Age 65 or Older
The majority of Medicare beneficiaries qualify due to age. American seniors age 65 or older who are U.S. citizens or have been permanent legal residents for at least five years qualify for benefits. You will need to enroll in Medicare Part A and Part B when you turn 65 to avoid having to pay a late enrollment penalty that follows you for the lifetime of the policy.
Your Initial Enrollment Period begins three months before the month of your 65th birthday and extends three months after. During this time you can decide to purchase Part A and Part B as well as select a Part D prescription drug plan, choose a Medicare Advantage plan, or sign up for a Medicare Supplement policy.
You can delay enrollment in Part B if you qualify for a Special Enrollment Period (SEP). The most common reason to delay is if you or your spouse are still working and have an employer group health plan. You can wait to sign up for Part B (and delay paying those monthly premiums) until you lose coverage or are no longer employed, whichever comes first.
You can otherwise delay if you have TRICARE and are an active duty service member or the spouse or dependent child of an active duty service member. You should be sure to enroll in Part B before the service member retires to keep your full benefits.
If you decide you do not want to be enrolled in Part B, you can contact Social Security to drop the coverage. Those who were automatically enrolled can follow the instructions that came with the card to drop Part B coverage. If your Medicare coverage has already started, you should contact Social Security to learn how to submit a signed request.
Disability Under 65
After you have received your disability benefits from Social Security or the Railroad Retirement Board for at least 24 months, you are eligible for Medicare benefits. You automatically get Medicare Part A and Part B, so you do not need to sign up. You will receive your red, white, and blue Medicare card in the mail three months before your 25th month of disability benefits. Coverage begins on the first day of the 25th month.
Under 65 Disabled Working Individuals
As long as you are medically disabled, you can keep your Medicare coverage, even if you decide to go back to work. You will not have to pay for your Part A premium for the first 8.5 years but will then have to pay your premium. If you cannot afford your Part A premium, you can see if you qualify for a Medicare Savings Program. The Qualified Medicare Beneficiary program helps to pay for Part A and Part B premiums as well as cost-sharing expenses such as deductibles and copayments. The Qualified Disabled and Working Individuals (QDWI) Program helps to pay your Part A premium once you lose your premium-free Part A because you go back to work. There are qualifying monthly income limits and resource limits to qualify for the program.
Amyotrophic Lateral Sclerosis (ALS)
People who are diagnosed with Amyotrophic Lateral Sclerosis (also known as Lou Gehrig’s Disease) are eligible for Medicare benefits during the first month they start receiving disability benefits. You can apply for disability benefits from Social Security or the Railroad Retirement Board as soon as you become disabled.
You do not need to sign up for Medicare because you automatically receive Part A and Part B. You will receive your Medicare card in the month your disability benefits begin. Coverage begins this same month. You are also eligible for a Chronic Condition Special Needs Plan tailored to your neurologic condition. Read more under Eligibility for Medicare Advantage.
End-Stage Renal Disease (ESRD)
You can choose whether or not to enroll in Medicare. To get the full benefits available to cover dialysis and kidney transplant services, you need to be enrolled in both Part A and Part B. You can do so by contacting Social Security. With ESRD, you will be exempt from the Part B late enrollment penalty.
If you have ESRD, you can receive Medicare benefits at any age if:
- Your kidneys are no longer working
- You have had a kidney transplant or need regular dialysis treatments
- One of the following applies to you:
- You have worked for 10 years or more while paying Medicare taxes
- You received Medicare-covered government employment benefits
- You are already receiving benefits from Social Security or the Railroad Retirement Board, whether or not you have filed for them yet
- You are the spouse or dependent child of someone who meets the above requirements
If you are on dialysis, coverage kicks in after a four-month waiting period. Medicare coverage will start on the first day of the fourth month of your dialysis treatments. If you have an employer group health plan, they will be the primary insurance for the first three months of treatment.
You may be able to receive coverage in the first month of dialysis if you perform it at home instead of at an outpatient treatment center. You will have to participate in a home dialysis training program from a Medicare-certified training facility during the first three months of your regular course of dialysis as well as have the approval and confidence of your doctor that you will finish training and be able to do your own dialysis.
Coverage for people with ESRD is retroactive from the time you enroll for up to 12 months, depending on how long you waited to enroll after you qualified for Medicare. These 12 months go back as early as the first month you began to qualify for Medicare due to ESRD. You are also eligible for a Chronic Condition Special Needs Plan, which is discussed under Eligibility for Medicare Advantage.