UNDERSTAND YOUR RIGHTS AND OPTIONS
In general, Medicare (Part A-Hospital Insurance and Part B-Medical Insurance) is available for people age 65 or older, certain people under age 65 with disabilities, and people with End Stage Renal Disease-ESRD (permanent kidney failure requiring dialysis or transplant).
An individual is eligible for premium-free Part A if age 65 or older and:
- they are receiving or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board or
- their spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or Railroad Retirement benefits or
- they or their spouse worked long enough in a government job through which they paid Medicare taxes or
- they are the dependent parent of a fully insured deceased child.
An individual under age 65 is eligible for premium-free Part A if they have been entitled to Social Security disability or Railroad Retirement disability benefits for 24 months. If a person has ALS (Amyotropic Lateral Sclerosis, also known as Lou Gehrig's disease), their Medicare benefits begin the first month entitled to disability benefits.
An individual of any age is eligible for premium-free Part A if they have End Stage Renal Disease-ESRD (permanent kidney failure requiring dialysis or transplant) and they either worked the required amount of time under Social Security, the Railroad Retirement Board (RRB) or as a government employee, are already receiving or are eligible for Social Security or RRB benefits, or are the spouse or dependent child of a person who meets either of those requirements.
If an individual does not meet the qualifiers for premium-free Medicare Part A, they may be able to get Part A by paying a monthly premium. Usually they can purchase this coverage only during designated enrollment periods.
Anyone who is eligible for premium-free Medicare Part A can enroll in Medicare Part B by paying a monthly premium. Some people with higher incomes may pay a higher monthly Part B premium. This monthly Part B premium is deducted from a person’s Social Security, Railroad Retirement, or Civil Service Retirement check. If a person does not get any of these payments, Medicare sends a bill for the Part B premium every 3 months.
A person can only sign up for Medicare Part B during designated enrollment periods. If they do not enroll in Part B when first eligible for it, they may have to pay a late enrollment penalty for as long as they have Part B coverage (some exceptions).
If a person is not eligible for premium-free Part A, they can buy Part B without having to buy Part A if they are age 65 or older and they are one of the following: a U.S. Citizen or a lawfully admitted non-citizen who has lived in the United States for at least five years.
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Medicare Enrollment Periods
Initial Enrollment Period (IEP)
When a person is first eligible for Medicare, they have a seven month Initial Enrollment Period (IEP) to sign up for Medicare Part A and/or Part B (three months before month of eligibility, the month first eligible, and three months after the month of eligibility). (Special Note: for a person who was born on the first of the month, when turning 65 their IEP will start one month earlier.)
See the chart below regarding when coverage will begin.
Note: A person who is eligible for Medicare under age 65 will have a second Initial Enrollment Period at age 65. If a Part B late enrollment penalty was previously assessed that penalty will end at age 65.
Special Enrollment Period (SEP)
Once their Initial Enrollment Period ends, a person may have the chance to sign up for Medicare during a Special Enrollment Period. If a person is covered under an employer group health plan (EGHP) based on current employment (Retiree health insurance and COBRA do not count), they can sign up for Part A and/or Part B anytime during the SEP as long as:
- The person or spouse (or family member if disabled) is working and
- The person is covered by a group health plan through the employer or union based on that work.
The SEP exists while still covered by the EGHP and during the 8-month period that begins the month after either current employments ends or the month after the EGHP, based on current employment, ends (whichever comes first). Usually a late enrollment penalty is not assessed if a person signs up during the SEP.
This SEP does not apply to people with End Stage Renal Disease (ESRD).
A person may qualify for a SEP for Part A and Part B if a volunteer, serving in a foreign country.
General Enrollment Period (GEP)
A person who did not sign up for Medicare during their IEP can sign up for Part B (and Part A if they have to pay a premium for it) during the General Enrollment Period from January 1 – March 31 of each year. Coverage will start July 1. They may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.
Other Medicare Enrollment Scenarios
While some people need to sign up for Medicare Parts A and B, others may be automatically enrolled. In most cases, it depends on whether a person is receiving Social Security benefits.
If a person is receiving benefits from Social Security (SS) or the Railroad Retirement Board (RRB) at least 4 months before turning 65, they will automatically be enrolled in Parts A and B starting the first day of the month they turn 65. (Note: If a person’s birthday is on the first day of the month, Parts A and B will start the first day of the prior month.)
An individual over age 65 can enroll at any time after age 65 for premium-free Part A if eligible for retirement benefits (SS or RRB) but not yet receiving them. Part A coverage will backdate up to six months (but not earlier than the first month eligible for Medicare).
If a person is under age 65, disabled, and has received benefits from Social Security or the Railroad Retirement Board for 24 months, they will automatically be enrolled in Parts A and B. If a person has ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease) they will automatically be enrolled in Parts A and B the month disability benefits begin.
If a person has End Stage Renal Disease (ESRD), enrolling in Medicare is an option. If entitled to Medicare because of ESRD, an individual can enroll in Part A and Part B. May be retroactive in some cases. When their coverage begins depends on their treatment plan. Enrolling in Part B is a choice, but a person will need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services. Remember, there is no Special Enrollment Period for Part B with ESRD.
