You’re eligible for Medicare when you turn 65 or potentially earlier if you’re receiving Social Security Disability Insurance. Your costs will depend on your income and work history.

You can qualify for Medicare when you reach the eligible age or if you have a diagnosed condition or disability for which you’re receiving Social Security Disability Insurance (SSDI).

No matter how you qualify, your work history and income play a role in how much you’ll pay for Medicare. You can get help paying for Part B and Part D if you have a limited income. You’ll pay more if you have a higher income.

Medicare covers a wide range of services, but you’ll need to meet the guidelines for each service in order to receive coverage.

This article reviews Medicare eligibility guidelines, how costs are determined for each part of Medicare, and the qualifications for specific services such as hospice care and inpatient rehabilitation.

Medicare is a federally funded health insurance program for people ages 65 years and older and those who have certain medical conditions or disabilities. Medicare helps cover costs related to staying healthy and treating any health conditions you might have.

The rules for enrolling in Medicare are different depending on how you become eligible. You can become eligible in these ways:

  • Age: You’ll become eligible for Medicare when you turn 65 years old. You can enroll starting 3 months before the month you turn 65. Your enrollment period lasts through your birth month and the 3 months after your birth month. If you miss this window, you may need to pay a late enrollment penalty.
  • Disability: You’ll be automatically enrolled in Medicare once you’ve received 24 months of SSDI at any age. You’ll need to have a disability that meets Social Security’s criteria. Generally, this means it must prevent you from working and must be expected to last for at least another year.
  • ESRD or ALS: You’ll be automatically enrolled in Medicare if you have a diagnosis of end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) at any age. If you qualify as a result of one of these conditions, there’s no 24-month waiting period.
What are the different parts of Medicare?

Medicare is divided into a few parts, each of which covers different healthcare needs. Currently, the parts of Medicare are:

  • Medicare Part A: Medicare Part A is hospital insurance. It covers your care during short-term inpatient stays in hospitals, as well as services such as hospice care. It also provides limited coverage for skilled nursing facility care and select in-home healthcare services.
  • Medicare Part B: Medicare Part B is medical insurance that covers non-hospital care such as doctor’s appointments, preventive services, mental health services, medical equipment, and urgent care visits.
  • Medicare Part C: Medicare Part C is also called Medicare Advantage. These plans combine the coverage of parts A and B into a single plan. Medicare Advantage plans are offered by private insurance companies and are overseen by Medicare.
  • Medicare Part D: Medicare Part D is prescription drug coverage. Part D plans are stand-alone plans that cover only prescriptions. These plans are also provided through private insurance companies.
  • Medigap: Medigap is also known as Medicare supplement insurance. Medigap plans help cover the out-of-pocket costs of Medicare, such as deductibles, copayments, and coinsurance.

Your income, work history, and other factors can play a big role in your Medicare costs.

Medicare is funded by taxpayer contributions to Social Security. When you work and pay into Social Security, you earn Social Security work credits. Social Security work credits determine your eligibility for services such as SSDI and premium-free Medicare Part A.

You earn up to four work credits for each year you work. You’ll qualify for premium-free Part A if you’ve earned at least 40 work credits during your lifetime. This means most people are eligible for premium-free Part A after 10 years of work.

Tip

You can check how many work credits you have and what programs you’re eligible for by creating an account on the Social Security website.

You’re still eligible for Medicare if you’ve earned fewer than 40 credits, but you’ll need to pay a monthly premium for Part A.

In 2025, if you have 30 through 39 work credits, your Part A premium will be $285 per month. If you have fewer than 30 work credits, your Part A premium will be $518 per month.

If you have more than 40 credits, you won’t have to pay a monthly premium for Part A coverage.

How are Part B costs determined?

The standard Part B premium that most people pay in 2025 is $185 per month. But not everyone pays that amount.

If you earn a high income, you’ll pay more for Part B. For example:

An IRMAA is a surcharge that’s added to your monthly premiums.

If you have a limited income, you might qualify to pay less for Part B. Medicare offers a few programs that can help you pay the cost of your Part B premium.

How are Part C costs determined?

Medicare Part C plans, also known as Medicare Advantage plans, are offered by private companies that contract with Medicare. These plans typically cover the same services as Original Medicare (parts A and B), and many plans cover additional services as well, such as hearing and vision coverage.

The cost of your Medicare Advantage plan will depend on multiple factors, including:

  • where you live
  • the company offering the plan
  • how comprehensive the plan is
  • the plan’s network

You can search for plans in your area to compare costs and coverage using Medicare’s plan comparison tool.

How are Part D costs determined?

Private companies also offer Medicare Part D plans. Costs set by these companies are affected by the same factors as the cost of Medicare Advantage.

Paying for Part D works a lot like paying for Part B. Most people will pay the standard amount they see when they go to purchase a plan.

However, as with Part B, in 2025, if you earn between $106,000 and $133,000 as an individual, you’ll pay an IRMAA. Again, the IRMAA will add a set cost to your monthly premium.

For example, in 2025, if you earn between $106,000 and $133,000 as an individual, you’ll pay an additional $13.70 each month for your Part D premium.

You can also get help paying your Part D costs if you have limited income. Medicare’s Extra Help program can help you pay your Part D premium, copayments, and other costs.

Medicare covers a wide range of services. You’ll need to meet the guidelines for each service to get coverage. The sections below will go over some common services you might be wondering about.

Hospice guidelines

Hospice care is covered under Medicare Part A. You can get complete coverage for hospice services if you meet these conditions:

  • Your doctor must certify that you have a life expectancy of 6 months or less.
  • You need to sign a waiver agreeing to stop treatments seeking to cure your condition.
  • You must agree to comfort-focused end-of-life care.
  • You must sign a hospice agreement.

You won’t pay anything for hospice care if you meet these conditions. The only cost to you might be a $5 monthly charge for any prescriptions you’re still taking.

Skilled nursing facility guidelines

Medicare Part A covers limited skilled nursing facility stays. Just as with hospice care, you’ll need to meet a few conditions:

  • You need to have received at least 3 days of inpatient hospital care in the last 30 days — this is called a qualifying hospital stay.
  • Your stay in a skilled nursing facility must be ordered by a doctor who’s enrolled in Medicare.
  • You must require “skilled service,” which is a healthcare service that only a professional, such as a registered nurse or physical therapist, can provide.

Part A will pay for up to 100 days of skilled care in each benefit period.

In 2025, on days 1 through 20, your stay will be completely covered, with no copayment. On days 21 through 100, you’ll pay a coinsurance amount of $209.50 per day. For days 101 and beyond, you’ll pay all costs.

Physical therapy guidelines

Medicare will pay for medically necessary physical therapy under Part B coverage.

The services need to be ordered by your doctor to treat a condition or prevent a condition from getting worse — for example, physical therapy to reduce pain or to help you regain mobility after a stroke.

You’ll pay a coinsurance cost of 20% of the Medicare-approved amount for each approved visit.

Your costs might differ if you’re using a Medicare Advantage plan. Check with your plan provider ahead of time so you know what costs to expect.

Inpatient rehab guidelines

You can get coverage for inpatient rehab through Part A. Your doctor will need to order your stay in an inpatient rehabilitation center and certify that your condition needs treatment.

If you haven’t paid your Part A deductible yet, you’ll need to meet it before coverage will begin.

In 2025, you’ll pay a deductible of $1,676. The deductible will be your total cost on days 1 through 60 of your stay. On days 61 through 90, you’ll pay $419 per day in coinsurance costs.

After day 91, you’ll pay $838 per day until you’ve used all your lifetime reserve days.

You have 60 total lifetime reserve days. This is a set number of days you can use over your lifetime — they don’t renew each year. Every time you use some of them, you’ll have fewer extra days to use in the future.

Once you’ve used all your lifetime reserve days, you’ll pay all of the costs for services.

Home health aide guidelines

Medicare pays for home health aides only as part of qualified home health services. You’ll need to meet some guidelines to qualify:

  • Your doctor must certify that you need skilled home health services. Just like a stay at a skilled nursing facility, skilled care includes the services of registered nurses, therapists, and other professionals.
  • Your doctor must have a plan of care for you that includes how the home health aide will help you meet your health goals.
  • Your doctor must certify that you’re homebound. Medicare considers you homebound if you have trouble leaving your home independently.

Medicare doesn’t pay for long-term home healthcare. It also won’t pay if you need only the custodial services of home health aides. But home health aides are generally part of the services you receive as part of a home healthcare plan.

You won’t pay anything for home healthcare if you qualify. The only costs to you will be for any medical equipment needed for your home healthcare. You’ll be responsible for 20% of the Medicare-approved amount for any equipment.

If you still have questions…

For additional help understanding how you can qualify for Medicare benefits, you can use these resources:

You can become eligible for Medicare through age or disability. Your Medicare costs will depend on your work history, your income, and other factors.

In 2025, you’ll pay a surcharge for Part B and Part D if your individual yearly earnings are more than $106,000.

Medicare pays for a wide range of services, but you’ll need to meet the guidelines for each service to get coverage.