Jane Dotson
Medicare is a health insurance program for people aged 65 or older. Initial enrollment begins three months before one turns 65 and ends three months after one turns 65. People with Social Security retirement or disability benefits at least four months before turning 65 are automatically enrolled in Medicare Parts A and B. Those who are still working with employer-provided health insurance may delay enrollment without penalty. People with End-Stage Renal Disease, disabilities, or ALS may be eligible for Medicare before turning 65.
| Characteristics | Values |
|---|---|
| Eligibility age | 65 years |
| Initial Enrollment Period | 7 months, starting 3 months before your 65th birthday and ending 3 months after |
| Late enrollment penalty | Yes, if you don't sign up during your Initial Enrollment Period, you may have to pay a monthly penalty for as long as you have Part B coverage |
| Automatic enrollment | If you are 65 or older and receive Social Security benefits, you will be automatically enrolled in Part A |
| Part A coverage | Begins up to 6 months before the month you apply if you are over 65 |
| Part B coverage | Begins the month after you sign up |
| Special Enrollment Period | 8 months, starting when you or your spouse stop working or lose your health insurance, whichever happens first |
| General Enrollment Period | Between January 1 and March 31 each year |
| Medicare parts | Part A (Hospital Insurance) and Part B (Medical Insurance) |
| Additional coverage | Prescription drug coverage (Part D), a Medigap policy, or a Medicare Advantage or other Medicare health plan |
| Eligibility before 65 | If you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease) |
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What You'll Learn
Initial Enrollment Period
Medicare is health insurance for people aged 65 or older in the United States. However, you may be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also known as Lou Gehrig's disease).
The Initial Enrollment Period is the first time you can sign up for Medicare, and it typically begins when you turn 65. This enrollment period lasts for 7 months, starting 3 months before your 65th birthday and ending 3 months after the month of your birthday. For example, if your birthday is in June, your Initial Enrollment Period would be from March to September.
It's important to sign up for Medicare during your Initial Enrollment Period to avoid any gaps in coverage or late enrollment penalties. If you miss this 7-month window, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. This penalty increases the longer you wait.
The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always begins on the first day of the month. If you qualify for premium-free Part A, your coverage will start on the first day of the month you turn 65.
During your Initial Enrollment Period, you can select a Medicare Advantage Plan (Part C) or another Medicare plan, and you have the option to include drug coverage. If you choose a Medicare Advantage Plan, you can change to another Medicare Advantage Plan or switch to Original Medicare within the first 3 months of having Part A and Part B.
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Late enrollment penalties
Medicare is health insurance for people aged 65 or older. However, you may be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease).
Most people sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) when they are first eligible, i.e., at the age of 65. Signing up promptly is important to avoid gaps in coverage or late enrollment penalties.
Part A
If you don't sign up for Medicare Part A during your Initial Enrollment Period (IEP), you will pay a late enrollment penalty. The penalty is 10% of the cost of your monthly premium. For instance, if you were eligible for Part A one year ago but didn't sign up, you will pay the 10% premium penalty every month for two years. The penalty goes up the longer you wait.
Part B
If you don't enroll in Medicare Part B during your IEP and don't qualify for a Special Enrollment Period, you will incur a late enrollment penalty. Your monthly premium will increase by 10% for every 12-month period that you were eligible for Part B but didn't sign up. For example, if you waited for two full years to sign up for Part B and didn't qualify for a Special Enrollment Period, you will pay a 20% late enrollment penalty (10% for each full year) plus the standard Part B monthly premium.
Part D
The Part D late enrollment penalty is calculated by multiplying 1% by the "national base beneficiary premium" ($36.78 in 2025) for each full month you were eligible for Medicare drug coverage but didn't sign up and didn't have other creditable prescription drug coverage. This penalty is added to your premium for as long as you have Medicare drug coverage, and the amount may change each year.
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Medicare and job-based insurance
Medicare is typically available to people aged 65 and over. However, it can also be accessed earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also known as Lou Gehrig's disease).
If you have job-based insurance, you can still sign up for Medicare. Job-based insurance is insurance offered by an employer or union for current employees and family members. You can sign up for Medicare at any time while working and still covered by the group health plan. You can also sign up within eight months of stopping work, or within eight months of the group health plan ending.
If you have job-based insurance, it is important to understand whether it is primary or secondary to Medicare. Job-based insurance is primary if it is from an employer with 20+ employees, in which case, Medicare is secondary. Some people choose not to enrol in Part B of Medicare in this case, due to the additional monthly premium. Job-based insurance is secondary if it is from an employer with fewer than 20 employees, in which case, Medicare is primary. If you delay Medicare enrolment with secondary job-based insurance, your job-based insurance may provide little or no coverage. Therefore, it is recommended to enrol in Part B of Medicare to avoid high costs for your care.
If you have job-based insurance and Medicare, your plans will coordinate benefits to determine which one pays first or second. For example, if you need to be admitted to the hospital, your employer insurance will likely pay first, and Medicare Part A may then help cover any remaining copays or costs. Part B of Medicare requires you to pay a monthly premium and covers healthcare provider visits and outpatient medical supplies.
To decide whether to enrol in Medicare if you have job-based insurance, you should consider the costs and coverage details of both plans. You can contact your or your spouse's human resources department to find out if your job-based insurance is primary or secondary. You can also call the Center for Medicare and Medicaid Services' Benefits Coordination and Recovery Center for more information.
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Medicare and retirement benefits
Medicare is health insurance for people aged 65 or older. If you have a disability, End-Stage Renal Disease (ESRD), or ALS (also known as Lou Gehrig's disease), you may be eligible for Medicare earlier than 65.
Most people sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) when they are first eligible, typically at age 65. If you are already 65 or older and receiving Social Security benefits, you will be automatically enrolled in Part A. It is important to sign up promptly to avoid gaps in coverage or late enrollment penalties. However, if you are still covered by an employer group health plan, you may want to delay signing up for Medicare or Part B.
Your Initial Enrollment Period for Medicare starts 3 months before you turn 65 and ends 3 months after your birthday month. If you miss this 7-month window, you may have to pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty increases the longer you wait.
If you have retiree health coverage from your employer, you may need to enroll in both Medicare Part A and Part B to get full benefits from your retiree coverage. Generally, Medicare pays first for your healthcare bills, and your retiree coverage pays second. Retiree coverage may also pay for care or services that Medicare does not cover, such as vision care, dental care, and prescription drugs. Therefore, deciding whether to keep your retiree coverage after enrolling in Medicare depends on your anticipated healthcare needs and costs.
Some employers offer Medicare Advantage Plans, which provide both Medicare and retiree health benefits. In some cases, you may be required to join a Medicare Advantage Plan to continue receiving retiree health benefits after becoming Medicare-eligible. Alternatively, you can choose to sign up for Original Medicare, the fee-for-service health insurance program offered by the federal government, and purchase a Medigap policy to pay for certain remaining costs.
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Medicare and disability benefits
Medicare is typically available to people aged 65 or older. However, individuals with disabilities can also get Medicare before turning 65. People who qualify for Social Security Disability benefits are generally automatically enrolled in Medicare Parts A (hospital insurance) and B (medical insurance).
There are three distinct time frames for Medicare eligibility for working people with disabilities. The first is the trial work period, which lasts for 9 months after a disabled individual obtains a job. During this time, beneficiaries may receive at least 7 years and 9 months (93 months) of continued Medicare coverage, as long as their disabling condition still meets the required rules. The second time frame is the 93 months after the trial work period, during which beneficiaries can continue to receive premium-free Medicare coverage. The third time frame is an indefinite period following those 93 months, during which individuals can continue to receive Medicare benefits as long as they remain medically disabled. However, they will have to pay the premium for Part A and Part B.
If you are receiving Social Security disability benefits, you will be automatically enrolled in Medicare after receiving disability benefits for 24 months. If you have ALS (Lou Gehrig's disease), you will be automatically enrolled as soon as you start receiving disability benefits. If you are under 65 and have End-Stage Renal Disease (ESRD), you may also be eligible for early Medicare.
It is important to note that Medicare coverage for individuals with disabilities is the same as for those who qualify based on age. This includes coverage for certain hospital, nursing home, home health, physician, and community-based services. Additionally, Medicare may be the "'secondary payer" when you have healthcare coverage through your work. This means that if you have health insurance through your job, you can sign up for Medicare at any time while you are still covered by your group health plan.
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Frequently asked questions
You can first sign up for Medicare insurance when you turn 65.
No, you can sign up for Medicare insurance starting 3 months before you turn 65, and ending 3 months after the month you turn 65. This is called your Initial Enrollment Period.
Most people sign up for Medicare insurance when they first become eligible at 65. However, if you're already covered through an employer group health plan, you can delay signing up for Medicare insurance.
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