Medicare Eligibility and Enrollment

Everyone becomes eligible for Medicare when they turn 65, but depending on each individual’s specific circumstances, how and when to apply may be different. Certain groups of people are automatically enrolled into Medicare Part A (hospital insurance) and Part B (medical insurance).

Anyone who has received social security benefits or Railroad Retirement Board benefits will automatically be enrolled in Part A and Part B on the first day of the month that they turn 65. Any individual who has ALS (Lou Gehrig’s disease) will be automatically enrolled into Part A and Part B the month their disability benefits begin. Anyone who does not fit the aforementioned criteria is expected to apply on their own.

There is a 7 month enrollment period that begins three months before your 65th birthday and lasts for three months after. If you do not sign up during the initial enrollment period, there is open enrollment each year from Jan 1 to March 31. However, if you sign up after the initial enrollment period you will be subjected to pay a higher premium as a penalty for late enrollment. This is a permanent penalty and can go up by 10% for each full 12-month period that you are eligible for Medicare but do not sign up. This premium generally only applies to Part B as most individuals do not pay a premium for Part A at all. How much you have to pay for your Part A coverage depends on your work history (if and how long you have paid Medicare taxes).

An exception to the initial enrollment period may apply to individuals who have health coverage through an employer. The best way to determine this is to ask your employer or benefits administrator if you are required to sign up as soon as you become eligible. If not, you can apply during the special enrollment period, which begins a month after your health coverage or employment ends. This special enrollment period lasts for eight months. The special enrollment does not apply to individuals covered through a former employer or COBRA. In this case, once you apply for Medicare it becomes your primary insurance. Any health care costs not covered by Medicare can be submitted to your other plan.

You can apply for Medicare online at the Social Security Administration website or by going to your local Social Security office. There is a separate application for those who already have Medicare Part A and just wish to apply for Medicare Part B.