How to Apply for Medicare

As you approach Medicare eligibility, typically around your 65th birthday, it's helpful to familiarize yourself with the application process. Applying is usually straightforward, whether you are already receiving Social Security benefits or just starting to consider your health care options.

First, check if you are eligible. Typically, you qualify for Medicare if you are 65 or older, though some younger people with disabilities or specific diseases can also qualify. To apply, you can visit the Social Security Administration (SSA) website, call the SSA or go to a local field office.

As you approach your Medicare application, remember to use official Medicare resources to guide the process and avoid outdated information or scams. Contact the Social Security Administration (SSA) directly with any questions.

1. Determine Your Eligibility

Medicare is generally available for people aged 65 or older, younger individuals with disabilities and those with end-stage renal disease (ESRD). You're eligible for Medicare when you turn 65, even if you're not ready to retire and take Social Security benefits.

2. Know the Enrollment Periods

Your Initial Enrollment Period for Medicare begins three months before your 65th birthday, includes the month you turn 65, and continues for three months after, offering a total initial enrollment window of seven months.

If you don't sign up during the Initial Enrollment Period, you can enroll in Medicare during the General Enrollment Period from January 1 to March 31 each year. Your coverage will then start on July 1. However, you might have to pay a late enrollment penalty.

If you or your spouse are still working and you have health insurance through an employer, you can sign up for Medicare Part B during a Special Enrollment Period (SEP) without a late enrollment penalty. This period is available anytime as long as you have group health coverage and for eight months after the employment or coverage ends, whichever comes first.

3. Documents to Submit While Applying for Medicare

When you apply for Medicare, you’ll need to provide some personal information, including, but not limited to:

• Your Social Security number
• Proof of your age (birth certificate or other proof of birth)
• Information about your current health insurance, if any
• Details about your employment, if you're applying during a SEP

Gathering any other relevant documentation will help ensure a more straightforward application process.

4. Applying for Medicare

You can apply for Medicare in one of three ways:

• Online: Visit the SSA's website to apply for Medicare. This method is often the quickest and easiest way to apply, especially if you are already familiar with using online services.
• By Phone: If you prefer to speak to a representative who can guide you through the application process, you can apply over the phone by calling Social Security at 800-772-1213 (TTY 800-325-0778).
• In Person: If you like face-to-face interactions, visit your local Social Security office to apply. It's a good idea to make an appointment to avoid long wait times.

5. Choose a Medicare Plan

When you sign up for Medicare, you have several coverage options to consider. Each part of Medicare covers different aspects of your health care needs.

• Medicare Part A (Hospital Insurance): This part covers hospital stays, care in skilled nursing facilities, hospice care and certain home health services. Most people who have paid Medicare taxes while working do not have to pay a premium for Part A.

• Medicare Part B (Medical Insurance): This part helps cover the costs of doctor visits, outpatient care, medical supplies and preventive services. There is a monthly premium for Part B, which varies according to your income level. It's $174.70 in 2024 if your income is less than $103,000.

• Part C (Medicare Advantage): Part C is an alternative to Original Medicare that includes all the benefits and services under Part A and B and often comes with Medicare prescription drug coverage (Part D). It might also include extra benefits like dental and vision. Private companies approved by Medicare offer these plans.

• Part D (Prescription Drug Coverage): This is optional and covers prescription drugs. You can join a separate Part D plan if you have Original Medicare.

Additionally, you can enhance your Medicare coverage by choosing a Medigap (Medicare Supplement) Plan. These plans, offered by private companies, cover costs not paid by Original Medicare, such as copayments, co-insurance and deductibles, helping you manage out-of-pocket expenses. Medigap plans do not cover long-term care, vision or dental care. To buy a Medigap plan, you must have both Part A and Part B of Medicare.

6. After Applying for Medicare

After you apply, you'll receive a welcome kit and your Medicare card in the mail. Keep this card as proof of your Medicare insurance.

Your coverage start date depends on when you enroll:

• Before Your 65th Birthday Month: Coverage starts the month you turn 65.
• During Your 65th Birthday Month or the Three Months After: Coverage begins the next month.
• During the General Enrollment Period (January 1 to March 31): Coverage starts the month after you enroll.
• During a Special Enrollment Period: Coverage starts the next month.

If your birthday is on the first of a month, your coverage begins a month early.

You could face late enrollment penalties if you miss your Initial Enrollment Period for Medicare and don't have other qualifying coverage. You can avoid these penalties by ensuring you have other creditable coverage to qualify for a Special Enrollment Period.

• Medicare Part A: If you need to buy Part A and don't sign up on time, you could face a penalty that increases your monthly premium by 10%, and you'll pay this higher amount twice the length of time you were eligible but didn't sign up.

• Medicare Part B: For every 12-month period you delay enrolling in Part B, your monthly premium increases by 10%. This penalty lasts as long as you have Medicare Part B.

• Medicare Part D: Missing your enrollment for Part D and going without creditable drug coverage for 63 or more consecutive days will result in a penalty. The penalty is 1% of the national base beneficiary premium ($34.70 for 2024) per month you didn't have coverage, added to your monthly premium. This penalty is recalculated yearly and continues for as long as you have Medicare Part D.

These penalties drive home the importance of making a plan for your health care coverage well in advance.

If you're already receiving Social Security benefits and close to turning 65, signing up for Medicare is usually done on your behalf. However, there are some nuances to be aware of:

• Automatic Enrollment in Part A and Part B: If you've been getting Social Security benefits for at least four months before you turn 65, you will automatically get Medicare Part A (hospital insurance) and Part B (medical insurance). Your Medicare coverage will start on the first day of the month you turn 65.

• Enrollment Timing: If you start your Social Security application three months before your 65th birthday or later, you can enroll in Medicare at the same time. Your Initial Enrollment Period spans three months before to three months after your 65th birthday, providing a seven-month window for enrollment.

• Options for Enrolling in Medicare Part B: Although you are automatically signed up for Part B, you can choose to delay it if you have other health insurance, such as from your job or a union. This can help you avoid paying Part B premiums while having other coverage.

• Applying for Part B: If you apply for Social Security close to your 65th birthday and haven't received benefits for four months or more, you'll automatically get Medicare Part A. However, you need to sign up for Part B on your own. Enrolling in Part B during your Initial Enrollment Period is important to avoid any late enrollment penalties.

Consider your circumstances to determine if you need to apply for Medicare and how to time things right to avoid enrollment penalties, if applicable.

If you are under 65 and have a disability, you can qualify for Medicare. These rules ensure you have timely access to Medicare benefits without navigating a complex application process.

You are eligible for Medicare if you have received Social Security Disability Insurance (SSDI) payments for 24 months. On the 25th month of disability benefits, you are automatically enrolled in Medicare. You should receive your Medicare card in the mail before your coverage starts.

Medicare coverage for people under 65 and disabled includes both Part A (hospital insurance) and Part B (medical insurance). After enrollment, you also have the option to choose Part D for prescription drug coverage or a Medicare Advantage plan that might offer additional benefits.

If you are 65, still working and not ready to start Social Security, you can apply only for Medicare. If your employer’s health plan covers you, you might delay enrolling in Part B without a penalty until you retire by using a Special Enrollment Period. But, if you work at a company with fewer than 20 employees, you need to confirm with your employer if you can defer enrolling in Part B to avoid penalties.

However, if you enroll in Medicare while working, it can coordinate with your existing coverage. Medicare usually becomes secondary to employer insurance.

MoneyGeek has compiled frequently asked questions to help you navigate the Medicare enrollment process efficiently and effectively.