Alyssa Lane
Medicare is the United States' federal health insurance program for individuals aged 65 or older, or those with certain disabilities or permanent kidney failure. Signing up for Medicare is a straightforward process, and you can choose to enroll in Part A (Hospital Insurance) and Part B (Medical Insurance). If you are already receiving Social Security disability benefits, you will be automatically enrolled in Medicare Parts A and B after 24 months. However, if you are signing up for the first time, you will need to contact the Social Security Administration and may need to fill out certain forms. This guide will provide a comprehensive overview of the Medicare enrollment process, ensuring that you are well-informed and prepared to make the best decisions regarding your healthcare coverage.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare? | People aged 65 or older, or with certain disabilities or permanent kidney failure |
| When to sign up for Medicare? | You can sign up for Medicare Part A and Part B through Social Security. You can enroll online or by calling the Social Security Administration at 1-800-772-1213. |
| How to sign up for Medicare? | You can sign up for Medicare by filling out forms CMS-10797, CMS-40B, or CMS-L564 and sending them to your local Social Security office by fax or mail. You can also sign up online at Social Security's website. |
| What is included in Medicare? | Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Most people get Part A for free, but some have to pay a premium. You can choose whether you want Part B when you apply for benefits. |
| Are there any penalties for late enrollment? | If you don't sign up for Part B when you first become eligible, you may have to pay a late enrollment penalty. The penalty is assessed for as long as you have Part B, and the monthly premium may increase by 10% for each full 12-month period that you could have had Part B but did not sign up. |
| Can I drop Part A or Part B? | You can generally only drop Part A if you have to pay a premium for it. You can choose to drop Part B, but there are some risks to dropping coverage. |
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What You'll Learn
Medicare eligibility
Medicare is the United States' federal health insurance program for people aged 65 and above, or those with certain disabilities.
Eligibility
If you are 65 or older, you are eligible for Medicare. You can sign up for Parts A and B, or Part A only. Part A (Hospital Insurance) is provided automatically once you start receiving benefits from Social Security or the Railroad Retirement Board. You can choose whether to add Part B (Medical Insurance) when you apply for benefits. If you do not sign up for Part B when you turn 65, you may have to pay a monthly late enrollment penalty.
If you are under 65, you may still be eligible for Medicare if you have a qualifying disability or permanent kidney failure. You will automatically begin receiving Parts A and B after receiving disability benefits for 24 months. If you have Lou Gehrig's disease (ALS), you will receive Parts A and B immediately when you enrol in Social Security disability benefits. If you have End-Stage Renal Disease (ESRD), you can call 800-772-1213 to apply for Medicare.
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Part A and Part B
Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) are offered to some people automatically, while others have to sign up for them. If you live in Puerto Rico or outside the U.S., you will need to sign up for Part B. You will receive Part A automatically. If you don't sign up for Part B within 3 months of receiving Part A, you may have to pay a monthly late enrollment penalty.
You will receive Part A automatically if you are receiving benefits from Social Security or the Railroad Retirement Board. You will need to apply for Part B when you apply for these benefits. You can apply online, which is the fastest way to sign up and receive any financial help you may need. You will need to create a secure my Social Security account to do this.
If you are under 65, you may still be eligible for Medicare if you have permanent kidney failure or receive disability benefits. If you have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease), you should already have Part A and Part B and be receiving disability benefits. You will have been mailed a welcome package with your Medicare card.
If you are applying for Part B during the Special Enrollment Period, you will need to fill out the Request for Employment Information (CMS-L564) form. If you have a special situation, you will need to fill out the Application for Medicare Part A and B — Special Enrollment Period (Exceptional Conditions) (CMS-10797) form.
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Signing up outside the US
If you live outside the US, you don't necessarily have to enrol in Medicare. However, if you plan to move back to the US, it is recommended to sign up when you first become eligible. If you don't sign up when you're initially eligible for Medicare, you may experience a gap in coverage and incur late enrolment penalties.
Medicare typically doesn't provide coverage for healthcare expenses incurred outside the US. Therefore, if you live abroad permanently, you should decide whether to keep Medicare Part A and Part B. Most people qualify for premium-free Part A, meaning you pay nothing for coverage. If you must pay a premium for Part A, be aware of the high monthly cost for maintaining Part A coverage. While you can have Medicare while living abroad, it usually won't cover the care you receive.
If you decide to sign up for Part B while living outside the US, you can do so by contacting the nearest US embassy or consulate in your country of residence. You can find contact information on the Social Security Administration's international webpage.
Each special enrolment period for Medicare beneficiaries living abroad is different. For Part A, the special enrolment period lasts for two months after you return to the US if you don't qualify for premium-free Part A. If you do qualify, you can sign up at any time without penalty. For Part B, the special enrolment period lasts for eight months after you or your spouse stops working when you have private or public health insurance in your country of residence; it lasts six months after you stop volunteering if you have insurance through a volunteer organisation.
If you have health care coverage from your employer or your spouse's employer, you can delay enrolling in Medicare Part B without facing late enrolment penalties. Additionally, if you are covered under the public national health system of your country of residence, you can also delay enrolling in Part B. However, this only applies if either you or your spouse is still working, not if you have retired.
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Late enrollment penalty
It is important to sign up for Medicare coverage during your Initial Enrollment Period. If you don't, you may have to pay an extra amount, known as a late enrollment penalty. This penalty is not a one-time fee but an amount that is added to your monthly premium for as long as you have that type of coverage.
The Part B late enrollment penalty is calculated based on the number of full years that you could have had Part B but didn't. For each 12-month period, there is a 10% penalty. For example, if you waited 2 full years to sign up for Part B, you will have to pay a 20% late enrollment penalty, plus the standard Part B monthly premium.
The Part A penalty is different. It goes up the longer you wait to sign up and is based on how long you go without coverage similar to Medicare. If you have to buy Part A and you don't buy it when you're first eligible for Medicare, your monthly premium may increase by 10%. You'll have to pay this penalty for twice the number of years you didn't sign up.
The Part D late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" by the number of full months you were eligible for Medicare drug coverage but didn't have it or another credible prescription drug coverage. This penalty is added to your Medicare drug coverage premium and is usually charged for as long as you have that coverage.
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Applying for Part B
To apply for Medicare Part B, you must be a US citizen or permanent resident aged 65 or older. You may also be eligible if you are under 65 and have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease). You can apply for Part B online, by phone, or by mail.
If you are already receiving Social Security benefits, you will automatically be enrolled in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You will receive a welcome package with your Medicare card three months before your Medicare coverage starts. If you live in Puerto Rico or outside the US, you will need to sign up for Part B.
If you are not automatically enrolled, you can apply for Part B during certain enrollment periods. The Initial Enrollment Period for Part B starts three months before you turn 65 and ends three months after you turn 65. If you don't sign up during this period, you might have to pay a monthly late enrollment penalty.
If you or your spouse were working and had employer-provided health insurance when you turned 65, you may be eligible for a Special Enrollment Period. This period starts when your employment ends or your employer-provided health insurance ends, whichever comes first, and lasts for eight months. During this period, you can apply for Part B without penalty.
To apply for Part B, you will need to fill out the Application for Enrollment in Medicare Part B (CMS-40B) form. You may also need to fill out additional forms, such as the Request for Employment Information (CMS-L564) or the Application for Medicare Part A and B — Special Enrollment Period (Exceptional Conditions) (CMS-10797), depending on your situation. You can submit the completed forms to your local Social Security office by mail or fax.
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Frequently asked questions
Medicare is a health insurance program for people aged 65 or older, or with certain disabilities or permanent kidney failure.
You can sign up for Medicare Part A and Part B through Social Security. You can apply online, by phone, or by filling out and submitting forms.
Part A is Hospital Insurance. You get Part A automatically once you start receiving benefits.
Part B is Medical Insurance. You choose whether you want Part B when you apply for benefits. You can only sign up for Part B at certain times.
If you live outside the US, you get Part A automatically. You will need to sign up for Part B and you may want to do this if you plan to return to the US to get health care services.
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