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Individuals Required to Apply for Medicare
Application Requirements
Part A
The following applicants/recipients are required to apply for Medicare Part A:
- An individual 64 years and 9 months of age or older who is either a US Citizen or LPR who has been in the US for 5 years or more.
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Note: Non-citizens eligible for Restricted Scope are not required to apply for Medicare. These individuals could qualify for free Part A if they have paid into SSA the required quarters or are eligible to receive benefits from a spouse/parent (alive or deceased) who paid into SSA for the required quarters. If an undocumented individual on restricted scope is approved for Medicare Part B, the premium must be entered as an expense.
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- Any individual applying for MC on the basis of blindness or disability (e.g., DDSD approvals).
- Any individual receiving RSDI or Railroad Retirement (RR) disability payments.
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Exception: Individuals who have received RSDI or RR disability benefits for less than 24 months are not eligible for Medicare Part A and are not required to apply for it. These individuals will automatically become eligible for Medicare in the 25th month of receipt.
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- Any individual receiving dialysis-related health care services.
- Any individual who has paid into SSA for the required quarters.
- Any individual eligible to receive benefits from a spouse/parent (alive or deceased) who paid into SSA for the required quarters.
- Any person applying for MC as a Qualified Medicare Beneficiary must apply for Conditional Medicare Part A if they don't already have it.
Acceptance
Insured individuals receive Part A without paying monthly premiums. However, those uninsured individuals who would only be eligible for Medicare Part A if they paid a premium are not required to accept Part A benefits.
The following applicants/recipients are required to apply for Medicare Part B:
- Individuals who are applying for Medi-Cal on the basis of being aged.
- Individuals who are applying for Medi-Cal on the basis of blindness or disability,
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Note: These individuals will automatically become eligible for Medicare in the 25th month of receipt. When verification of the beginning month of receipt of RSDI or RR disability is obtained, the EW must set up a case alert indicating the 25th month to begin the Part B Buy-In process.
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- Individuals receiving dialysis-related health care services.
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