Eligibility & Enrollment

Medicare is available to U.S. citizens & legal residents who have lived in the U.S. for at least 5 years in a row. It's important to note that Medicare is individual insurance therefore it does not cover spouses or dependents.

You may become eligible to receive Medicare based on any of the following criteria:

• You are age 65 or older
• You are younger than 65 with a qualifying disability and have received Social Security benefits for 24 months.
• Any age with a diagnosis of End-Stage Renal Disease or ALS

Around your 65th birthday you'll have a 7 month window in which you can sign up for Medicare. This is called your Initial Enrollment Period (IEP). Your IEP includes your birthday month, 3 months before and 3 months after.

Learn More About Enrolling In Medicare For The 1st Time At Age 65 >

If you plan to keep working or have employer coverage through a spouse, you have some options to consider when signing up for Medicare. Depending on your individual situation, you may or may not be want to delay your Medicare enrollment. Additionally, your Initial Enrollment Period (IEP) happens when you turn 65 whether your still going to work or not. Be sure to know your IEP dates and plan ahead.

Understand Your Options For Medicare When Working Past 65 >

You may be eligible for Medicare before age 65 if you have a qualifying disability. Eligibility usually starts after you've received disability benefits for 24 months. You will be automatically enrolled in Medcare Parts A & B. In addition you may make other coverage choices during your IEP such as a Medicare Advantage Plan (Part C). Your 7 month IEP includes the month you receive your 25th disability check, the 3 months before and the 3 months after.

Medicare isn't free. The amount you'll pay depends on the coverage you choose, the health care services and benefits you use during the year, and if your insurance plan has rules about network vs out-of-network costs. 

Costs you may pay with Medicare

Medicare Part Band most Medicare Part C, Part D and Medigap plans charge monthly premiums. A premium is a fixed amount you pay for coverage to either Medicare or a private insuranceIn somecases you may also be required to pay a premium for Part A also

Most people don't pay a premium for Medicare Part A because, assuming you worked longer than 10 years, you paid taxes to cover this. Part B, however has a premium you pay directly to Medicare, and how much you pay varies based on your income level. This amount can vary from year to year based on inflation and other factors. Other costs you may pay include deductibles, co-pays and co-insurance which we discuss below:

What is meant by cost share?

You'll also pay a share of the cost for your healthcare, while your Medicare or Medigap coverage pays the rest. There are basically three methods of cost sharing:                                               

•  Deductible = A set amount you pay for covered services before Medicare or your insurance plan begins to pay.
• Co-pay = A fixed amount you pay at the time you receive a covered service. For example, you might pay $20 when you visit your doctor.
• Co-insurance = The amount you pay for the cost of a covered service but usually in the form of a percentage. For example, Medicare Part B pays about 80% of the cost of a surgery and you would pay the remaining 20%.                                          

After you become eligible for Medicare it's time to actually enroll. You will need to enroll in Medicare Part A and/or Part B first before you can enroll in any additional coverage like a Medicare Supplement (Medi-gap) or a Medicare Advantage Plan (Part C).

Some people are automatically enrolled in Original Medicare (Part A & Part B) once they become eligible, but not everyone. See below:

              You'll be automatically enrolled in Original Medicare if:

• Your already receiving Social Security or Railroad Retirement Board benefits when you turn 65, or
• You're eligible for Medicare because of a disability or medical condition

             You must enroll yourself in Original Medicare if:

• You're NOT receiving Social Security benefits when you become eligible for Medicare

             There are three ways to enroll yourself in Original Medicare:

1. Online at www.socialsecurity.gov
2. Call Social Security at 1-800-772-1213                                  (TTY users 1-800-325-0778), Mon-Fri from 7am to 7pm
3. In person at your local Social Security office

As mentioned above, you can enroll in Original Medicare for the first time due to age or disability during what's known as the Medicare Initial Enrollment Period (IEP). It is the month you actually turn 65, the three months before and the three months after. 

If you plan to work past 65 and have benefits through your employer, you may be able to effectively delay enrolling in Medicare without penalty. However, your Medicare enrollment options depend on the size of your employer, how many employees are staffed, and if your current insurance carried through your employer is considered "creditable" by Medicare.

So, I DO have "creditable" coverage. When can I enroll in Medicare?

If you can delay Medicare enrollment past age 65 due to creditable employer coverage, you can then enroll in what's known as a Special Enrollment Period (SEP). This is an 8 month period during which you can enroll in Medicare Part A & B, Medicare Advantage (Part C) and/or Part D. However, it's important to note that you only get the first 2 months of your SEP to enroll in a Medicare Advantage (Part C) or Part D without penalty.

If you miss your Initial Enrollment Period (IEP), Medicare offers another chance to receive coverage known as the General Enrollment Period (GEP)

                       General Enrollment Period (GEP)

• The General Enrollment Period is available if you didn't sign up during your IEP. It runs Jan 1 to Mar 31 each year. During this time you can enroll in Medicare Part A & B and may even be able to add a Medicare Advantage (Part C) or a Part D and a Medi-gabetween Apr 1 and June 30 of the same year. 

Once you're ready to enroll in Medicare, follow these action items:

1. Enroll in Original Medicare Part A and/or Part B through the Social Security department as previously described. 
2. Research any additional Medicare coverage you may want such as Medicare Advantage (Part C), Prescription Drug (Part C) and/or Medicare supplement (Medi-gap)
3. Enroll separately into Medicare Advantage (Part C), Prescription Drug (Part D) and/or a Medicare supplement policy (Medi-gap) if desired.