Are You 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 old and a citizen or permanent resident of the United States.
If you are not 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 have not 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 benefit for 24 months. You are a kidney dialysis or kidney transplant patient.
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. It 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.
Do I need to apply for Medicare?
If you’ve received Social Security retirement benefits for at least four months before your 65th birthday, you will be enrolled automatically in Parts A and B of Medicare at the beginning of the month you turn 65. If your birthday is on the first day of a month, your coverage will start a month earlier.
Since the full retirement age is 66 or older for people born in 1943 or later, most people haven’t signed up for Social Security benefits by 65. That means they need to take steps to enroll in Medicare.
You can sign up for Medicare only at certain times. You can enroll during your seven-month initial enrollment period, which starts on the first day of the month three months before the month you turn 65 and lasts through the three months after the birthday month. Most people enroll in Parts A and B, but you may decide to sign up for just Part A.
Medicare Part A helps pay hospital costs and some skilled nursing care after a hospital stay as an inpatient. Most people don’t pay premiums for Part A because they or their spouse had Medicare taxes deducted from their paychecks for at least 10 years. Part B helps pay for doctor visits and other outpatient services, such as lab tests, medical equipment and X-rays, and costs $174.70 a month for most people in 2024.
Common reasons beneficiaries delay Medicare Part B include:
- Health insurance through a previous employer (such as COBRA or retiree health insurance)
- To remain with spousal coverage, if available, as Medicare Part B premiums are based on income reported two years prior (IRMAA)
- Union coverage
- Employer coverage
If you are — or your spouse is — still working and either of you has health insurance from an employer with 20 or more employees. This job-based coverage from a current employer — not retiree health insurance or COBRA, which allows most people to stay on their company’s insurance plan for up to 18 months after they leave their job — is what will allow you to defer signing up for Part B.
The easiest way to sign up during your initial enrollment period is at the Social Security website. If you don’t want to sign up online, you may be able to apply at a local Social Security office. To avoid long lines, officials hope you’ll try to apply online. Otherwise, contact your local office to schedule an appointment or call Social Security at 800-772-1213.
How to Apply for Medicare
Medicare enrollment is easier than ever. Once you meet eligibility requirements, you are ready to choose from a variety of plans in which to enroll. As we mentioned earlier, some beneficiaries can receive automatic enrollment, and some must apply manually.
There are three ways to apply for Medicare Part A and Part B.
Applying for Medicare Online
Applying for Medicare online is a quick and easy process on the Social Security website (ssa.gov), taking approximately ten minutes. After you have applied for Medicare online, you can check the status of your application and/or appeal, request a replacement card, and print a benefit verification letter. You can easily apply online for Medicare and Social Security retirement benefits or just Medicare.
Applying for Medicare by Phone
Just like applying online, applying for Medicare by phone is easy. You can contact a representative at 1-800-772-1213. Depending on call volume, there might be a wait time. If the wait time is above average, you can schedule an appointment to have a representative call you. The only downfall with applying for Medicare by phone is that it can take longer than online. If you’re ahead of the game and start well before your birthday, applying by phone shouldn’t cause any issues.
Applying for Medicare in Person
If you prefer to apply in person, you can sign up for Medicare at your local Social Security office. Their website has a ZIP Code lookup tool to show you the closest office to you.
Documents You Need to Apply for Medicare
To begin the application process, you’ll need to ensure you have the following documentation to verify your identity:
- A copy of your birth certificate
- Your driver’s license or state I.D. card
- Proof of U.S. citizenship or proof of legal residency
You may need additional documents as well. Make sure to have on hand:
- Your Social Security card
- W-2 forms if still active in employment
- Military discharge documents if you previously served in the U.S. military before 1968
- Information about current health insurance types and coverage dates
If you are already enrolled in Medicare Part A and have chosen to delay enrollment in Medicare Part B, you must complete the additional forms (listed below).
- Link 40B form: This allows you to apply for enrollment into Medicare Part B only. The 40B form must be included in your online application or mailed directly to the Social Security office.
- Link L564 form: Your employer must complete this form if you delayed Medicare Part B due to creditable group coverage through said employer. You must also include the completed L564 form in your online application, or mail it directly to the Social Security office.
What Happens After I Register for Medicare?
Once you have submitted your application, Medicare will review it to ensure all the information is accurate and complete. Be sure to double-check the accuracy of your contact information. This is important to ensure prompt delivery of your identification card, as well as in the event Medicare needs to contact you about your enrollment.
After your application is received and processed, a letter will be mailed to you with the decision. If you encounter any questions or problems during the process, you can always contact Social Security for assistance.
In most circumstances, you’ll get a Medicare I.D. card several weeks after your initial application is approved. Unfortunately, waiting times can be as long as 90 days in some cases.
However, if you automatically enroll in Medicare because you already get Social Security benefits, you will receive your I.D. card two months before turning 65.
Don’t Register for Medicare Alone
If you’re uncomfortable with applying for Medicare alone, we can help! Our services are entirely free for you. When applying, if you would like an agent by your side, we can walk you through setting up all your coverage.
Have questions? Give us a call and let us help you with your Medicare Health insurance needs.