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Medicare Eligibility and Enrollment

3 things to know about Medicare eligibility and enrollment:

  1. You may be enrolled in Original Medicare (Part A and Part B) automatically.
  2. If not automatically enrolled, you can apply during certain enrollment periods.
  3. To qualify for Medicare, you must meet certain age, residency, or disability criteria.

Typically, you are eligible for Medicare if you are age 65 or older and a citizen (or permanent legal resident) of the United States. You may also qualify for Medicare if you’re under 65 and have a qualifying disability or medical condition. 

Automatic enrollment 

You may be enrolled in Original Medicare automatically if one of the following applies to you:

  • You’re turning 65 and are already receiving Social Security benefits or benefits through the Railroad Retirement Board (RRB).
  • You’re under 65, disabled, and have been getting Social Security or RRB benefits for over 24 months.

If you are eligible for automatic Medicare enrollment, you will get a Medicare card in the mail 3 months before your 65th birthday. 

Manual enrollment 

If you are not automatically enrolled in Medicare Part A and Part B, you can enroll during one of the following enrollment periods:

  • Initial Enrollment Period (IEP)
  • Special Enrollment Period (SEP)
  • General Enrollment Period (GEP)

Initial Enrollment Period (IEP)

The Medicare Initial Enrollment Period (IEP) is the first window when you can enroll in Medicare.

Your IEP is 7 months long. Your IEP begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after you turn 65.

Here’s an example: if you turn 65 on June 5, your IEP starts on March 1st (3 months before June) and ends on September 30 (3 full months after June).

Your Medicare IEP is the best time to enroll in Medicare. Failing to enroll during your IEP could cause your Part B premiums to increase, and there could be a delay in receiving your Medicare benefits. 

Special Enrollment Period (SEP)

If you did not enroll in Medicare during your IEP because you were covered by an employer health insurance plan, you should qualify for a Special Enrollment Period. 

If this situation applies to you, you can enroll in Original Medicare during the following periods:

  • Any time when you’re still covered by the group health plan
  • During the 8 months after either employment or group coverage ends. The 8-month period starts after whichever of those two ends first.

(Note: COBRA and retiree health plans are not considered employment-based group health plans.)

General Enrollment Period (GEP)

The Medicare General Enrollment Period lasts from January 1 to March 31 of each year, and allows you to enroll in Medicare if you missed your IEP. But remember: if you enroll outside of your IEP, you may have to pay higher Part B premiums and you will not receive coverage until July 1 of that year.

Medicare Enrollment process

Once you’re eligible for Medicare, you can apply with the Social Security Administration. Before enrolling in Medicare, you should have the following information ready:

  • Date and place of birth
  • Medicaid number and start/end dates
  • Current health insurance information

After the application is submitted, you will be contacted by a SSA representative if they need any additional information. Accepted applicants should receive a decision letter in the mail. If you manually enroll, your card will arrive within 30 days of enrollment.

Medicare Supplement Insurance Eligibility

If you have Original Medicare, a Medicare Supplement Insurance plan (also called Medigap) can help pay for some of your Medicare out-of-pocket costs, such as deductibles, coinsurance, and copayments. A licensed insurance agent can help you find Medicare Supplement Insurance plans in your area today! Compare plans today!

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