Medicare Eligibility: Are You Ready to Enroll?
Key Takeaways
- Most people are eligible for Medicare when they turn 65 years old, but you may have to take action to enroll.
- Original Medicare (Parts A and B) is the starting point for coverage. Once you have Parts A and B, you can add a MedigapMedicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you’ll need to pay. and/or a Part D plan or switch to a Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan.
- You should be aware of the rules that determine when you can sign up for Medicare offerings and whether you could face a late enrollment penalty for missing your initial window.
Some people simply think of Medicare as their health insurance plan for retirement, but not everyone will retire when they turn 65. And, while most U.S. adults become eligible for healthcare coverage from Medicare when they turn 65 years old, some may qualify sooner.
To plan for your healthcare needs in the years ahead, you should know what to expect by the time of your initial Medicare enrollment window.
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Are You Eligible for Medicare?
Age 65 or olderTypically, you’re eligible for Medicare if:
- You are a U.S. citizen or a permanent resident.
- You or your spouse have paid Medicare taxes for at least 10 years through employment.
You may become eligible for Medicare before you turn 65 if:
- You receive Social Security disability or Railroad Retirement Board benefits for 24 consecutive months.
- You have a qualifying disability or condition such as permanent kidney failure or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease).
You’re generally eligible for Medicare benefits when you turn 65, but don’t assume your Medicare card will arrive in the mailbox along with your birthday cards. The Social Security Administration (SSA) oversees Original Medicare enrollment and automatically enrolls individuals who receive Social Security benefits or Railroad Retirement Board benefits at least four months before turning 65.
Your Medicare ID Card
You should receive your Medicare ID card and further instructions in the mail about three months before turning 65.
What If I’m Not Automatically Enrolled?
If not, it is up to you to apply for Medicare through the Social Security Administration online, on the phone, or in person.
When Can I Enroll in Medicare?
There are multiple opportunities to enroll in Medicare or change your plan. Think ahead to make sure you get the benefits and coverage you need.
Initial Enrollment Period
If you are new to Medicare, you have an Initial Enrollment Period (IEP). For most people, this seven-month period includes the three full months before and after the month you turn 65.
For example, if you turn 65 in June:
- Three months before you turn 65: March, April, May
- Your birth month: June
- Three months after you turn 65: July, August, September
Use GoHealth’s New to Medicare Enrollment Dates Checker to find your dates!
If you are eligible for premium-free Part A but miss your initial window, you may sign up at any time, and the benefits will be retroactive for six months (assuming it’s been at least six months since you became eligible).
Annual and Special Enrollment Periods Explained
If you don’t sign up during your IEP, you have three Medicare enrollment periods during the calendar year. It’s essential to understand how these enrollment periods work because they are not all the same.
- Open Enrollment Period (OEP) January 1 to March 31
- Annual Enrollment Period (AEP) October 15 to December 7
- Special Enrollment Period (SEP) An open period based on certain life events
Can I bundle multiple benefits into one plan?
IEP
Part A and Part B
Yes
Medicare Advantage
Yes, but must enroll in Part A and Part B first.
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
Yes
Yes
Medicare Advantage
Yes, but must enroll in Part A and Part B first.
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
Yes
AEP
Part A and Part B
Yes
Medicare Advantage
Yes
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
Yes
Yes
Medicare Advantage
Yes
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
Yes
OEP
Part A and Part B
Can switch from Medicare Advantage to Original Medicare; can add Part B, but a late penalty is applied to your premium.
Medicare Advantage
You can switch your MA plan.
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
You can add Part D if you switch from MA to OM.
Can switch from Medicare Advantage to Original Medicare; can add Part B, but a late penalty is applied to your premium.
Medicare Advantage
You can switch your MA plan.
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
You can add Part D if you switch from MA to OM.
SEP
Part A and Part B
Yes
Medicare Advantage
Yes
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
Yes
Yes
Medicare Advantage
Yes
Medicare Supplement
You can add Medicare Supplement coverage anytime.
Part D (Prescription)
Yes
Which Medicare Plans Can I Combine During Enrollment?
When you enroll in Medicare, all the possibilities for coverage can be confusing. Let’s take a look at some of the options that could get you the care and benefits you need.
Original Medicare (Part A and Part B)- Part A provides hospital coverage, and Part B provides medical coverage. You can add Medicare Supplement and Medicare Part D plans to Original Medicare.
- Also known as Medigap, these plans can be added to Original Medicare to fill in the gaps in your coverage, paying for out-of-pocket costs such as coinsurance and copayments.
- These policies can be added to Original Medicare to cover prescription drug costs.
A Medicare Advantage plan substitutes for Original Medicare coverage, most include Part D prescription drug coverage. Plans may offer additional benefits such as dental, vision, and hearing
Original Medicare (Parts A and B)
Part A is premium-free for anyone age 65 or older who paid Medicare taxes for at least 10 years (or had a spouse who did). Part B requires a monthly premium.
Medicare Supplement
Medicare Supplement plans — also known as Medigap — are offered by private insurance companies but regulated by Medicare. They fill in the gaps of Original Medicare by covering out-of-pocket costs.
Medicare Part D
Part D prescription drug coverage can be purchased as a standalone policy from a private insurance company.
If you go more than 63 days without drug coverage that Medicare considers creditable (meaning that the coverage is equivalent to what you’d get from a Part D plan) can result in a late enrollment penalty when you do sign up. This penalty will be a permanent increase to your premium that’s calculated by taking 1% of the national average premium for each month you went without Part D.
Medicare Advantage (Part C)
Private insurance companies administer Medicare Advantage, but Medicare regulates it. Part C plans substitute for Part A and B, and they may provide Part D prescription drug coverage as well as additional benefits like dental and vision. Most people on Medicare Advantage plans still pay their Part B premium, but no additional monthly premium. In certain cases, a Medicare Advantage plan can even reduce that premium for eligible members.
I know when I can enroll in various Medicare offerings, but how exactly do I enroll?
Your initial enrollment in Original Medicare goes through the Social Security Administration. From there, you join plans directly through private insurance carriers or review your options in a marketplace.
A licensed insurance agent can help determine the best choice for your personal situation when it comes to enrolling in a Medicare Advantage plan or adding Medigap or Part D coverage to Original Medicare.
A licensed insurance agent can help determine the best choice for your personal situation when it comes to enrolling in a Medicare Advantage plan or adding Medigap or Part D coverage to Original Medicare.
Should I consider enrolling in Medicare at age 65 even if I'm covered by an employee healthcare plan?
If your employer has 20 or more employees, it’s up to you. If your Part A is premium-free, signing up for it at 65 provides an extra level of coverage. Your employer coverage can be primary insurance with Part A as secondary. Part B is not premium-free, and it will be secondary to your employer coverage. This option could be expensive, so you will likely prefer to wait and join Part B when your employer-paid coverage ends.
If your employer has fewer than 20 employees, they can require you to sign up for Medicare at age 65. In that case, Medicare would be your primary insurance, so you should enroll in both Part A and Part B.
If your employer has fewer than 20 employees, they can require you to sign up for Medicare at age 65. In that case, Medicare would be your primary insurance, so you should enroll in both Part A and Part B.
What are the qualifying disabilities that could make me eligible for Medicare before the age of 65?
Regardless of your age, you will be automatically enrolled in Medicare when you begin receiving Social Security benefits for certain disabilities like Lou Gehrig’s Disease (also known as Amyotrophic Lateral Sclerosis or ALS), or if you have End-Stage Renal Disease.
Ready for a new Medicare Advantage plan?
Sources
- Ready to sign up for Part A & Part B. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.