An individual is eligible for premium-free (no cost) Medicare Part A (hospital insurance) if he or she is 65 or older and receiving, or eligible for, retirement benefits from Social Security or the Railroad Retirement Board, or is younger than 65 and has received Railroad Retirement disability benefits for the prescribed time and meets the Social Security Act disability requirements, or had Medicare-covered government employment, or is younger than 65 and has end-stage renal disease (ESRD). If an individual is not eligible for premium-free Medicare Part A, he or she can buy Part A by paying monthly premium if he or she is 65 or older and enrolled in Part B, a resident of the United States, and either a citizen or an alien lawfully admitted for permanent residence who has lived in the United States continuously during the 5 years before the month in which they apply.

An individual is automatically eligible for Part B if he or she is eligible for premium-free Part A. They are also eligible for Part B if they are not eligible for premium-free Part A but are age 65 or older and a resident of the United States or a citizen or an alien lawfully admitted for permanent residence. In this case, they must have lived in the United States continuously during the 5 years immediately before the month during which he or she enrolls in Part B.

Qualified to receive health insurance or government program benefits.

Individuals who are permitted to apply and maintain membership in a health insurance plan (i.e., spouse and children of the insured). Under some insurance policies, parents, other family members, and domestic partners may be insured as dependents.

Medications that are covered by a prescription drug plan. In a Medicare Part D plan, drugs that qualify are listed on the plan’s formulary.

Employed worker who qualifies for health insurance plan benefits as one who is insured.
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An employee who is eligible based on the requirements as indicated in the group contract.

Specific medical services and supplies for which the insurance plan or federal or state program will pay for covered persons under the terms of the plan.
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Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or “customary and reasonable” charges.

Individuals allowed insurance under a group policy such as individual employer groups, multiple employer groups, labor union groups, credit-debtor groups, and certain association groups.

Types of medical care expenses that an insurance plan covers.

Individuals in a group who qualify for a group insurance plan, or in a family who qualify for a family insurance plan.