Medicare

What is Medicare?

Medicare is the Federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Original Medicare has two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

How do I get Medicare?

Automatic Enrollment

If you already get benefits from Social Security or the Railroad Retirement Board (RRB), you automatically get Part A and Part B starting on the first day of the month you turn 65 (if your birthday falls on the first day of the month, Part A and Part B will start on the first day of the previous month).

If you're under 65 and disabled, you'll automatically get Part A and Part B after you receive Social Security disability benefits or certain disability benefits from the RRB for 24 months.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you'll automatically receive Part A and Part B the month your Social Security disability benefits begin. If you are automatically enrolled, you will receive your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or 25 months of disability benefits. If you do nothing, you'll keep Part B and have to pay
Part B premiums through your Social Security benefits. You can choose not to keep Part B, but if you decide you want Part B later, you may have to wait to sign up and pay a penalty as long as you have Part B.

 

Important Note

If you live in Puerto Rico and receive benefits from Social Security or the RRB, you will automatically get Part A on the first day of the month you turn 65 or after receiving disability benefits for 24 months. However, if you want Part B, you will need to enroll by completing an “Application for Enrollment in Part B Form” (CMS-40B).

Download form CMS-40B in Spanish

Download form CMS-40B in English

 

Manual Enrollment

If you're close to age 65 but don't get Social Security or Railroad Retirement Board (RRB) benefits, you'll need to sign up for Medicare by contacting Social Security 3 months before you turn 65, or you can apply online. If you worked for a railroad, you will need to contact the RRB. In most cases, if you don't sign up for Part B when you're first eligible, you may have a delay in getting Medicare coverage in the future (in some cases, more than a year), and you may have to pay an enrollment penalty as long as you have Part B.

If you have End Stage Renal Disease (ESRD) and want Medicare, you will need to register. Contact Social Security to find out when and how to sign up for Part A and Part B.

 

When can I sign up for Medicare?

If you are not automatically enrolled in premium-free Part A, you can enroll in Part A once your Initial Enrollment Period begins. Your Part A coverage will begin 6 months before the month you apply for Medicare (or Social Security/RRB benefits), but not before the first month you turn 65. However, you can only sign up for Part B (or Part A if you have to buy it) during the hours listed below.

 

Initial Enrollment Period

You can first sign up for Part A and/or Part B during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65 .

If you enroll in Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage begins on the first day of the month of your birthday. However, if your birthday falls on the first day of the month, your coverage will begin on the first day of the previous month.

If you enroll in Part A (which you must pay) and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, your Part B coverage start date will be will delay.

 

Special Enrollment Period

After the Initial Enrollment Period is over, you may have the opportunity to enroll in Medicare during a Special Enrollment Period. If you didn't sign up for Part B (or Part A if you have to buy it) when you first became eligible because you're covered by a group health plan based on current employment (yours, a spouse, or a family member (if you have a disability), you can sign up for Part A and/or Part B:

As long as you are covered by the group health plan

During the 8-month period beginning the month after employment or coverage ends, whichever comes first

You generally don't pay a late enrollment penalty if you enroll during a special enrollment period. This Special Enrollment Period does not apply to people who are eligible for Medicare because of End Stage Renal Disease (ESRD). It also does not apply if you are still in your Initial Enrollment Period.

 

Important notes

If you have a disability and your group health plan coverage is based on the current employment of a family member (other than a spouse), the employer offering the group health plan must have 100 or more employees for you to get a Special Enrollment Period.

COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, retiree health plans, Veterans Administration (VA) coverage, and individual health coverage (such as through the Health Insurance Marketplace) are not considered employment-based coverage current. You are not eligible for a Special Enrollment Period to enroll in Medicare when that coverage ends. To avoid paying a higher premium, be sure to sign up for Medicare when you're first eligible.

 

General Enrollment Period

If you didn't sign up for Part A (if you have to buy it) and/or Part B (for which you have to pay premiums) during your Initial Enrollment Period, and you don't qualify for a Special Enrollment Period, you can sign up between 1 January and March 31 of each year. Your coverage won't start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium because of late enrollment.