Who is eligible for Medicare in North Carolina?

Who qualifies at 65?

You can enroll in Medicare at 65 if you're a U.S. citizen or national, or a lawful permanent resident who has lived in the U.S. for at least 5 continuous years. Where you live in North Carolina doesn't matter; Medicare eligibility is federal. Your 7-month Initial Enrollment Period starts 3 months before the month you turn 65. See Medicare enrollment periods and turning 65 in North Carolina.

Whether you pay a premium for Part A depends on how long you or your spouse paid Medicare taxes:

A current, former (married 10 years or more) or deceased spouse's work record can give you premium-free Part A even if you never worked enough yourself. Part B has no work requirement; almost everyone pays the Part B premium.

The 2025 citizenship and immigration rule

Section 71201 of Public Law 119-21, signed July 4, 2025, narrowed who can get Medicare. Now only these groups can be entitled to or enrolled in Medicare:

• U.S. citizens and nationals;
• lawful permanent residents (green card holders);
• Cuban and Haitian entrants; and
• people lawfully living in the U.S. under a Compact of Free Association.

Before the law, other lawfully present immigrants, such as refugees, asylees and some parolees, could qualify. People in those groups who already had Medicare on July 4, 2025 lose it 18 months later, on January 4, 2027. Social Security is reviewing records and sending notices; if you get one, respond with any proof that you're in an eligible group, such as a green card. Lawful permanent residents still need 5 years of continuous U.S. residence to buy Part A or enroll in Part B on age alone. CMS put these rules into regulation in its final rule of November 9, 2026.

North Carolina public employees

Unlike some states, North Carolina's public workforce mostly pays into Social Security: in 2023, about 93% of the state's state and local government employees had Social Security coverage on their jobs, according to the Congressional Research Service. So most teachers, state employees and local government workers earn premium-free Part A the same way private-sector workers do. For the smaller group without Social Security coverage, public employees hired after March 31, 1986 still pay the Medicare tax, which earns quarters toward premium-free Part A.

Retiree health coverage has its own requirements. The State Health Plan says Parts A and B must be in effect to enroll in its group Medicare Advantage options; without them, retirees are placed on the 70/30 Plan. See State Health Plan retirees and Medicare.

Medicare before 65 because of a disability

If you get Social Security Disability Insurance (SSDI) or a Railroad Retirement disability annuity, Medicare starts automatically after 24 months of benefits. Social Security mails your card about 3 months before. You can then keep Part B or turn it down. If your disability benefits stop because you go back to work, your Medicare can usually continue for years under the work incentive rules; ask Social Security how long. See Can I get Medicare before 65 in North Carolina?

ALS (Lou Gehrig's disease)

People with ALS get Medicare Part A and Part B the month their Social Security disability benefits begin, with no 24-month wait. You apply for disability benefits through Social Security, and Medicare follows.

Kidney failure (end-stage renal disease)

You can get Medicare at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and you (or your spouse or a parent) have paid Medicare taxes long enough or get Social Security or Railroad Retirement benefits. You must apply through Social Security; it isn't automatic.

• In-center dialysis: Medicare usually starts the first day of the fourth month of dialysis.
• Home dialysis training: coverage can start the first month of dialysis.
• Kidney transplant: coverage can start the month you're admitted for the transplant, or up to 2 months earlier if the transplant is delayed.

People with ESRD can join Medicare Advantage plans. Medicare covers immunosuppressive drugs after a transplant; if your Medicare would end 36 months after a transplant, a separate immunosuppressive-drug benefit may continue drug coverage. See Medicare.gov's ESRD page in the sources.

What if I also have other coverage?

• Job-based coverage from current work may let you delay Part B without a penalty. See working past 65.
• NC Medicaid: if you qualify for both, you're dual eligible, and you'll get your Medicaid through NC Medicaid Direct. NC Medicaid's expansion covers adults 19 to 64 who don't have Medicare. See NC Medicaid and Medicare.
• TRICARE or VA care: TRICARE For Life requires Part A and Part B. See military, veterans and TRICARE in North Carolina.
• Indian Health Service or tribal care, such as at Cherokee Indian Hospital: you can have Medicare too, and IHS, tribal and urban Indian care counts as creditable drug coverage. See American Indians and Medicare in North Carolina.

How do I check my eligibility?

1. Look at your work record. Create a my Social Security account at ssa.gov/myaccount to see your earnings record and Medicare-covered quarters.
2. Ask Social Security. Call 1-800-772-1213 (TTY 1-800-325-0778) or visit a Social Security office. Ask about a spouse's record if your own falls short.
3. Check your retiree coverage rules. If you'll have State Health Plan or other retiree coverage, ask what it requires before your Medicare starts.
4. Plan your coverage. When you're ready, you can request a call from a licensed insurance agent to review plans from the companies they work with.

Sources

• Social Security — Medicare eligibility
• Social Security — Sign up for Medicare
• Social Security — Mandatory Medicare coverage for state and local government employees (hired after March 31, 1986)
• Federal Register — CY 2027 Physician Fee Schedule final rule, section III.E, Limiting Medicare Coverage of Certain Individuals (November 9, 2026)
• Medicare.gov — End-stage renal disease (ESRD)
• Medicare.gov — When does Medicare coverage start?
• CMS — 2026 Medicare Parts A and B premiums and deductibles
• eCFR — 42 CFR Part 406, hospital insurance eligibility and entitlement
• Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961)
• North Carolina General Assembly — G.S. 58-54-45, Medigap by reason of disability
• State Health Plan — Retiree presentation (Parts A and B must be in effect)
• NC Medicaid — North Carolina expands Medicaid
• CMS — Your Guide to Medicare Drug Coverage (Indian health care as creditable coverage)

Frequently asked questions

Medicare in your North Carolina county

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