Medicare Eligibility: Are You Enrolling for the First Time?

Turning 65 is a major milestone. It’s time to start thinking about retiring, traveling, and making significant changes to your healthcare decisions, including getting private medical insurance or enrolling in Medicare.

Below is a guide to walk you through Medicare eligibility, enrollment timelines, costs, and available options.

Am I Eligible for Medicare at 65?

Most Americans become eligible for Medicare when they turn 65. Here are the basic requirements:

• You are a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 consecutive years.
• You’re age 65 or older.
• You paid Medicare taxes for at least 10 years while working. If your spouse paid Medicare taxes while employed, you can also qualify based on their work history.

People younger than 65 can also qualify for Medicare if they have certain disabilities or medical conditions, like ALS, kidney failure, or Lou Gehrig’s disease.

If you receive Railroad Retirement Board or Social Security benefits when you turn 65, you’ll be automatically enrolled in Medicare Parts A and B. Otherwise, you’ll need to actively enroll yourself.

When Can I Enroll in Medicare?

For most people, your initial Medicare enrollment window is the 7-month period that begins three months before your 65th birthday, including the month you become 65 years old, and ends three months after your birthday.

Enrolling on time is important to avoid delays in coverage or late enrollment penalties. Here are the key Medicare enrollment periods:

• Three months before your 65th birthday – The first day you can enroll in Medicare. Your coverage will start the month you turn 65.
• The month you turn 65 – Enroll now for coverage that starts up to 3 months after your birth month.
• Three months after you turn 65 – Final chance to enroll on time. Coverage starts 1-3 months after you enroll.
• After your Initial Enrollment Period – You may have to pay a late penalty if you delay and can only make changes during designated times.

Use the Medicare enrollment calculator on Medicare.gov to determine your specific deadlines.

How Do I Enroll in Medicare?

Enrolling in Medicare Parts A and B is easy. Just follow these three steps:

1. Contact Social Security – You don’t need to do anything if you are currently receiving Social Security benefits. You’ll be automatically enrolled in both Parts A and B when you turn 65.
2. Apply online – Visit Medicare.gov to apply for Medicare online. You can submit your application electronically through your online Medicare account.
3. Apply by phone or in person – Call Social Security at 1-800-772-1213 to speak with a representative or visit your local Social Security office.

Once enrolled, you’ll receive your Medicare card by mail. Make sure to keep this card handy as proof of insurance.

How Much Does Medicare Cost?

Medicare has different parts and plans that cover specific services at different costs. Here’s a quick breakdown of what’s covered and typical costs:

• Part A (Hospital Insurance) – Free for most people. It covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services. It requires a deductible for hospital stays.
• Part B (Medical Insurance) – Requires a monthly premium. Covers doctor visits, preventive care, lab tests, surgeries, and durable medical equipment at an annual deductible plus 20% of costs.
• Part C (Medicare Advantage) – Offered by private insurers as an alternative to Original Medicare. It combines Parts A, B, and usually D.
• Part D (Prescription Drug Coverage) – Requires a monthly premium. It helps cover the cost of prescription medications.

Medicare Parts A and B also have additional out-of-pocket limits each year to help protect against unexpected medical costs. It’s a good idea to shop options for Medicare to keep your total healthcare expenses in check.

How Do I Shop Options for Medicare Plans?

The best time to review your Medicare plan options is during Medicare’s Annual Enrollment Period each fall. Here are some tips for comparing and choosing plans:

• Review coverage – Make sure the plan covers your providers, hospitals, medications, and health services and adjust accordingly.
• Check costs – Compare monthly premiums, deductibles, copays/coinsurance, and maximum out-of-pocket costs.
• Think long-term – Consider your expected healthcare needs and budget over the next few years. Plans with more benefits may cost less in the long term.
• Ask about add-ons – Many Advantage plans offer dental, vision, hearing, and other supplemental benefits.
• Get help – Consult a Medicare broker or your State Health Insurance Assistance Program (SHIP) for free personalized advice.
• Enroll on time – Make changes during Medicare’s open enrollment period each year, or you may miss out on certain plans.

Reviewing and comparing your Medicare options ensures you get the right benefits and cost savings. Reaching age 65 is an exciting new chapter, so consider having the proper medical coverage for your needs.