The Basic Rules for Medicare

You can get Medicare if you are 65 or older, or if you have End-Stage Renal Disease (ESRD), or if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. Age 65 is the most common path. You do not have to be retired to sign up at 65, and you do not have to be a U.S. citizen — but you do need to be a permanent resident who has lived in the United States for at least five years.

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). It is not based on income or savings. If you meet one of the three conditions above, you are may be able to access regardless of how much money you have or earn.

Key Takeaways

  • You become may be able to access for Medicare at age 65, or earlier if you receive SSDI or have End-Stage Renal Disease.
  • Permanent residents who have lived in the United States for at least five years can enroll, not just citizens.
  • You must enroll during your Initial Enrollment Period, which runs for seven months centered on your 65th birthday month, or face a permanent penalty on your premiums.
  • Medicare has four parts — Part A (hospital), Part B (doctor visits), Part D (prescription drugs), and Part C (an alternative bundled plan) — and you choose which ones you need.
  • If you are still working at 65 and have health insurance through your job, you may be able to delay enrollment without penalty if your employer has 20 or more employees.

Turning 65 and Your Enrollment Window

Your Initial Enrollment Period is seven months long: it starts three months before the month you turn 65, includes the month you turn 65, and ends three months after. For example, if you turn 65 in June, your period runs from March through September. You must enroll during this window or pay a permanent 10 percent increase on your Part B premium for as long as you have Medicare.

You enroll through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your birth certificate, proof of citizenship or permanent residency, and your financial information. The enrollment itself is free.

If you miss your Initial Enrollment Period, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage begins July 1 of that year. However, you will owe the permanent premium penalty unless you had a may have access to reason to delay, such as employer coverage or active military service.

SSDI Recipients and the 24-Month Rule

If you are receiving SSDI, you become may be able to access for Medicare automatically after you have been on SSDI for 24 consecutive months. You do not have to explore separately. Social Security will enroll you in Part A and Part B automatically, and you will receive your Medicare card in the mail about three months before your coverage begins.

The 24 months are counted from the date your SSDI payments began, not from the date you filed. If you are unsure when your 24 months end, you can call Social Security at 1-800-772-1213 and ask. They will tell you the exact date you become may be able to access.

End-Stage Renal Disease and when ready Coverage

If you have End-Stage Renal Disease (ESRD) — meaning your kidneys no longer work and you need dialysis or a transplant — you become may be able to access for Medicare when ready, regardless of age. You do not have to wait until 65 or be on SSDI. You must enroll within 12 months of the month your kidney failure began, or you may lose coverage retroactively.

To enroll with ESRD, contact Social Security with documentation from your doctor or dialysis center showing the date your kidney failure started. Coverage can begin as early as the first day of the month in which your condition began, so timing matters.

Working Past 65 and Delayed Enrollment

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay Part B enrollment without penalty. Your employer's health plan is considered primary, meaning it pays first, and Medicare pays second. You can stay on your employer plan and enroll in Medicare later without the 10 percent premium penalty.

However, you must still enroll in Part A (hospital insurance) during your Initial Enrollment Period, even if you do not enroll in Part B. Part A has no monthly premium if you or your spouse paid Medicare taxes for at least 10 years, so there is no financial reason to delay it.

If your employer has fewer than 20 employees, Medicare becomes primary at 65, and you should enroll in Part B during your Initial Enrollment Period to avoid the penalty. Ask your employer's benefits administrator how many employees the company has if you are unsure.

Immigrants and Permanent Residents

You do not have to be a U.S. citizen to get Medicare, but you must be a permanent resident (green card holder) and have lived in the United States for at least five years. The five years do not have to be continuous — time spent outside the country can count toward the five years if you maintained your permanent resident status.

When you enroll, bring your green card and proof of your five-year residency, such as tax returns, bank statements, or utility bills. If you became a permanent resident fewer than five years ago, you are not yet may be able to access, but you will become may be able to access on the date you reach five years of residency.

What Happens After You Enroll

Once you enroll, you will receive your Medicare card in the mail within two to four weeks. Your coverage begins on the first day of the month in which you enroll, or the first day of the following month if you enroll after the 15th. You can then choose which parts of Medicare you want: Part A (hospital), Part B (doctor and outpatient care), Part D (prescription drugs), or Part C (a bundled alternative plan offered by private insurers).

Part A and Part B are the foundation. Part D is optional but recommended if you take prescription medications — if you do not enroll in Part D when you first become may be able to access, you may pay a permanent penalty if you enroll later. Part C is an alternative to Parts A and B offered by private insurance companies; if you choose Part C, you do not use traditional Medicare.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

No, unless you have ESRD or have been on SSDI for 24 months. Your Initial Enrollment Period begins three months before you turn 65. If you try to enroll earlier, Social Security will reject your process and tell you to reapply when your period begins.

What if I am a permanent resident but have not lived in the U.S. for five years yet?

You are not yet may be able to access. You will become may be able to access on the date you complete five years of permanent residency. Mark that date on your calendar and enroll during your Initial Enrollment Period after that date arrives. If you turn 65 before you reach five years, your enrollment period will not begin until you have been a permanent resident for five years.

Do I have to enroll in all four parts of Medicare?

No. Part A (hospital) and Part B (doctor visits) are separate choices. Part D (prescription drugs) is optional. Part C is an alternative to Parts A and B, not an addition. Most people enroll in Parts A and B and then choose whether to add Part D based on whether they take medications regularly.

What if I miss my Initial Enrollment Period?

You can still enroll during the General Enrollment Period (January 1 through March 31), and coverage will begin July 1. However, you will owe a permanent 10 percent increase on your Part B premium for as long as you have Medicare, unless you had a may have access to reason to delay, such as employer coverage or active military service.

Does Medicare cost anything to join?

Enrollment is free. However, Medicare has monthly premiums for Part B and Part D, and Part A has a premium if you did not pay Medicare taxes for at least 10 years. Part A is free for most people. You will receive information about premiums when you enroll.