Medicare Eligibility & Enrollment

You are qualified for full Medicare benefits at 65 if you meet specified eligibility requirements. You may qualify before 65, but only if you have certain medical conditions or disabilities. Your initial enrollment is open from three months before the month of your 65th birthday to three months after it, but there are other windows for Medicare enrollment as well.

Lamia Chowdhury, editor for RetireGuide.com
Fact Checked
Fact Checked

Our fact-checking process starts with vetting all sources to ensure they are authoritative and relevant. Then we verify the facts with original reports published by those sources, or we confirm the facts with qualified experts. For full transparency, we clearly identify our sources in a list at the bottom of each page.

Cite Us
How to Cite RetireGuide.com's Article

APA Chowdhury, L. (2022, June 22). Medicare Eligibility & Enrollment. RetireGuide.com. Retrieved June 22, 2022, from https://www.retireguide.com/medicare/eligibility-and-enrollment/

MLA Chowdhury, Lamia. "Medicare Eligibility & Enrollment." RetireGuide.com, 22 Jun 2022, https://www.retireguide.com/medicare/eligibility-and-enrollment/.

Chicago Chowdhury, Lamia. "Medicare Eligibility & Enrollment." RetireGuide.com. Last modified June 22, 2022. https://www.retireguide.com/medicare/eligibility-and-enrollment/.

Why Trust RetireGuide.com
Why You Can Trust Us

Content created by RetireGuide and sponsored by our partners.

Key Principles

RetireGuide’s mission is to provide seniors with resources that will help them reach important financial decisions that affect their retirement. Our goal is to arm our readers with knowledge that will lead to a healthy and financially sound retirement.

We’re dedicated to providing thoroughly researched Medicare information that guides you toward making the best possible health decisions for you and your family.

We partner with Senior Market Sales (SMS), a leader in the insurance industry with over 30 years of experience and a network of 66,000 independently licensed agents across the United States.

Our partnership with SMS (and Insuractive, the company’s consumer-facing branch) allows us to deliver expertly researched and reviewed content at no cost or obligation to all of our visitors. It also gives our visitors the opportunity to take the next step in their Medicare journey by requesting help from our partner through the phone numbers or forms provided on our website.

If a visitor chooses to inquire about a health care plan through SMS as a result of our research and accurate information, RetireGuide may receive compensation for connecting the visitor with SMS. The revenue we earn for helping visitors get the help they’re seeking makes RetireGuide stronger for our audiences.

The content and tools created by RetireGuide adhere to strict Medicare and editorial guidelines to ensure quality and transparency.

Editorial Independence

While the experts from SMS are available to help you navigate various Medicare plans, RetireGuide retains complete editorial control over the information it publishes.

We operate independently from SMS, which allows the award-winning RetireGuide team to provide you with unbiased information.

Visitors can trust our inflexibility regarding our editorial autonomy. We do not allow our partnership to influence RetireGuide’s editorial content whatsoever.
Key Takeaways
  • You are eligible for Medigap, Medicare Advantage and Plan D prescription drug coverage at the same time you become eligible for Original Medicare.
  • Income does not impact your Medicare eligibility, but it does impact how much you’ll pay for premiums.
  • You can still get Medicare if you’ve never worked, but it will most likely be more expensive and depends on your spouse’s total work history.
  • Medicare enrollment is automatic only if you are already receiving Social Security benefits. If you have not received Social Security benefits, you must enroll for Medicare manually.
  • You can apply for Medicare even if you are not planning to retire right away; however, you can only enroll at certain times.

Medicare is best known as a federal health insurance program for people 65 and older. But not everyone will automatically qualify for Medicare benefits when they turn 65.

There are several requirements you must meet in order to qualify for the program. These requirements include a minimum number of years you have to have paid into the Medicare program via payroll taxes, as well as your U.S. citizenship and immigration status.

Medicare Eligibility at 65 and Older

You can apply for Medicare the year you turn 65, but you generally must meet three eligibility requirements to qualify for full Medicare benefits at this age.

The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.

In addition, you must meet one of the following other requirements:
  • You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means you have worked for at least 10 years. You must be eligible for these Social Security benefits even if you are not yet receiving them.
  • You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.

If you pay Medicare payroll taxes for 10 full years, you won’t have to pay premiums for Medicare Part A, which covers hospital care.

You don’t need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, and Medicare Part D, which covers prescription drugs. Everyone pays premiums for both regardless of work history.

If you are still working at 65, you don’t have to sign up for Medicare — but there are benefits to signing up while still employed. Similarly, if you have never worked, you can still get Medicare. It may be more expensive depending on your spouse’s work history.

Other Ways To Get Medicare Coverage at Age 65

If you don’t qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.

Other Medicare Eligibility Options
  • You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
  • You can pay monthly premiums for Medicare Part B medical services insurance. You’ll pay the same premiums as anyone else enrolled in Part B.
  • You can pay monthly premiums for Medicare Part D prescription drug coverage. Your premium will be the standard rate and would depend upon the plan you choose.

You will not be able to purchase a Medicare Advantage plan or Medigap supplemental insurance unless you are enrolled in Original Medicare — Medicare Parts A and B.

Bob Glaze, a licensed insurance agent, explains who is eligible to enroll in Original Medicare.

Medicare Eligibility If You Are Under 65

People younger than 65 may qualify for Medicare if they have certain costly medical conditions or disabilities.

If you are under 65, you can qualify for full Medicare benefits if:
  • You have been receiving Social Security disability benefits for at least 24 months. These do not need to be consecutive months.
  • You have end-stage renal disease requiring dialysis or a kidney transplant. You qualify if you or your spouse has paid Social Security taxes for a specified period of time, based on your age.
  • You have amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. You qualify for Medicare immediately upon diagnosis.
  • You receive a disability pension from the Railroad Retirement Board and meet certain other criteria.

Who Is Eligible for Medicare Advantage Plans?

You’ll automatically qualify for Medicare Advantage (Part C) once you qualify for Part A and Part B coverage. Advantage plans are sold by private companies and are designed to cover some of the out-of-pocket costs Original Medicare does not cover.

4 Medicare Advantage Eligibility Requirements
  1. You must be a U.S. citizen, a U.S. national or lawfully present in the U.S.
  2. You must be enrolled in Medicare Parts A and B.
  3. You must live in the chosen Medicare Advantage plan provider’s service area.
  4. You must not have end-stage renal disease (ESRD).

While regular Medicare Advantage does not cover ESRD, you may qualify for a Medicare Special Needs Plan (SNP). SNPs are special types of Advantage plans specifically designed for a particular condition or financial situation.

You can keep your Medicare Advantage plan if you purchased it before developing ESRD. You can also buy an Advantage plan after being medically determined to no longer have ESRD — usually from a successful kidney transplant.

Don't Leave Your Health to Chance
You've worked hard your whole life by thinking ahead. Now do the same for your health. Get free Medicare help to plan your future.

Medicare Supplement Plan Eligibility

Like Medicare Advantage, Medicare supplemental insurance — often called Medigap because it fills in the out-of-pocket coverage gaps in Medicare Parts A and B — is also purchased from private insurers.

Medigap helps cover copayments, coinsurance and deductibles from Medicare Part A and Part B.

You must meet one of these qualifications to be eligible for Medigap coverage:
  • You must be 65 or older.
  • You have been diagnosed with Lou Gehrig’s disease.
  • You have been entitled to Social Security or U.S. Railroad Retirement Board disability payments for at least 24 months.
  • You have been diagnosed with end-stage renal disease, requiring regular dialysis or a kidney transplant.
Did You Know?
You cannot enroll in a Medicare Advantage plan and a Medigap plan at the same time. You must choose one or the other.

Medicare Enrollment

Enrollment is automatic if you’re already receiving Social Security benefits. If not, you can sign up online, by phone or in person at your Social Security office. Enrollment takes less than 10 minutes online, according to the Social Security Administration (SSA).

You can apply for Medicare even if you are not planning to retire right away; however, you can only enroll at certain times of the year.

It’s important to understand how Medicare enrollment works so that you can avoid common mistakes and penalties.

John Clark, licensed insurance advisor and owner of Senior Solutions Insurance Agency, explains Medicare eligibility and the three ways to sign up for coverage.

Initial Enrollment Periods for Medicare

Your initial enrollment period is open three months before your 65th birth month, includes your birth month and runs until the next three months after it.

You enroll in Medicare through the SSA. After that, your benefits will be administered by the U.S. Centers for Medicare & Medicaid Services.

How to Enroll in Medicare

  • Apply online at the Social Security website.
  • Call the Social Security Administration toll-free at 1-800-772-1213 (TTY 1-800-325-0778).
  • Visit your local Social Security office. The agency has a Social Security office locator on its website.

When you first enroll, you will sign up for Medicare Part A hospital insurance. If you’ve worked and paid Medicare payroll taxes for at least 10 years, there will be no premium. At that point, you’ll be given the choice to sign up for Medicare Part B medical insurance.

During this time, you’ll also be able to sign up for a Medicare Advantage plan. If you stay with Original Medicare, you can select a Medicare Part D plan for stand-alone prescription drug coverage. Otherwise, Medicare Part D is often included in a Medicare Advantage plan.

Read Our New to Medicare Checklist

Open Enrollment Periods for Medicare

Outside of the initial enrollment period, there are certain times each year when you can switch or enroll in different Medicare plans. One such time is called the Medicare open enrollment period.

Did You Know?
The Medicare open enrollment period runs from Oct. 15 to Dec. 7 each year.

Open enrollment is made available to beneficiaries because Medicare health and drug plans can make changes once per year. Plan changes may include how much the plans cost, what the plan covers or which doctors, pharmacies and other health care providers are in the plan’s network.

The Medicare open enrollment period gives you a chance to switch plans if you don’t like the changes made by your provider to your plan.

Learn how to prepare before enrolling in Medicare from Tom Parkin, a Medicare expert who has more than a decade of experience in the insurance industry.

Special Enrollment Periods for Medicare

Medicare special enrollment periods can happen any time during the year due to changes to your personal circumstances.

Examples of Medicare Special Enrollment Qualifying Events
  • Moving somewhere outside of the coverage area of your current Medicare Advantage plan
  • Phasing out of your employer’s health insurance plan
  • Your current Medicare Advantage provider ending its contract with Medicare

Late Enrollment Penalties

You can decline Part B coverage during initial enrollment if you don’t want to pay the premium — but applying for it later will cost you a monthly penalty. The cost of your Part B monthly premium will increase by 10% for each 12-month period you were eligible but did not enroll.

You may also have to pay a late enrollment penalty on Medicare Part D if you go more than 63 days without creditable prescription drug coverage after your initial enrollment period ends.

There is no late enrollment penalty fee for Medicare Advantage plans.

Don't Leave Your Health to Chance
You've worked hard your whole life by thinking ahead. Now do the same for your health. Get free Medicare help to plan your future.

Frequently Asked Questions About Medicare Eligibility & Enrollment

Who is eligible for Medicare?

You are typically eligible for Medicare when you turn 65 if you are a U.S. citizen or permanent legal resident. You can become eligible at a younger age if you have certain rare conditions or disabilities like amyotrophic lateral sclerosis (ALS) or end-stage renal disease.

To qualify for premium-free Part A, you must have worked and paid Medicare payroll taxes for at least 10 years.

When are you eligible for Medicare?

You have a window to enroll in Medicare that begins three months before the month of your 65th birthday and ends three months after. You may be automatically enrolled at 65 if you are already receiving Social Security benefits.

Does income affect eligibility for Medicare?

Income does not affect your eligibility for Medicare but may impact how much you pay for it. Your Part B premium, which is typically $170.10 in 2022, can increase depending on your level of income.

Is Medicare enrollment automatic at age 65?
Medicare enrollment is automatic only if you are already receiving Social Security benefits. If you have not received Social Security benefits, you must enroll for Medicare online, by phone or in person at your local Social Security office.
Do I have to sign up for Medicare when I turn 65?

If you have health insurance through your or your spouse’s employer, you may not have to enroll in Medicare when you turn 65.

If the employer has 20 or more employees, you can delay enrolling in Medicare until your employer’s health coverage ends without any penalties. Then, you will encounter a special enrollment period to sign up for Medicare.

If the employer has fewer than 20 employees, the company can require you to enroll in Medicare instead of using the company’s health insurance.

What happens if I miss my Medicare enrollment?
If you miss your initial or special enrollment periods, you can still enroll in Medicare during the next open enrollment period. But you may incur additional monthly penalties added to your Medicare Part B and Part D premiums.
When will I get my Medicare card?
If you actively enroll, you will get your Medicare card about three weeks after you sign up. If you are already receiving Social Security benefits before you turn 65, you’ll be automatically enrolled and your Medicare card should show up in the months before your 65th birthday.
When is the Medicare open enrollment period?
The Medicare open enrollment period is Oct. 15 to Dec. 7 each year. You will be able to enroll in Medicare coverage during that time if you didn't enroll during your initial or special enrollment period.
Last Modified: June 22, 2022

11 Cited Research Articles

  1. U.S. Centers for Medicare & Medicaid Services. (2019, November 15). Original Medicare (Part and B) Eligibility and Enrollment. Retrieved from https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol
  2. U.S. Centers for Medicare & Medicaid Services. (2019, September). Understanding Medicare Advantage Plans. Retrieved from https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
  3. U.S. Centers for Medicare & Medicaid Services. (2020, February 11). Top 5 Things You Need to Know About Medicare Enrollment. Retrieved from https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/Top-5-things-you-need-to-know-about-Medicare-Enrollment
  4. U.S. Centers for Medicare & Medicaid Services. (2020, February 11). Medicare Open Enrollment. https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment
  5. U.S. Centers for Medicare & Medicaid Services. (n.d.). Eligibility & Premium Calculator. Retrieved from https://www.medicare.gov/eligibilitypremiumcalc
  6. U.S. Centers for Medicare & Medicaid Services. (n.d.). Get Started with Medicare. Retrieved from https://www.medicare.gov/basics/get-started-with-medicare
  7. U.S. Centers for Medicare & Medicaid Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
  8. U.S. Centers for Medicare & Medicaid Services. (n.d.). When Can I Buy Medigap? Retrieved from https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap
  9. U.S. Department of Health and Human Services. (2014, September 11). Who Is Eligible for Medicare? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
  10. U.S. Social Security Administration. (2019, September). Understanding Medicare Advantage and Prescription Drug Plan Enrollment Periods. Retrieved from https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf
  11. U.S. Social Security Administration. (n.d.). Apply for Social Security Benefits. Retrieved from https://www.ssa.gov/benefits/forms/