Medicare

What is Medicare?

Medicare is the federal health insurance program for people who are 65 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 consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). 

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How do I get Medicare?

Automatic Enrollment

If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), 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.)

If you’re under 65 and have a disability, you’ll 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.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), you’ll get Part A and Part B automatically the month your Social Security disability benefits begin. If you’re automatically enrolled, you’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or 25th month of disability benefits. If you do nothing, you’ll keep Part B and will 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 enroll and pay a penalty for as long as you have Part B.

Important Note

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

Download form CMS-40B in English

Download form CMS-40B in Spanish

Manual Enrollment

If you’re close to 65, but not getting 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 also apply online.  If you worked for a railroad, you’ll 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 over a year), and you may have to pay a late enrollment penalty for as long as you have Part B. 

If you have End-Stage Renal Disease (ESRD) and you want Medicare, you’ll need to sign up. 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’re not automatically enrolled in premium-free Part A, you can sign up for Part A once your Initial Enrollment Period starts. Your Part A coverage will start 6 months before the month you apply for Medicare (or Social Security/RRB benefits), but no earlier than 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 times listed below.

Initial Enrollment Period

You can first sign up for Part A and/or Part B during the 7-month period that begins 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 sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.

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

Special Enrollment Period

After your Initial Enrollment Period is over, you may have a chance to sign up for 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 were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or a family member’s (if you have a disability)), you can sign up for Part A and/or Part B:

  • Anytime you’re still covered by the group health plan
  • During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first

Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period doesn’t apply to people who are eligible for Medicare based on End-Stage Renal Disease (ESRD). It also doesn’t apply if you’re still in your Initial Enrollment Period.

Important Notes

If you have a disability, and the 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, VA coverage, and individual health coverage (like through the Health Insurance Marketplace) aren’t considered coverage based on current employment. You aren’t eligible for a Special Enrollment Period to sign up for Medicare when that coverage ends. To avoid paying a higher premium, make sure you 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 must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up between January 1–March 31 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 for late enrollment.

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