Medicare Eligibility & Enrollment

Who Is Eligible For Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States. If you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits but haven’t yet filed for them.
  •  You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if you have:

  • Received Social Security or Railroad Retirement Board disability benefits for 24 months.
  • End-Stage Renal Disease and meet certain requirements.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it.  The Standard Part B monthly premium in 2013 is $104.90 (Note: please see income threshold chart below).  Your Medicare Part B premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check.  If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months. Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits. For more information, please visit our retirement age FAQ. If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 or visit or call your local Social Security office. TTY users should call 1-800-325-0778. You can also get information about buying Part A as well as Part B if you don’t qualify for premium-free Part A.

Enrolling In Medicare

Medicare has two parts:

  • Medicare Part A (Hospital Insurance), which helps pay for care in a hospital and skilled nursing facility, home health care, and hospice care; and
  • Medicare Part B (Medical Insurance), which helps pay for doctors, outpatient hospital care, and other medical services.

Most people don’t have to pay for Medicare Part A. Most people pay for Medicare Part B. To find out how you enroll in Medicare Part A & B, please go to the Medicare Eligibility Tool.

General Enrollment Period

If you didn’t sign up for Medicare Part B when you first became eligible, you may be able to sign up during the General Enrollment Period. This period runs from January 1 through March 31 of each year. During this time, you can sign up for Medicare Part B at your local Social Security office. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-877-772-5772. Your Medicare Part B coverage will start on July 1 of the year you sign up. Important: The cost of Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B but didn’t take it, except in special cases. You will have to pay this penalty as long as you have Medicare Part B. If you already have Medicare Part A and need Medicare Part B you can sign up for Part B at your local Social Security office or by calling 1-800-772-1213 (TTY users should call 1-800-325-0778).

Special Enrollment Period

When a Special Enrollment Period Can Occur If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse’s employer or union, you can sign up for Medicare Part B during a Special Enrollment Period. You can sign up:

  • Anytime you are still covered by the employer or union group health plan through your or your spouse’s current or active employment, or
  • During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first).

If you are disabled and working (or you have coverage from a working family member), the Special Enrollment Period rules also apply. When Coverage is Effective if you sign up during a Special Enrollment Period

  • If you enroll in Medicare Part B while covered by the group health plan or during the first full month after coverage ends, your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following 3 months.
  • If you enroll during any of the 7 remaining months of the Special Enrollment Period, your Medicare Part B coverage begins the month after you enroll.

 Are You Eligible for a Special Enrollment Period? To find out if you are eligible for a Special Enrollment Period, please contact the Social Security Administration at 1-800-772-1213. You may also contact your local Social Security office. Remember: If you don’t enroll in Medicare Part B during your Special Enrollment Period, you’ll have to wait until the next General Enrollment Period, which is January 1 through March 31 of each year. You may then have to pay a higher Medicare Part B premium because you could have had Medicare Part B and didn’t take it. Please call Social Security at 1-800-772-1213 for more information or to enroll in Medicare.

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