What to Know About Eligibility and Enrollment Before You Enroll
Key Takeaways
- Medicare is for all qualified Americans aged 65 and older; some under 65 may also be eligible under certain circumstances.
- The enrollment period to join Medicare the year you turn 65 is called the Initial Enrollment Period (IEP)The Initial Enrollment Period (IEP) is the seven-month period around your 65th birthday when most people are eligible for the first time to enroll in Medicare. .
- There are several different Medicare enrollment periods throughout a calendar year, and each allows specific options, which allow you to add, drop, change, or enroll.
Am I Eligible for Medicare?
Medicare eligibility begins at age 65 for most Americans. Some circumstances make people eligible for Medicare before age 65. Here’s an eligibility overview:
Age 65 or olderYou may be Medicare-eligible if:
- You are a U.S. citizen.
- You’re a legal permanent resident but not an American citizen.
You may be Medicare-eligible if:
- You’ve received Social Security disability or Railroad Retirement Board benefits for 24 consecutive months.
- You’re living with a qualifying disability or special condition.
- You have end-stage renal disease (ESRD).
Am I Automatically Enrolled at 65?
Simply put, most people are not automatically enrolled in Medicare at 65. Automatic enrollment is a common Medicare Myth. Some people who receive Social Security benefits before turning 65 may be automatically enrolled in Part A and Part B, but everyone must enroll in Part B at 65.
How Do I Know if I Am Signed Up for Medicare?
If you applied for Medicare online, you can check the status of your application through your Medicare or Social Security account. Medicare provides a tool on its website to check your enrollment after you provide information, e.g., your name, date of birth, or Medicare number.
You can also check the status of your application by visiting or calling a Social Security office.
Medicare will send new members a Welcome Kit that contains useful information and you’ll receive your Medicare Red, White and Blue ID card in the mail.
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When Can I Enroll in Medicare?
If you’re new to Medicare, your first chance to enroll is during your Initial Enrollment Period (IEP). If you miss your IEP, you can enroll during the annual General Enrollment Period (GEP) with a late enrollment penalty. Before you do, check to see if you qualify for a Special Enrollment Period (SEP). If so, you can change plans during the SEP without penalty. Enrollment can be tricky, let’s take a closer look at the different enrollment periods.
Initial Enrollment Period (IEP)
If you’re turning 65 and new to Medicare, you have a seven-month window to enroll. This is known as your Initial Enrollment Period (IEP). For anyone not born on the first of the month, it begins three months before you turn 65, and remains open for three months after your birth month.
For example, if you turn 65 between June 2 and 30,
- IEP begins: start of March
- Birth month: June
- IEP closes: end of September
For example, if you turn 65 on June 1,
- IEP begins: start of Feb
- Birth month: June
- IEP closes: end of August
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Special Enrollment Period
If you’ve missed your first Medicare enrollment window, see if you’re eligible for a Special Enrollment Period. These are times when you can enroll without penalty outside of your IEP. For example, if you are working when you turn 65, you may choose to stay on your group plan. When that coverage ends, you may have an SEP to enroll in Medicare Part B.
General Enrollment Period
If you missed your IEP and don’t qualify for an SEP, you’ll need to wait for the next General Enrollment Period (GEP). This is held each year from January 1 to March 31. You can enroll in Medicare Parts A and B at this time, but you’ll pay enrollment penalties. These plans typically begin July 1.
Why Do I Have to Wait Two Years for Medicare?
People under the age of 65 who receive Social Security Disability Income (SSDI) may have a two-year waiting period before they can get Medicare benefits. A two-year waiting period does not apply to anyone ages 65 or older.
However, Medicare may waive this waiting period under some conditions. Anyone with ESRD or with ALS (Amyotrophic Lateral Sclerosis) is eligible to receive benefits sooner than the typical two years.
- ESRD: Medicare begins on the first day of the fourth month of the person’s dialysis treatment.
- ALS: If you have ALS, Medicare allows you to enroll in the first month the SSA approves you for SSDI benefits.
How Do Medicare Plans Work Together?
Medicare Advantage (Part C) replaces Original Medicare (Part A and B), but offers the same Part A and B benefits or coverages as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles your benefits with additional ones like dental, hearing, vision and prescription drug coverage.
When you have Medicare Part C, your Part C benefits ID card replaces your Medicare “Red, White & Blue” card at every visit.
Here’s an overview of the parts of Medicare.
Medicare Coverage Options
- Original Medicare
- Medigap
- Part D
- Medicare Advantage (Part C)
Medical coverage
- Original Medicare
- Medigap
- Part D
- Medicare Advantage (Part C)
Hospital coverage
- Original Medicare
- Medigap
- Part D
- Medicare Advantage (Part C)
Offers Prescription Drugs
- Original Medicare
- Medigap
- Part D
- Medicare Advantage (Part C)
Has Out-of-pocket Costs
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Original Medicare (Parts A and B)
Original Medicare is a fee-for-service health insurance program with two parts: Part A and Part B. Original Medicare Part B has a monthly premium to maintain coverage. For services, Original Medicare has cost-sharing that requires you to pay a deductible and Medicare pays a determined percent of the costs, and you pay coinsurance.
Medicare Supplement (Medigap)
Medicare Supplement Insurance plans help cover gaps in your Part A and B coverage and out-of-pocket costs. Private insurance carriers administer Medigap plans but Medicare regulates the policies.
Medicare Part D
Part D is an individual prescription drug plan that is included with most Medicare Advantage plans or can be added to Original Medicare. Private insurance carriers administer Part D plans that utilize a carrier’s pharmacy network.
If you need it, don’t go too long without it. After 63 days without creditable prescription coverageCreditable coverage is prescription drug coverage that is considered to be as good as or better than the Medicare prescription drug benefit (Part D) in monetary value. , you may incur a late enrollment penalty. For Part D, this typically means 1% of the national average premium for each month you went without Part D. So If you delay enrollment for six months, your penalty will increase your monthly premium payment by 1% of the average premium for each month and continue to increase until you have creditable coverage.
Medicare Advantage (Part C)
Medicare Advantage is sold and administered by private health insurance companies, but Medicare regulates it. Also called Part C, Medicare Advantage Plans bundle Parts A and B, Medigap, and often Part D. Some policies also offer dental and vision options, resulting in a comprehensive option.
How Do I Enroll?
- Original Medicare Parts A and B: You’ll need to enroll with the Social Security Administration. You can do this online, over the phone (SSA’s Medicare phone number: 1-800-772-1213), or in-person at a nearby office.
- Medicare Advantage, Part D and Medigap or Part D Prescriptions Drug Plans: Instead of shopping plan-by-plan, many enrollees choose to contact a licensed agent, like those at GoHealth, for impartial guidance and advice on their policy options. They’ll go through what’s available and make sure your needs are taken care of.
Should I still enroll if I have group coverage through my or my spouse’s job?
This depends on a few factors, including how many employees your company has. For example:
- If your employer has 20 or more employees: You have the option of staying in your group plan or enrolling in Medicare. If you worked long enough to get Part A, keeping employer coverage at 65 may be more cost-effective. In this case, your employer coverage will be your primary insurance, with Part A acting as a secondary policy. You will be granted a Special Enrollment Period when you leave group coverage with an enrollment window of three months following your loss of group coverage.
- If your employer has fewer than 20 employees: Your employer may require you to enroll in Medicare when you turn 65 to serve as your primary insurance.
I have end-stage renal disease (ESRD) — is it true I can’t enroll in Medicare Advantage?
Not anymore. As of 2021, patients living with ESRD are allowed to enroll in Medicare Advantage. Previously, ESRD patients were restricted to Original Medicare. This is a sizable shift for ESRD patients because they can now take advantage of the out-of-pocket maximums that come with Medicare Advantage plans.
Who gets automatically enrolled in Medicare when they turn 65?
If you were receiving Social Security or Railroad Retirement Benefits before being eligible for Medicare, you’ll be automatically enrolled. If so, you’ll have the option of declining or changing your coverage to a Medicare Advantage plan at that time.
- Medicare. SSA.gov.
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.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.