Medicare Eligibility: Are You Ready to Enroll?
![Medicare Writer Bryan Strickland Medicare Writer Bryan Strickland](https://www.gohealth.com/wp-content/uploads/2020/12/medicare-content-writer-bryan-strickland-150x150.jpg)
Written by: Bryan Strickland
![Medicare Licensed Insurance Agent Selah Lee Medicare Licensed Insurance Agent Selah Lee](https://www.gohealth.com/wp-content/uploads/2020/10/medicare-licensed-insurance-agent-selah-lee-150x150.jpg)
Reviewed by: Selah Lee, Licensed Insurance Agent
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 Medigap and/or a Part D plan or switch to a Medicare Advantage 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.
Find a local Medicare plan that fits your needs.
Find Plans TodayAre You Eligible for Medicare?
Age 65 or older
Typically, 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.
Under 65
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
However, if you were born on the first of the month, then you can enroll up to four months before your birth month and up to two full months afterward.
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
Find the Medicare Plan that works for you.
Find My Ideal PlanWhich 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, Medigap and Part D vs. Medicare Advantage
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.
Medicare Supplement
- 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.
Medicare Part D
- These policies can be added to Original Medicare to cover prescription drug costs.
Medicare Advantage
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.