Who can enroll into Medicare
Medicare is the federal health individual insurance program that is available to US Citizens and to legal residents who have lived in the United States at least 5 years in a row. You may become eligible to receive Medicare benefits based on your age, disability or medical condition.
Age: You must be 65 years old to enroll into Medicare. It does not cover spouses or dependents.
You may enroll even if you do not yet receive social security benefits.
You may enroll if you worked past the age of 65 and had employer coverage, or were covered by your spouse’s employer
Disability: If you are under 65 and disabled, and have received social security disability income for 24 months have been. You will be automatically enrolled into Original Medicare
Medical Condition: Persons with Lou Gehrigs disease (ALS) or End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) automatically qualify for Medicare.
When to enroll into Medicare
There are only certain times when people can enroll into Medicare. Depending on the situation, some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically and other people have to sign up for it. In most cases, it depends on whether you’re getting Social Security benefits. The first time you can enroll is called your Initial Enrollment Period. Your 7-month Initial Enrollment Period usually:
Medicare Initial Enrollment Period (IEP)
This is when you’re first eligible to enroll in Medicare. Your IEP is 7 months long and happens around your 65th birthday or the 25th month of receiving Social Security disability benefits if you under 65. It’s important to take action during your IEP. You’ll have some decisions to make, even if you have other insurance.
· Begins 3 months before the month you turn 65
· Includes the month you turn 65
· Ends 3 months after the month you turn 65
If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.
Medicare General Enrollment Period (GEP)
The General Enrollment Period (GEP) is like make-up time. It’s when you can enroll in Medicare if you didn’t sign up during your Initial Enrollment Period. The GEP is January 1 - March 31 every year. You may have to pay a Part B penalty for late enrollment. Coverage takes effect on July 1.
Medicare Special Enrollment Period (SEP)
A Medicare Special Enrollment Period (SEP) allows you to enroll in Medicare or change your Medicare coverage outside of standard enrollment periods without penalty. There are different SEPs that apply in specific circumstances, and each has its own rules about timing.
Medicare Supplement Open Enrollment
Medicare supplement insurance may be added to Original Medicare at any time after you’re enrolled in both Part A and Part B, but you have “guaranteed issue rights” only at certain times. If you join at other times you may have to pay more and you could be denied coverage. Get more information about Medicare supplement insurance.
How to enroll into Medicare Parts A & B
Some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically and other people have to sign up for it. In most cases, it depends on whether you’re getting Social Security benefits. Select the situation that applies to you to learn more.
I am turning 65 and I already receive benefits from Social Security or the Railroad Retirement Board (RRB).
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Do I need to sign up?
No. In most cases, you'll automatically get Part A and Part B starting the first day of the month you turn 65.
If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
Note
If you live in Puerto Rico, you automatically get Part A. If you want Part B, you need to sign up for it. Complete an Application for Enrollment in Part B (CMS-40B) to sign up for Part B.
Should I get Part B?
Most people should enroll in Part A when they turn 65, but certain people may choose to delay Part B. Find out more about whether you should take Part B.
How do I sign up?
You don’t need to sign up if you automatically get Part A and Part B. You'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday.
When do I sign up?
You don’t need to sign up since you automatically get Part A and Part B.
Can I get a health or drug plan?
When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).
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I am turning 65 and will not be getting benefits from Social Security or the Railroad Retirement Board (RRB) before I turn 65.
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Do I need to sign up?
If you aren’t getting benefits from Social Security (or the RRB) at least 4 months before you turn 65, you'll need to sign up with Social Security to get Part A and Part B.
Should I get Part B?
Most people should enroll in Part A when they turn 65, but certain people may choose to delay Part B.
How do I sign up?
· Apply online at Social Security. If you started your online application and have your re-entry number, you can go back to Social Security to finish your application.
· Visit your local Social Security office.
· Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
· If you worked for a railroad, call the RRB at 1-877-772-5772.
· Complete an Application for Enrollment in Part B (CMS-40B). Get this form and instructions. Remember, you must already have Part A to apply for Part B.
· Call a Senior Benefits Center enrollment specialist.
When do I sign up?
Learn about when you can sign up for Parts A and B.
Can I get a health or drug plan?
When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).
There are specific times when you can sign up for these plans, or make changes to coverage you already have.
I'm under 65 and have a disability.
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Do I need to sign up?
You automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months.
Should I get Part B?
Most people should enroll in Part A when they're first eligible, but certain people may choose to delay Part B. Find out more about whether you should take Part B.
How do I sign up?
You don’t need to sign up if you automatically get Part A and Part B. You'll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.
When do I sign up?
You don’t need to sign up since you automatically get Part A and Part B.
Can I get a health or drug plan?
When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).
There are specific times when you can sign up for these plans, or make changes to coverage you already have.
I have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease).
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Do I need to sign up?
You automatically get Part A and Part B the month your disability benefits begin.
Should I get Part B?
Most people should enroll in Part A when they're first eligible, but certain people may choose to delay Part B. Find out more about whether you should take Part B.
How do I sign up?
You don't need to sign up if you automatically get Part A and Part B. You'll get your red, white, and blue Medicare card in the mail the month your disability benefits begin.
When do I sign up?
You don’t need to sign up since you automatically get Part A and Part B.
Can I get a health or drug plan?
When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).
There are specific times when you can sign up for these plans, or make changes to coverage you already have.
I have End-Stage Renal Disease (ESRD).
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Do I need to sign up?
If you’re eligible for Medicare because of ESRD, you can enroll in Part A and Part B.
If you qualify for Part A, you can also get Part B. Enrolling in Medicare is your choice. But, you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.
When you enroll in Medicare based on ESRD and you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. This waiting period will start even if you haven’t signed up for Medicare. For example, if you don’t sign up until after you’ve met all the requirements, your coverage could begin up to 12 months before the month you apply.
If you're covered by an employer group health plan, your Medicare coverage will still start the fourth month of dialysis treatments. Your employer group may pay the first 3 months of dialysis.
Medicare coverage can start as early as the first month of dialysis if you meet all of these conditions:
· You take part in a home dialysis training program offered by a Medicare-certified training facility to teach you how to give yourself dialysis treatments at home.
· Your doctor expects you to finish training and be able to do your own dialysis treatments.
· The regular course of dialysis is maintained throughout the waiting period that would otherwise apply.
If you have Medicare only because of permanent kidney failure, Medicare coverage will end:
· 12 months after the month you stop dialysis treatments.
· 36 months after the month you have a kidney transplant.
Your Medicare coverage will be extended if:
· You start dialysis again, or you get a kidney transplant within 12 months after the month you stopped getting dialysis.
· You start dialysis or get another kidney transplant within 36 months after the month you get a kidney transplant.
Should I get Part B?
If you qualify for Part A, you can also get Part B. Enrolling in Part B is your choice. But, you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.
You can enroll in Part B without paying a late enrollment penalty if you apply for Medicare and are approved based on End-Stage Renal Disease (ESRD).
If you’re paying a late enrollment penalty for Part B, when you apply for Medicare and enroll in Part B based on ESRD, your Part B late enrollment penalty will be removed.
How do I sign up?
Visit your local Social Security office or contact Social Security.
Can I get a health or drug plan?
When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).
There are specific times when you can sign up for these plans, or make changes to coverage you already have.
I missed my initial enrollment period.
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First of all, don’t worry. You can still sign up for Medicare, and you might be able to avoid late penalties, depending on your situation.
Medicare General Enrollment Period (GEP)
The General Enrollment Period (GEP) is like make-up time. It’s when you can enroll in Medicare if you didn’t sign up during your Initial Enrollment Period. The GEP is January 1 - March 31 every year. You may have to pay a Part B penalty for late enrollment. Coverage takes effect on July 1.
You can enroll into Part A and / or Part B or both during this time. You may enroll in a Medicare Advantage ( Part C ) or a prescription drug (Part D) plan April 1st – June 30th of the same year.
