 because they have a disability that qualifies them for Medicare.

For example, customers with end-stage renal disease (ERSD) can qualify for Medicare coverage, regardless of their age.

Besides age, disability, and medical conditions, customers must meet other requirements to qualify for Medicare insurance.

For example, customers must be either a U.S. citizen or a legal permanent resident for at least five years (Learn More: Who is eligible for Medicare?).

Medicare Eligibility Requirements

Who is not eligible for Medicare? Anyone under 65 without a qualifying medical condition, but another important factor is work history.

You won’t be eligible for Medicare insurance if you didn’t pay enough into Social Security taxes while employed. However, some people may still qualify if their spouse meets certain work requirements.

When to Sign Up for Medicare

When you are turning 65, you have an initial enrollment period that provides you time to choose the Medicare policy that best suits you without invoking any late penalties (Read More: How to Sign up for Medicare).

It is important to note that delaying Medicare coverage can drive up the cost of monthly charges, so the longer you wait, the more you will pay.

Medicare Enrollment Periods: Key Details

Medicare enrollment is once a year, unless you meet special exceptions for applications outside of the regular enrollment period.

For example, if you turn 65 outside of the enrollment period, you can still apply for coverage. When applying for Medicare insurance, it can be helpful to familiarize yourself with some common enrollment and policy terms.

Key Medicare Terms to Know

You can also apply for coverage outside of general enrollment if you meet one of the special circumstances outlined by Medicare. Examples would be if you lost your employee health insurance or were diagnosed with ALS or ESRD.

Understanding Your Medicare Coverage Options

Medicare is a federal health insurance program composed of several parts, each providing different types of coverage.

Understanding what each part covers is essential if you want to buy the right Medicare plan. For example, when you sign up for Medicare, you may be automatically enrolled in Part A, which is hospital insurance.

There are three other parts to Medicare: Part B, Part C, and Part D. Part B is important for medical insurance, which would help cover outpatient care, doctor visits, and certain medical supplies.

Medicare Part D is another useful coverage that helps cover prescription drug costs, which is important for customers on multiple medications.

Part C is known as Medicare Advantage, which is a more comprehensive plan than Original Medicare plans that only include Part A and Part B.

Part C typically includes hospital insurance, medical insurance, and prescription drug coverage in one convenient policy with one fixed premium.

Wondering which is better, original Medicare or Medicare Advantage? Read our guide on Medicare Advantage vs. Original Medicare to see which fits your lifestyle.

If having prescription drug coverage is important for you, for example, you may not want to carry just an Original Medicare plan.

Comparing Medicare Coverage Costs

How much does Medicare cost? Just like other insurance plans, Medicare has deductibles and copays that have to be paid.

The medical costs covered by Medicare depend on what Medicare plan you choose, as copays and premiums will vary depending on the Medicare plan.

Medicare Costs and Coverage by Part

For example, Part A costs $0 for a hospital stay of 60 days or less, but it charges a daily fee for any day after that.

Copays with Medicare Part A will also depend on the length of the hospital stay. The longer a hospital stay is, the more you pay in copays.

Medicare Premium, Copay, & Coinsurance Breakdown

Medicare Part B is the only plan without a copay, but you must meet the Medicare deductible before coverage applies.

Medicare Advantage costs will vary by plan and by state, so it’s important to compare Medicare insurance quotes online to get an idea of costs in your area.

If you want extra assistance with payments, you may want to look into Medigap supplemental insurance (Medigap) coverage.

Medigap coverage can help cover deductibles and copays on Medicare coverage. Not everyone will qualify for Medigap, as there is a maximum income limit.

Speaking with a licensed insurance agent can help you navigate Medicare. Call (855) 634-0435 to speak with someone today or enter your ZIP in our free tool to get quotes.