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If you’re new to Medicare, you may be wondering how eligibility and enrollment works. To qualify for Medicare, you must be 65 or older and either a United States citizen or a legal permanent resident of at least five continuous years. You can also qualify for Medicare if you’re under 65 through disability or by having certain conditions.
How and when you enroll in Medicare may depend on your specific situation and how you qualify for Medicare. Some people are automatically enrolled in Medicare, while others need to sign up for it manually. Read on to learn how Medicare enrollment works and what you need to do to sign up for coverage.
Many individuals are automatically enrolled in Original Medicare, Part A and Part B. If you’re already receiving retirement benefits from the Social Security Administration or Railroad Retirement Board before you turn 65, then you’ll be automatically enrolled in Medicare Part A and Part B on the first day of the month that you turn 65. If your 65th birthday occurs on the first day of the month, you’ll be automatically enrolled in Medicare Part A and Part B on the first day of the prior month. Your Medicare card will be mailed to you three months before your 65th birthday.
Another situation where you’ll be automatically enrolled in Medicare Part A and Part B is if you qualify for Medicare because of disability or because you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). Disabled individuals are eligible for Medicare after two years of disability benefits and will be automatically enrolled in Medicare in the 25th month of receiving disability benefits from Social Security or the Railroad Retirement Board. If you qualify for Medicare because of Lou Gehrig’s disease, you’ll be a utomatically enrolled in the first month of disability benefits.
If the above situations don’t apply to you, you’ll need to sign up for Medicare manually. You can enroll through the Social Security Administration (SSA) during your Initial Enrollment Period, which is the seven-month period that starts three months before you turn 65, includes your birthday month, and ends three months later.
You can also qualify for Medicare at any time if you have end-stage renal disease and any of the following apply to you:
You may be eligible for Medicare benefits if you have end-stage renal disease and have worked long enough to qualify for Social Security or Railroad Retirement Board benefits or if you’re already receiving retirement benefits. You’ll usually need to work at least 10 years (40 quarters) to qualify for retirement benefits. You can also qualify for Medicare through your spouse’s employment history or if you are the dependent child of someone who has enough work quarters to qualify.
For those who need to apply manually for Medicare, you can do so through Social Security in the following ways:
Did you work for a railroad? If so, you can apply for Medicare by contacting the Railroad Retirement Board at 1-877-772-8772 (TTY users, dial 1-312-751-4701), Monday through Friday, from 9AM to 3:30PM.
Once you have enrolled and are approved for Original Medicare, your coverage begins. Your coverage “effective date” (or start date) depends on the specific month of your Initial Enrollment Period that you enrolled in Medicare Part A and/or B.
If you sign up during:Then your coverage will begin:
|The three months before your eligibility month||The first day of your eligibility month|
|Your eligibility month (the month you turn 65)||One month after you turn 65|
|One month after you turn 65||Two months after the month you enroll|
|Two months after you turn 65||Three months after the month you enroll|
|Three months after you turn 65||Three months after the month you enroll|
Once your Initial Enrollment Period has passed, your next chance to sign up for Medicare Part A and Part B is the General Enrollment Period that occurs every year from January 1 to March 31. If you use this period to enroll, your Medicare coverage won’t start until July 1. Keep in mind that enrolling in Medicare coverage outside of your Initial Enrollment Period may result in a late-enrollment penalty for Medicare Part A and/or Part B
You may a late-enrollment penalty for Medicare Part A if you don’t get it when you’re first eligible and don’t have enough work history to qualify for premium-free Part A (10 years, or 40 quarters). If you need to pay a premium for Medicare Part A and you wait to sign up for it, you may owe a late-enrollment penalty when you do enroll in Part A later on.
Similarly, if you don’t sign up for Medicare Part B when you’re first eligible, you may have to pay a late-enrollment penalty if you enroll later on. This penalty comes in the form of a higher premium, which you may have to pay for as long as you’re enrolled in Medicare Part B.
You may not have to pay a late-enrollment penalty for Medicare Part A and/or Part B if you delayed enrollment because you were still working and had group coverage through your work (or through your spouse’s employer). You’ll get an eight-month Special Enrollment Period to sign up for Medicare once your employer-sponsored coverage ends or you stop working (whichever happens first).
One alternative to Original Medicare is Medicare Part C, which is available through Medicare Advantage plans that must provide at least the same level of coverage as Medicare Part A and Part B. Medicare Advantage plans are available through private insurance companies that contract with Medicare and may also cover benefits beyond Original Medicare, such as routine vision or dental, hearing, health wellness programs, or prescription drugs.
Eligibility and enrollment works differently when it comes to Medicare Part C. You’re eligible for Medicare Part C if you:
You’re first eligible to enroll in a Medicare Advantage plan during your Initial Coverage Election Period. For most people, this period takes place at the same time as their Initial Enrollment Period for Part B, starting three months before they’re eligible for Medicare benefits, including the month of eligibility, and ending three months later. If you delay Medicare Part B enrollment because you’re still working and have employer-sponsored coverage, your Initial Coverage Election Period will start three months before you’re enrolled in Medicare and end the last day of the month before you have both Part A and Part B. The effective date of your Medicare Advantage plan coverage will vary, depending on when you enroll.
Medicare Part D is prescription drug coverage, available through private insurance companies that are approved by Medicare. You can get this coverage in two ways:
Like Medicare Advantage plans, Medicare Part D enrollment also works differently. You’re usually first eligible for Medicare Part D when:
You can enroll in Medicare Part D coverage once you meet both of the above requirements. Your Initial Enrollment Period for Part D is when you’re first eligible to sign up for prescription drug benefits, and this period usually coincides with when you’re first eligible for Medicare coverage. For most people, their Initial Enrollment Period for Part D takes place at the same time as their seven-month Initial Enrollment Period for Part B, starting three months before they turn 65, including the month they turn 65, and ending three months later. For those who qualify because of disability, they’ll be first eligible to enroll in Medicare Part D three months before the 25th month of Social Security or Railroad Retirement Board disability benefits, including the 25th month, and ending three months later.
Even if you don’t currently take prescription medications, you may want to consider signing up for Medicare Part D. Keep in mind that if you don’t enroll in Medicare Part D when you’re first eligible, you could face a late-enrollment penalty if you don’t have creditable prescription drug coverage, or insurance that’s expected to pay, on average, as much as the Medicare Part D benefit. If you don’t have Medicare Part D and go without creditable prescription drug coverage for 63 consecutive days or more, you may have to pay a late-enrollment penalty if you enroll in Medicare prescription drug coverage later on.
Keep in mind that enrollment for Medicare Advantage plans and Medicare Prescription Drug Plans works differently from Original Medicare. Instead of enrolling through Social Security or the Railroad Retirement Board, you can find Medicare plans by contacting the Medicare plan directly or by calling Medicare at 1-800-633-4227 (TTY users, dial 1-877-486-2048), 24 hours a day, seven days a week.
Another option is to find Medicare plan options through a licensed insurance broker like eHealth. You can use the plan finder tool on this page to immediately view plan options in your location; simply enter your zip code into the census on this page to get started. If you need more personalized assistance, you can also contact eHealth to discuss your Medicare questions with a licensed insurance agent.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.