How Do I Enroll in Medicare?
Am I Eligible for Medicare?
Medicare is a federal health insurance program for people ages 65 or older and for people under 65 who have certain disabilities or conditions. If you’re 65 years of age or older you may be likely eligible for Medicare.
If you’re younger than 65, you may be eligible for Medicare if one of the following applies to you:1
- You have received Social Security disability benefits for at least 24 months (not necessarily consecutive);
- You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS);
- You receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
- You have been diagnosed with End-Stage Renal Disease (ESRD) and receive maintenance dialysis or have had a kidney transplant.
If you are not sure if you are eligible for Medicare, a licensed insurance agent can give you more information.
When Can I Enroll in Medicare?
The period during which you can enroll in Medicare depends on how you are eligible.
Enrolling in Medicare When You Turn 65
If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Medicare Part A. Your Medicare card will be sent to you in the mail.
In fact, you can sign up with the Social Security Administration three months before you turn 65, during the month of your 65th birthday, and three months after your birthday. This is called your Initial Enrollment Period. For example, if your birthday is June 4, you can enroll any time from March 1 to September 30 of the year you turn 65. If you are not receiving Social Security benefits, you don’t have to wait until your 65th birthday to enroll in Medicare Parts A & B.
If you don’t sign up for Medicare when you’re first eligible, you may have to pay a late enrollment penalty for Part A and/or Part B, which you’ll have to pay for as long as you have your Medicare coverage. If you sign up for Part D coverage after your Initial Enrollment Period, you may have to pay a late penalty for as long as you have your Part D coverage.
Medicare Special Enrollment Period
If you miss your Initial Enrollment Period seven-month window, you might be eligible for a Special Enrollment Period (SEP). If you get health insurance through your employer’s group health plan, you can sign up for Medicare Part A and/or Medicare Part B at any time as long as you or a family member is working for that employer. You also have a Special Enrollment Period for the eight months after either your employment ends or the insurance plan you get through your employment ends.
Medicare General Enrollment Period
If you aren’t eligible for a Special Enrollment Period, you can sign up for Medicare Part A and/or Medicare Part B during the General Enrollment Period (GEP). The GEP occurs every year from January 1 through March 31. People who enroll in Parts A and/or B during the General Enrollment Period will begin receiving benefits on July 1.
Late Enrollment Penalty
For Part A, you may have to pay an extra 10% in premium payments. For Part B, the penalty is 10% above your premium rate for each year you went without the coverage while you were eligible.
Medicare Enrollment When You Have a Disability, ALS, or ESRD
If you receive disability benefits from Social Security or the Railroad Retirement Board, you will automatically be enrolled in Medicare on the 25th month that you receive disability benefits. You will receive a Medicare card in the mail about three months before you are eligible.
If you have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), you don’t have to wait to be enrolled in Medicare. You’ll get Medicare benefits in the first month that you receive disability benefits.
If you have End-Stage Renal Disease (ESRD), you may be able to enroll in Medicare, but you will not be automatically enrolled. If you have ESRD, you are eligible for Medicare at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of the following applies to you:
- You’ve worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee.
- You’re already getting or are eligible for Social Security or Railroad Retirement benefits.
- You’re the spouse or dependent child of a person who meets either of the two requirements above.
To enroll in Medicare if you have ESRD, contact Social Security. Individuals who enroll in Medicare due to ESRD will receive coverage beginning on the first day of the fourth month of dialysis treatments, regardless of when you sign up. Benefits can be applied retroactively if you wait until after your fourth month of dialysis treatments to enroll.
You may be eligible to receive Medicare coverage as early as the first month of dialysis if you take part in a home dialysis training program offered by a Medicare-certified training facility. Or, if you are getting a kidney transplant, coverage can as soon as two months before your operation.
How Do I Enroll in Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is offered by private health insurance companies and provides the benefits of Medicare Parts A and B, and usually Part D drug coverage in a single plan.
There are three separate times you can sign up for a Medicare Advantage plan:
- When you first enroll in Medicare during your 7-month Initial Enrollment Period
- During the Medicare Annual Enrollment Period from October 15–December 7
- During the Medicare Advantage Open Enrollment Period from January 1 to March 31. You can only change your plan or disenroll at this time.
- During a Special Enrollment Period: You’re eligible to enroll during certain circumstances such as a relocation, getting care from a long-term care facility, or qualifying for Extra Help">Extra Help.
Medicare Advantage plans often include more than just the basic benefits of Medicare Parts A and B. Plans can include benefits such as prescription drug coverage, dental, vision, hearing coverage, wellness programs, and more. In 2022, 89% of Medicare Advantage plans offered prescription drug coverage, 95% offered telehealth services, 94% offered dental coverage, and 95% offered hearing aid and/or exam coverage.1
How Do I Enroll in Medicare Part D?
If you have Original Medicare (Parts A & B) or a Medicare Advantage plan that does not include drug coverage, and want the benefit you’ll need to consider a separate drug plan, known as Medicare Part D. These optional plans are run by private companies approved by Medicare and have varying levels of costs and coverage.
You can sign up for a Medicare Part D plan when you first enroll in Medicare. If you already have drug coverage from an employer or union, you can delay your Medicare Part D enrollment without penalty.
Need help with out-of-pocket drug costs? You may be eligible for the Medicare Extra Help">Extra Help program. The amount of help you receive depends upon your income and resources. See if you’re eligible with the HealthMarkets Extra Help">Extra Help calculator.
How Do I Enroll in Medigap?
Medicare Supplement Insurance, also called Medigap, is sold by private insurance companies to help cover some of the out-of-pocket costs like copays, coinsurance, and deductibles associated with Original Medicare. There are several plans to choose from to meet a variety of needs. If you are enrolled in a Medicare Advantage plan, you don’t need a Medicare Supplement plan. It’s only for people who are enrolled in Original Medicare (Parts A & B).
You have a six-month Medigap Open Enrollment Period during which you can buy any Medigap policy sold in your area. Your Medigap Open Enrollment Period begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. During this time, you can purchase a Medigap policy from any insurance company, regardless of your health.
If you miss your initial enrollment window, you can still apply for Medigap coverage any time. However, if you delay enrollment, you may be required to answer health-related questions. An insurance company could choose not to sell you a policy if you have underlying medical issues.
Get Medicare Help From HealthMarkets
How do you enroll in Medicare? With HealthMarkets! If you’re ready to purchase a Medicare Advantage and/or a Medicare Part D plan, shop and compare plans now. We can even help you determine which type of Medicare plan could be right for you. Call (800) 439-6916 to speak with a licensed insurance agent today.
1. “Medicare Advantage 2022 Spotlight: First Look.” KFF. November 2021. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/