As you become eligible for Medicare, you must take a few important steps. If you’re not receiving Social Security benefits, you’ll need to complete additional measures, and it’s important to enroll during your initial enrollment window.
Medicare is available to Americans 65 or older and those receiving Social Security Disability Insurance (SSDI). However, once you become eligible, you must take a few steps.
These steps will depend on how you become eligible, whether you already receive Social Security benefits, and which parts of Medicare you want to enroll in.
You’ll need to take some actions when you first become eligible for Medicare. These actions will depend on why you’re eligible for Medicare.
If you’re eligible due to a disability
If you’re eligible through a disability for which you receive SSDI, you’ll be automatically enrolled in Original Medicare (parts A and B) after 24 months of SSDI payments.
You’ll need to take additional steps if you want to enroll in other Medicare parts, such as Part C (Medicare Advantage) or Part D.
If you’re eligible due to age
However, if you’re eligible for Medicare because you’re turning 65 years old, you’ll need to take a few more steps. You’ll have to apply for Medicare during your initial enrollment window.
Your initial enrollment window runs from the 3 months before the month of your 65th birthday to the 3 months after it. So, if you turn 65 years old in August 2024, your enrollment window runs for six months from May 2024 through November 2024.
Enrolling during your initial enrollment window is important. If you miss your window, you could face late penalties later. That said, you can also join during the Open Enrollment Period, which runs from October 15 to December 7.
If you want to join Medicare Advantage, the general enrollment period is from January 1 to March 31, and if you need to purchase Medigap, you have 6 months to enroll, starting the first month you have Medicare Part B.
In addition, it’s a good idea to be aware of a few other enrollment periods. If you delayed Medicare enrollment for an approved reason, you can enroll during a special enrollment period. If you stop other insurance coverage, you have 8 months from the end of your coverage or the end of your employment to sign up without penalty.
In addition, if you don’t have Medicare Part A but are enrolled in Part B during the general enrollment period, you can enroll in a Part D prescription drug plan from April 1 through June 30.
Generally, before enrolling in Medicare, be prepared to provide Social Security and Medicare with information proving you’re eligible. In some cases, such as if you’re receiving Social Security retirement benefits, Social Security might already have this information; in other cases, you’ll need to provide it.
You’ll generally be asked for proof of age, work history, citizenship, and military service. You might need to provide supporting documents, such as your:
- birth certificate
- proof of citizenship or permanent residency if you weren’t born in the United States
- income statements
- W-2 or other tax forms
- discharge papers or other records of any military service before 1968
You can apply for Medicare online by calling Social Security at 800-772-1213 or through your local Social Security office.
If you’re applying through your local office, you can visit in person or send them a letter with your name, your Social Security number, and the date you’d like to enroll.
No matter how you become eligible for Medicare, there are some steps you need to take. You’ll take some of these actions during your enrollment window and others during your first year of Medicare membership.
General steps
These are steps to take a few months before your enrollment to help you prepare:
- Make sure your doctor and other providers accept Medicare.
- Use Medicare’s plan finder tool to research the cost of Medicare Advantage, Medicare Part D, and Medigap plans in your area.
- Determine whether you’ll be automatically enrolled in parts A and B or will need to take additional steps.
- Research how your current health plan works with Medicare.
- Look at the income requirements for any assistance programs, like Medicare Extra Help or a Medicare savings program, and apply if you think you might qualify.
- Research what Medicare covers and what it doesn’t.
- Determine if you’ll need additional coverage from a Medicare Advantage plan.
Medicare Part A and Part B
If you already receive Social Security benefits, you’ll be automatically enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), also called Original Medicare. You can skip down to the next section in the checklist.
If you don’t receive Social Security benefits, you should do the following:
- Check to make sure you’re eligible for Medicare. You can do this online by creating a My Social Security account or calling Social Security.
- Make sure you know when your enrollment window begins and ends.
- Gather any information and documents you might need.
- Decide whether you want to apply in person, by mail, phone, or online.
- Decide whether you need Medicare Part A and Part B or just Part A.
If you want Medicare Part C (Medicare Advantage)
If you’re considering a Medicare Advantage plan, you should:
- Compare the costs of plans in your area using Medicare’s plan finder tool. Remember that these costs will be in addition to any Medicare Part A and Part B premiums; however, some Advantage plans do cover some or all of the Part B premium.
- Ensure any doctors or other providers you use are part of the plan’s network.
- If the plan includes Part D coverage, make sure it covers any medications you take.
- Ensure that you can afford any premiums and additional costs.
- Enroll in the plan you choose, then pay your first premium.
If you want Medigap (Medicare supplement insurance)
For Medigap plans, take these steps:
- Compare the costs of plans in your area using Medicare’s plan finder tool.
- Determine how much coverage you need and which Medigap plan best meets your needs.
- Make sure the premiums for the plan you choose fit into your budget.
- Know that Medigap plans apply only to Medicare Parts A and B coverage. This means they don’t cover costs from Medicare Part C (Medicare Advantage) or Part D. In fact, you can’t have a Medigap and Advantage simultaneously; you can only choose one or the other.
- Apply for coverage along with your initial enrollment in Medicare. This may be the only time you can sign up without providing previous medical history to qualify.
- Pay your first premium.
Medicare Part D (prescription drug coverage)
To get prescription drug coverage, you should:
- Compare the cost of plans in your area using Medicare’s plan finder tool.
- Make sure any prescriptions you currently take are on the plan’s formulary. A formulary is a list of medications that the plan covers.
- Check that your pharmacy is part of the plan’s network.
- Ensure the premiums, deductibles, and other costs fit your budget.
- Know that if you choose to enroll in Part D later and go without Part D coverage, you’ll face a permanent late enrollment penalty.
- Enroll, then pay your first premium.
If you want an Advantage plan and Part D coverage
- See which Advantage plans in your area include Part D coverage. If one of these plans works for you, enroll and pay your first premium.
- If none of them work for you, you can select an Advantage plan without Part D and then purchase a separate Part D plan. Enroll in both plans and pay your initial premiums.
If you want a Medigap plan and Part D coverage
- Research Medigap and Part D plans in your area.
- Make sure both plans fit into your budget.
- Apply for your selected Medigap plan and pay your first premium.
- Enroll in your selected Medicare Part D plan and pay your first premium.
What should I do during my first year on Medicare?
You can begin by scheduling your free “Welcome to Medicare” preventive health checkup and creating online accounts for all the Medicare parts you use, including Parts A and B, Part C, Part D, and Medigap. Use your online accounts to monitor coverage and claims, pay bills, and find providers.
In addition, if you’re unable to talk, fill out an authorization form allowing Medicare to talk with your spouse, a family member, or a friend.
Lastly, you can consider visiting a local State Health Insurance Assistance Program (SHIP) center to get answers to your Medicare questions and details about local coverage.
How do I enroll in Medicare Part D for the first time?
If you’re interested in getting coverage for prescription drugs, you need to enroll in Part D along with Original Medicare during your enrollment window. Note that Part D plans can have different costs and cover different medications. It’s also completely optional and available to all Medicare members.
Even if you don’t currently take any prescription drugs, it may be worth considering enrolling in Medicare drug coverage. If you wait until later to join a plan and you don’t have other drug coverage, you could end up paying a penalty.
What are the three requirements for Medicare?
If you are a citizen of the United States or have been a legal resident for at least 5 years and meet the following criteria, you are eligible for Medicare: you are 65 years of age or older, and either you or your spouse has worked for at least 10 years (or 40 quarters) in a job covered by Medicare.
To enroll in Medicare, you must follow a few steps. The steps you follow will depend on the parts of Medicare you want and whether you already receive Social Security benefits.
It helps to be prepared with the information and documents you need to enroll before starting the process. You may also want to research which Medicare parts you want and what coverage is available in your area before enrollment.