Medicare Eligibility & Enrollment
Learn when your Medicare eligibility begins, when you should enroll, what plans you are eligible for, and more.
Medicare eligibility and enrollment are based on the number of years you and/or your spouse worked and paid into Social Security, your citizenship status, and possibly, your permanent disabilities.
Only those already receiving benefits from the Social Security Administration will receive automatic eligibility enrollment in Medicare when they turn 65. Therefore, most seniors need to enroll themselves. This guide will explain when your eligibility starts, as well as when you can enroll in Original Medicare—Medicare Part A and Medicare Part B—as well as Medicare Advantage plans, Medicare Supplement plans, and Part D plans for prescription drug coverage.
Eligibility at 65 and Older
If you aren’t permanently disabled prior to turning 65, you will become eligible for Medicare benefits on your 65th birthday. If you also qualify for Medicaid services, you can and should still enroll in Medicare once your eligibility opens. Medicaid will help reduce or eliminate your out-of-pocket expenses.
If you want your Medicare coverage to begin as soon as you turn 65, enroll during the three months prior to your birthday month. Your Medicare health plan will begin the first day of your birthday month.
There are two requirements that you must meet to qualify for Medicare services:
- You’re a United States citizen or a legal permanent resident who has lived in the country for a minimum of five years. Providing a valid social security number or proof of residency satisfies this requirement.
- You or your spouse have worked and paid taxes for enough years to earn your place in the Medicare program. That works out to roughly ten years. If your work history qualifies you to receive Social Security or railroad retirement benefits, you should also qualify for Original Medicare.
Eligibility Under Age 65
You can qualify for Medicare before turning 65 if you have received disability benefits from the SSA or Railroad Retirement Board (RRB). You must receive Social Security disability benefits for at least 24 months before enrolling in Medicare, but those months don’t need to be consecutive. There are other requirements for beneficiaries qualifying based on RRB disability pensions.
If you have paid Medicare taxes over the years, you may also qualify to receive early enrollment in Medicare if you’re diagnosed with one of the following medical conditions:
- End-stage renal disease (ESRD)
- Amyotrophic lateral sclerosis (Lou Gehrig’s Disease)
To early Medicare enrollment due to ESRD, you must be in permanent kidney failure with a need for a kidney transplant or dialysis. Medicare eligibility is immediate for those diagnosed with Lou Gehrig’s Disease.
You can enroll in a supplemental plan even if you have an active ESRD diagnosis. Eligibility is the same whether you enroll in Medicare at age 65 or earlier due to disability.
Medigap plans work as secondary payment sources. Original Medicare covers your medical bills first, and your supplement insurance pays any remaining out-of-pocket expenses up to plan limits. Think of it as trading ongoing medical bills for one monthly premium.
You will still have to pay the Part B deductible out of pocket along with a Medicare Part D prescription drug plan. All Medicare Supplement plans are standardized, so insurance companies cannot add benefits. No Medigap policies cover dental, vision, or hearing services.
You can act on your Medicare eligibility even if you want to continue working and don’t plan on receiving retirement benefits right away. If you are actively employed with adequate health insurance when you turn 65, you can also choose to delay Medicare enrollment. However, keep in mind that doing so may cause a delay when waiting for your first month of Medicare benefits.
The rest of this guide will focus on when and how to enroll in Medicare Part A hospital insurance and Medicare Part B primary care insurance. If you have a unique situation, you may want to talk to a professional to help determine the best time for Medicare enrollment.
Initial Enrollment Period for Medicare
Every beneficiary has an initial enrollment period that lasts seven full months. The first month is your birthday month, the year that you turn 65. The period starts three months prior and ends three months after.
If you enroll during the first three months, your coverage will begin on the first day of your birthday month. If you enroll during your birthday month or the final three months, coverage will begin the first day of the month following enrollment.
If you miss this period, you may need to wait for an open enrollment period to sign up. That may delay the start date for your Medicare coverage. Timing is important to ensure you don’t have a short-term lapse in health care coverage.
How to Enroll in Medicare
How do you apply for Original Medicare when you’re ready? The fastest option is to apply online. If you have all the needed information, it shouldn’t take long to fill out and submit the online form.
You will need basic personal information like birth date, social security number, and place of birth. The form also asks questions about your children, current and previous marriages, employers and income for the past two years, and military service. Before starting the application, gather social security numbers for all current and past spouses and children.
You may also need to submit some documentation to support your Medicare application. For instance, you may need to prove your citizenship or provide tax information and earnings records.
Where you can enroll in Medicare:
Use the Medicare documentation checklist provided by the SSA. It will make sure you have the information you need prior to starting the enrollment process.
Open Enrollment Periods for Medicare
Medicare has an open enrollment period every year from October 15 to December 7. You could use this period to enroll in Medicare if you didn’t do so during your initial enrollment period. Once enrolled, this period is your yearly opportunity to make changes to your plan.
Special Enrollment Periods for Medicare
If you didn’t enroll in Medicare during your initial enrollment period and don’t want to wait until the next open enrollment, you may qualify for a special enrollment period. These periods allow you to enroll in Medicare or make changes to your plan immediately due to special circumstances.
The most common reason for a special enrollment period is justified enrollment delay due to gainful employment. For example, beneficiaries may delay enrollment if they have adequate health care coverage through an employer when they turn 65. Eventually, they will stop working and lose that coverage. That’s when a special enrollment period can allow them to sign up for Medicare Parts A and B right away.
Late Enrollment Penalties for Medicare
A late enrollment penalty increases your Part B premium if you don’t enroll in Original Medicare during your initial enrollment period or a special enrollment period. The penalty is 10% of the standard Part B premium for the first year you failed to enroll in Part B. After that, it goes up every year that you go without Part B coverage.
You will pay the late enrollment penalty yearly as long as you’re enrolled in Medicare Part B.
Medicare Part A penalties differ because most beneficiaries qualify for premium-free Part A. That means there is no monthly premium to increase, so there technically is no late enrollment penalty. However, beneficiaries who don’t qualify for premium-free Part A and are at least two years late enrolling may face higher premiums as a penalty.
Suppose you delay enrollment in Original Medicare because you or your spouse is still working when your Medicare eligibility opens. In that case, you shouldn’t face any late enrollment penalties once you lose your employer’s health care coverage. Instead, you will have a short special enrollment period to sign up for Medicare benefits without penalty.