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MEDICARE ELIGIBILITY 

All U.S. citizens and legal residents age 65 and up are eligible for Medicare, as well as people under 65 with a qualifying disability, End Stage Renal Disease (ESRD), or Lou Gehrig’s disease (ALS).  
 
Once you are eligible for Medicare, you can choose what parts and coverage you want to enroll in. Signing up for certain parts of Medicare may not make sense if you are still working and have insurance through you or your spouse’s employer. However, you may have to pay a penalty if you miss your enrollment period and do not meet certain requirements. Make sure to talk to your employer, or a licensed agent, about the pros and cons of staying on your current medical benefits or switching to Medicare.

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Will Medicare be my primary insurance if I’m still working?

Your primary insurance will depend on your employer’s insurance policy, so it’s best to discuss your options with them before enrolling. Depending on the size of the company, some employers may require you to take full Medicare benefits, while with others, you can wait until you retire to sign up.

Talk to your employer before you turn 65 to understand how Medicare may affect your medical insurance.

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Will I lose Medicare if I start working again?

If you start working again after 65, you can continue receiving Medicare but may have the option to get coverage through your employer. If you are under 65 but receive Medicare because of a qualifying disability, you can keep your Medicare coverage for at least 8.5 years after you return to work, as long as your qualifying disability still meets Medicare standards.

 

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Can I get Medicare if I’ve never worked?

Yes, you can receive Medicare benefits through means other than your own employment history if you:

  • Meet the eligibility requirements and your spouse receives Medicare benefits
  • Are the dependent parent of a deceased child who was fully insured under Medicare
  • Have certain qualifying disabilities, which may allow you to qualify before age 65

If you do not fall in one of these groups, you can pay a monthly premium to receive Medicare Part A, in addition to your Part B premium, once you are 65. You may qualify for financial assistance to help pay premiums and out-of-pocket costs.

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Can I stay on my spouse’s insurance?

You may be able to stay on your spouse’s insurance depending on the employer’s insurance policy. Even if you stay on their insurance, you may want to enroll in Part A and only delay signing up for Part B. When your spouse retires, you will have a Special Enrollment Period (SEP) and can sign up for Medicare. As long as you enroll in Part B during your SEP, you won’t incur a late penalty. Make sure to check with your spouse’s employer for more information.

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Can my spouse be added to my Medicare coverage?

No, your spouse cannot be added to your Medicare coverage—only one person can be on a Medicare plan, no matter the part. So your spouse can only enroll in Medicare if they also meet the eligibility requirements. If your spouse is younger than you when you turn 65, they are not eligible. If your spouse turns 65 before you and they don’t work, they may qualify to pay Part A without premiums based on your work record if you are at least 62.

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Are there different eligibility requirements for different parts of Medicare?

The eligibility requirements for Original Medicare are the same. Private insurers may have additional eligibility requirements when purchasing a Medicare Advantage, Medicare supplement, or prescription drug coverage plan.

When to Enroll 

Your Initial Enrollment Period (IEP) is the first opportunity to sign up for Medicare and lasts for 7 months: it begins 3 months before your 65th birthday and ends 3 months after your 65th birthday. For example, if your birthday is in May, your IEP begins in February (3 months before) and ends in August (3 months after).

During your IEP, you can sign up for Medicare Parts A and B and add on prescription drug coverage (Part D), a Medicare Advantage (Part C) plan, or a Medicare supplement plan.

Initial Enrollment Period

Initial Enrollment Period - 3 months before your 65th birthday. The month of your 65th birthday. 3 months after your 65th birthday.

If you miss your IEP, you can sign up for Parts A and B during the Open Enrollment Period, which is January 1 to March 31, although you may have to pay a late enrollment penalty. You can then sign up for Medicare Advantage or a prescription drug plan (Part D) during the Annual Enrollment Period, which is October 15 to December 7.

You may also qualify to enroll during a Special Enrollment Period (SEP). There are many scenarios that warrant a SEP, but the most common is that you were still working and had creditable coverage through your employer, or had coverage through your spouse’s employer, when you first turned 65. You can sign up for Parts A and B as well as add on additional coverage during your SEP.

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Will I be automatically enrolled in Medicare?

You will be enrolled automatically in Original Medicare (Parts A and B) if:  

  • You are turning 65 and are receiving Social Security or Railroad Retirement Board benefits  
  • You are under 65 and have received disability benefits for at least 24 months. Note that these do not have to be consecutive payments.  
  • You have Lou Gehrig’s disease (ALS) and start receiving disability benefits  

You’ll receive a Medicare card in the mail if you fall under one of those three categories. Keeping the card means you accept Original Medicare (Parts A and B) coverage, and you also agree to pay Part B premiums, unless you live in Puerto Rico. You must tell Medicare if you decide to refuse or delay your Part B coverage by following the instructions on the back of your Medicare card. 

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Am I required to enroll in Medicare?

You are not required to enroll in Medicare, but there are penalties if you don’t enroll when you become eligible. If you reject Medicare Part A, you may forfeit your Social Security benefits. If you delay enrolling in Parts B or D, you may have to pay higher premiums if you sign up later.

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Is there a penalty for enrolling late?

There may be penalties for enrolling late in Parts B and D. However, there is no penalty for enrolling late in a Part C, Medicare Advantage plan. If you did not sign up for a Medicare Advantage plan during your Initial Enrollment Period, you can do so each year during the Annual Enrollment Period from October 15 to December 7.

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How to enroll

You can sign up for Original Medicare (Parts A and B) online at www.socialsecurity.gov or enroll in-person at a Social Security office. You can also call 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 a.m. to 7 p.m., to enroll by phone or to make an appointment for your in-person enrollment.

You can choose to enroll in a Medicare Advantage (Part C), Medicare supplement, or prescription drug (Part D) plan through a private insurance provider after you sign up for Parts A and B. Each option has specific times that you can sign up after you become eligible and enroll in Medicare.

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Do I need to enroll every year?

You only need to enroll in Original Medicare (Parts A and B) once. If you purchase additional coverage—Medicare Advantage, prescription drug coverage (Part D), or Medicare supplement—through a private insurance, you do not need to re-enroll in those plans each year. Your coverage will continue unless you dis-enroll or sign up for another plan.

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Does Medicare change every year?

Some parts of Medicare may change from year to year, such as monthly premium and deductible amounts. However, your Part B can’t exceed the amount that your annual Social Security cost of living adjustment increases, unless you pay a higher premium for having a higher income.

If you are enrolled in a Medicare Advantage (Part C) or a prescription drug (Part D) plan, your plan benefits and costs may change from year to year. Your insurer will send you a notification of these changes each fall, and you will have the option to enroll in a different Medicare Advantage or prescription drug plan during the Annual Enrollment Period (AEP) from October 15 to December 7 each year. Your Medicare supplement plan premiums may also go up once a year

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When can I adjust my coverage?

During the Annual Enrollment Period (AEP), which is from October 15 to December 7, you can change your Medicare Advantage (Part C) or prescription drug (Part D) coverage. If you only have Original Medicare, you can add on Medicare Advantage or prescription drug coverage during this time. 

There are also Special Enrollment Periods (SEPs) if you need to make a change due to certain life events, like a move or losing employer insurance. These SEPs allow you to enroll outside of the designated Initial Enrollment Period or General Enrollment Period without paying a penalty.

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What’s the difference between Medicare and Medicaid?

Medicare and Medicaid are two separate government-run programs that serve two different groups of people. Medicare is a U.S. federal program that provides health coverage if you’re 65 and over, have a qualifying disability under the age of 65, End Stage Renal Disease (ESRD), or Lou Gehrig’s Disease (ALS), no matter your income. Medicaid is a state-run program that provides health coverage if your household income is below a certain level. Check with your local Social Security office to find out if you qualify for Medicaid or both Medicare and Medicaid.

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Who is eligible for Medicaid?

Eligibility for Medicaid changes from state to state. In all states, Medicaid provides health coverage to qualifying low-income people, which is typically at least 100% of the federal poverty level. If you are eligible for both Medicaid and Medicare, in most states you can enroll in a Dual Eligible Special Needs Plan (D-SNP) which offers the combined benefits available through both programs.

Coverage eligibility and income limits vary by state so it’s important to learn your state’s policy, which you can find at medicaid.gov.

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