Original Medicare Eligibility & Enrollment

2 things to know about Medicare eligibility and enrollment:

  1. You may be enrolled automatically.
  2. If you are not automatically enrolled, you can apply only during an enrollment period.

In order to qualify for Medicare coverage, you must be at least 65 years old and a citizen (or permanent legal resident) of the United States. You also may qualify if you are under 65 and have a qualifying disability or disease.

Some people are enrolled in Medicare automatically. If you are not enrolled automatically, you can enroll on your own during certain enrollment periods.

Automatic enrollment for Medicare Parts A and B

Some people are enrolled in Medicare Parts A and B automatically.

You may be enrolled automatically if one of the following situations applies to you, according to Medicare.gov:

  • You are turning 65 and already get Social Security benefits or Railroad Retirement Board (RRB) benefits.
  • You are under 65, have a qualifying disability or disease, and have been getting Social Security or RRB benefits for over 24 months.
  • You have Amyotrophic Lateral Sclerosis (ALS), commonly called Lou Gehrig’s disease.

If you are automatically enrolled, you will get a Medicare card in the mail 3 months before your 65th birthday, or your 25th month of disability.

If you do not want Medicare Part B (which requires you to pay an additional premium), you should follow the instructions on the back of the card to opt out.

Manual enrollment for Parts A and B

If you are not enrolled in Medicare automatically, you need to apply during an enrollment period. Enrollment periods are windows when you can join Medicare. The following are the 3 enrollment periods to join Medicare Parts A and B:

  • Initial Enrollment Period
  • Special Enrollment Period
  • General Enrollment Period

Initial Enrollment Period (IEP)

The IEP is the first window when you can enroll in Medicare.

Your IEP is 7 months long. It starts 3 months before the month you turn 65, continues through the month you turn 65, and then for another 3 full months after that.

Here is an example of how the IEP works: If you turn 65 on June 5, your IEP starts on March 1 (3 full months before June) and ends on September 30 (3 full months after June).

If you want Medicare coverage, you should apply as early as possible. If you apply before the month of your 65th birthday, coverage will start the first day of the month you turn 65.

If you apply during the month of your birthday or later, there will be a delay, according to Medicare.gov.

Special Enrollment Periods (SEPs)

SEPs allow you to enroll in Medicare after your IEP ends. You may qualify for a SEP if you or a spouse was working and covered by an employment-based group health plan during your IEP. (Note: COBRA and retiree health plans are not considered employment-based group health plans.)

If this situation applies to you, you can enroll in Medicare Parts A and B during the following periods:

  • Any time when you or your spouse is working and still covered by the group health plan
  • During an 8-month period after either employment or group coverage ends, whichever happens first

General Enrollment Period (GEP)

The GEP is when you can sign up for Medicare Parts A or B if you are not eligible for an SNP and didn’t enroll during your IEP.

The GEP runs from January 1 to March 31 each year. If you enroll during the GEP, you may pay a higher premium and your coverage will start on July 1.

How to enroll online

Eligible applicants may apply online with the Social Security Administration (SSA). Before applying, you should have the following information ready:

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

After your application is submitted, you will be contacted by an SSA representative if they need any additional information. Accepted applicants should receive a decision letter and a Medicare card in the mail.