Medicare Age And Eligibility Requirements - Black Enterprise
Black Enterprise magazine Fall 2019 issue

When Are You Eligible For Medicare?

If you’re looking to sign up for Medicare in the near future, knowing when you’re eligible for enrollment is an essential part of the process. You qualify for full Medicare benefits beginning at age 65 if:

  • You are a citizen of the United States or permanent legal resident who has lived in the U.S. for at least five years; and
  • You’ve worked for 10 years and paid Social Security during that time; or
  • Your spouse worked for 10 years and paid Social Security during that time; or
  • You are divorced but were married for at least 10 years and would have qualified through your ex-spouse.

You may also qualify for Medicare before the age of 65 if:

  • You have received Social Security Disability benefits for 24 months.
  • You have end-stage renal disease (ESRD) and have been on dialysis for three months or have had a kidney transplant.
  • You have been diagnosed with Lou Gehrig’s disease (ALS).

Applying For Medicare When You Turn 65

If you are planning to apply for Medicare when you age into eligibility at 65, here’s what you need to know:

  • You can apply for Medicare three months before your 65th birthday, the month you turn 65, and three months after your 65th birthday.
    • If your birthday is in May, for example, you may enroll in the months of February, March, April, May, June, July, and August.
    • This time period is known as your Initial Enrollment Period. During this period, you can sign up for Part A, B, C, and D.
  • Part A is mandatory and covers costs associated with hospital visits.
  • Part B is optional but highly recommended and coverage costs associated with doctor visits.
  • Part C (Medicare Advantage) is optional and is a cost-saving option if you want Part A, B, and D combined with other benefits such as vision and dental.
  • Part D is optional but highly recommended and covers costs associated with prescription drug coverage.

You must sign up for Medicare Part A during this period even if you’re not going to quit working. You do not have to apply for Part B until you start receiving retirement benefits (see the below section on special enrollment), but you do need to apply for Part A. 

If you are applying for Medicare in full and you are not working, you must sign up for all Medicare programs you want to join. This means if you want Part B and D, you need to sign up for both when you sign up for Part A. If you’re going to sign up for Medicare Advantage, you also need to do so during your enrollment window.

If you apply for Part A on time but you wait to sign up for Part B, there will be a 10% increase on your premium for each year you delay enrolling. For example, if you sign up for Part A during your Initial Enrollment Period in 2020 but put off signing up for Part B until 2025, your premium fee increase will look like this: 

   2020   2021  2022 2023 2024 2025
Late Fee 0%  10% + 10% + 10% + 10% + 10%
Part B Premium $100  $110 $120 $130 $140 $150

What if you miss this period? There are two other time slots for enrollment: your Special Enrollment Period and open enrollment.

Special Enrollment Period

If you plan to work and receive health insurance through your employer, you can delay applying for Medicare Part B until you begin receiving Social Security or railroad retirement benefits. Once your employment ends and you start collecting retirement, you will be automatically enrolled in Part B as long as you signed up when applying for retirement benefits. If you did not sign up for Part B when applying for retirement benefits, or if you want to sign up for Part C or D, you may do so during this period.

From the time your job ends, you have eight months to enroll in Part B. If your employment ends in April, you will have May, June, July, August, September, October, November, and December to apply for Part B. This is known as your Special Enrollment Period. Special enrollment only applies to those who are still working and who will continue receiving healthcare through an employer.

Open Enrollment Period

Open enrollment applies to anyone who missed their initial or special enrollment periods or an enrolled person who desires to switch plans. If you missed your initial or special enrollment periods, you may apply during the Open Enrollment Period, but there will be a penalty.

The period for open enrollment occurs yearly from October 15 through December 7.

Ready To Apply For Medicare?

If you are ready to enroll in Medicare or want to better understand your eligibility and options, requesting a free, personalized quote online is a great first step. Doing so will only take a few minutes of your time and will connect you with an expert who can explain your coverage and benefits, along with your estimated monthly premium.