You may already know that people are eligible for Medicare when they turn 65. But did you know there are other criteria for eligibility, too? It’s a good idea to learn as much as possible about Medicare eligibility so you know when to enroll. This could be during one of the Medicare enrollment periods or you might qualify for a Special Enrollment Period. It pays to do your research.
What are the requirements for Medicare eligibility?
You’re eligible for Medicare when:
You’re 65 or older;
You or your spouse worked for at least 10 years in Medicare-covered employment;
You’ve been a U.S. citizen or legal resident for at least five consecutive years; and/or
You are younger than 65, but qualify for Medicare due to a disability or End-Stage Renal disease (ESRD).
If you’re nearing Medicare eligibility because of your age—also called “aging into” Medicare—it’s important to remember:
Even if you’re already collecting Social Security, you must wait until you’re 65 to join Medicare.
If you’re not collecting Social Security, you may still join Medicare after you turn 65.
You must be 65 to join Medicare. Your spouse’s age doesn’t count. So if you were receiving insurance benefits through your spouse and they are aging into Medicare, you will need to find coverage for yourself until you turn 65.
Initial Enrollment Period (IEP)
Your Medicare Initial Enrollment Period (IEP) is a 7-month period that begins 3 months before your 65th birthday, includes the month of your birthday, and lasts 3 months after your 65th birthday. You also enter an IEP when you become eligible for Medicare due to disability. This type of IEP also lasts 7 months: 3 months before you become eligible due to disability, the month you become eligible, and 3 months after your eligibility month. Remember: if you wait until after your IEP to join Medicare, you may find you’ll pay more and have fewer choices.
Medicare Annual Enrollment Period
The Medicare Annual Enrollment Period (AEP) is October 15 through December 7 of each year. It is also called the Medicare Open Enrollment Period (OEP). During this time, Medicare-eligible individuals may add, switch or drop Medicare coverage.
General Enrollment Period
The Medicare General Enrollment Period (GEP) runs from January 1 through March 31. During this time, you can enroll in Original Medicare Part A, Part B or both if:
You did not enroll during your Initial Enrollment Period (IEP).
You chose to delay enrollment when you first became eligible.
You previously terminated or withdrew from Part A, Part B or both and want to re-enroll.
When you enroll or re-enroll in Medicare during the GEP, your coverage begins on July 1 of the year you enroll.
Special Enrollment Periods
Medicare also offers Special Enrollment Periods for certain eligible individuals. Let’s say you had group health coverage through your or your spouse’s active employment at the time you became eligible for Medicare, so you delayed enrolling in Medicare Part B (which has a premium). You may qualify for a Special Enrollment Period. If you are disabled and working or are covered under a working family member’s employer health coverage, you may also qualify for a Special Enrollment Period.
There are specific rules and criteria for Special Enrollment Periods, so be sure to familiarize yourself with these to avoid missing deadlines and having to pay a penalty. To find out if you are eligible for a Special Enrollment Period, you can call the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778; 7 a.m. – 7 p.m., Monday – Friday). You may also contact your local Social Security office. They can also tell you what you need to do to avoid paying a higher Medicare Part B premium.
If you have questions about your eligibility for Original Medicare (Part A or Part B), or if you want to apply for Medicare, please call Social Security at 1-800-772-1213 (7 a.m. – 7 p.m., Monday – Friday) 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. You can also contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048 or UnitedHealthcare® Medicare Made Clear at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.
Understanding Medicare Enrollment Periods: Medicare.gov
Medicare Enrollment and Eligibility: Medicare.gov
Medicare Basics: MedicareMadeClear.com
Y0066_120130_131036 File & Use 02062012