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Medicare

Who Is Eligible for Medicare?

You must meet one of the following requirements to be eligible for Medicare:

  • You are age 65 or older and a U.S. citizen or a permanent U.S. resident who has lived in the U.S. continuously for five years prior to applying.

  • You are younger than 65 with a qualifying disability.

  • You are any age with a diagnosis of end-stage renal disease or ALS.

  • You are age 65 or older and a U.S. citizen or a permanent U.S. resident who has lived in the U.S. continuously for five years prior to applying.

  • You are younger than 65 with a qualifying disability.

  • You are any age with a diagnosis of end-stage renal disease or ALS.

If you... Then...

Plan to retire at age 65 or are not working, and don't already receive social security

You can enroll in Medicare benefits

Already receive Social Security retirement, disability, or Railroad Retirement Board benefits

You'll be enrolled automatically in Medicare Parts A and B

Are currently covered by an employer-provided group health plan and plan to continue working past age 65

You can still enroll in Medicare – Talk to your human resources department before you enroll to ensure you’re making the best decision for you

Have coverage through your spouse’s employer and are over 65

You can enroll in Medicare benefits and maintain the coverage through your spouse’s employer

When Can You Enroll in Medicare?

There are multiple opportunities to enroll in Medicare. There are certain rules around applying, when your coverage will begin and what types of Medicare plans you can sign up for, so make sure you understand your options.

Initial Enrollment Period (IEP)

Your first opportunity to sign up for Medicare is called the Initial Enrollment Period (IEP). Your IEP starts the three months before the month you turn 65, the month you turn 65 and lasts for the three months after you turn 65. During this 7-month period surrounding your 65th birthday, you can enroll in Original Medicare, Medicare Advantage, Prescription Drug, or Medicare Supplement plan.

If you don’t enroll in Medicare Part B or Part D when you’re first eligible to enroll, then decide later to enroll, you may have to pay a Part B and/or Part D Late Enrollment Penalty (LEP).

Annual Enrollment Period (AEP)

Every year, from October 15 through December 7, you can switch, drop or join the Medicare Advantage, Medicare Supplement or Medicare Prescription Drug Plan of your choosing. This period is referred to as the Annual Enrollment Period (AEP). During AEP, you can also enroll in Original Medicare. Your new coverage will begin January 1 of the following year.

Open Enrollment Period (OEP)

If you are enrolled in a Medicare Advantage (MA) plan, you are allowed to make a one-time change to another MA plan or to Original Medicare during the Open Enrollment Period. The OEP runs from January 1 through March 31. If you enroll in Original Medicare, you may also purchase a Medicare Supplement and/or a Prescription Drug Plan.

This is not a guaranteed-issue enrollment period for Medicare Supplement plans.

Special Enrollment Period (SEP)

After certain events, such as a recent move outside of your plan’s service area, or losing your employer or union coverage, you may be eligible for a Special Enrollment Period (SEP).

You may also qualify for an SEP under these circumstances:

  • If you have both Medicare and Medicaid.
  • If you lose group health coverage from your spouse's employer.
  • If you move away from your current plan's service area.
  • If your insurance company cancels your health plan.
  • If you get Extra Help paying for prescription drugs.

What Do You Do About Medicare if You’re Working Past 65?

A lot of people reach the age of Medicare eligibility and continue to work. Many have health insurance through their employers. Depending on your situation as you turn 65, you may or may not have to enroll in Medicare. You may want to consider enrolling in Medicare Part A even if you are still working.

For most people, Part A does not charge a Premium. And if you are required to pay a premium for Part A but don’t sign up during IEP, your monthly premium may increase by 10%. As for Part B, which does come with a monthly premium, your options to sign up will be determined by the size of your employer.

Check with your human resources department to see if signing up for Original Medicare Part A and/or B would be a good idea for you. They should also be able to tell you if your employer requires you to enroll in Original Medicare.

If you don't enroll in a Medicare plan, your employer's plan may not cover services that Medicare covers.

Talk to your employer for assistance with making the best decision for your coverage needs.

How Do You Enroll in Medicare?

Enrolling in Medicare Parts A & B

If you are already getting Social Security Retirement or disability (or Railroad Retirement benefits) when you turn 65:

  • You will be automatically enrolled in Medicare Parts A & B (Original Medicare).
  • You should get a “Welcome to Medicare” packet and Medicare card in the mail from Social Security Administration about 3 months before your 65th birthday.

If you are not yet collecting retirement benefits:

  • You need to contact Social Security to apply for Medicare.
  • It is best to apply 3 months before your 65th birthday. If you do not apply, you will not be enrolled in Medicare.

Three Ways to Apply for Medicare Parts A and B

Online

Visit Social Security's Website

By Phone

Call the Social Security Administration national customer hotline at
1-800-722-1213

In Person

Visit Your Local Social Security Office

What You May Need

  • An original or certified copy of your birth certificate

  • Proof of United States citizenship or legal residency (if you weren’t born in the U.S.)

  • Any W-2 forms you have from the last two years

  • Your Social Security card or number

  • An original or certified copy of your birth certificate

  • Proof of United States citizenship or legal residency (if you weren’t born in the U.S.)

  • Any W-2 forms you have from the last two years

  • Your Social Security card or number

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Last Updated: 10.01.2021
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