42 CFR § 406.5 - Basis of eligibility and entitlement.
---
identifier: "/us/cfr/t42/s406.5"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 406.5 - Basis of eligibility and entitlement."
title_number: 42
title_name: "Public Health"
section_number: "406.5"
section_name: "Basis of eligibility and entitlement."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "406"
part_name: "HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395i-2, 1395i-2a, 1395p, 1395q and 1395hh."
regulatory_source: "48 FR 12536, Mar. 25, 1983, unless otherwise noted. Redesignated at 51 FR 41338, Nov. 14, 1986."
cfr_part: "406"
---
# 406.5 Basis of eligibility and entitlement.
(a) *Hospital insurance without premiums.* Hospital insurance is available to most individuals without payment of a premium if they:
(1) Are age 65 or over, or
(2) Have received social security or railroad retirement disability benefits for 25 months; or
(3) Have end-stage renal disease. Subpart B of this part explains the requirements such individuals must meet to obtain hospital insurance without premiums.
(b) *Premium hospital insurance.* Many individuals who are age 65 or over, but do not meet the requirements set forth in subpart B of this part, and certain individuals under age 65, may obtain the benefits by paying a premium. Section 406.20 of this part explains the requirements individuals must meet to obtain premium hospital insurance.
[48 FR 12536, Mar. 25, 1983, as amended at 50 FR 33033, Aug. 16, 1985; 56 FR 38078, Aug. 12, 1991]