Eligibility & Enrollment

• ​receiving or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board or
  

• their spouse (living or deceased, including divorced spouses - married 10 years) receives or is eligible to receive Social Security or Railroad Retirement benefits or
  

• they or their spouse worked long enough in a government job through which they paid Medicare taxes or
  

• they are the dependent parent of a fully insured deceased child.
  
  

When an individual is first eligible for Medicare, they have a seven-month Initial Enrollment Period (IEP) to sign up for Medicare Part A and/or Part B (three months before the month of eligibility, the month of first eligible, and three months after the month of eligibility). (Special Note: for a person who was born on the first of the month, when turning 65 their IEP will start one month earlier.)

Note: A person who is eligible for Medicare under age 65 will have a second Initial Enrollment Period at age 65. If a Part B late enrollment penalty was previously assessed that penalty will end at age 65.

Once an individual's Initial Enrollment Period ends, they may have the chance to sign up for Medicare during a Special Enrollment Period. There are various SEPs available for individuals to enroll in Medicare. 

• The person or spouse (or family member if beneficiary is disabled) is working and
  

• ​The person is covered by a group health plan through the employer or union based on that work.​​       ​
  

The SEP exists while still covered by the EGHP and during the 8-month period that begins the month after either current employments ends or the month after the EGHP, based on current employment, ends (whichever comes first). Usually a late enrollment penalty is not assessed if a person signs up during the SEP. This SEP does not apply to people with End Stage Renal Disease (ESRD).

Loss of Medicaid Eligibility SEP: If an individual has lost Medicaid eligibility (Medicaid termination) they are eligible for a Special Enrollment Period to obtain Medicare coverage if they are not already entitled. This SEP begins from the date of the notice of upcoming Medicaid termination and ends 6 months following the termination of Medicaid coverage to enroll in Medicare.  In utilizing this SEP, Medicare coverage will begin the first of the month following enrollment into Medicare. ​​

Other Special Enrollment Periods: 

• ​​Individuals Impacted by a Government Declared Emergency or Disaster
  

• Misrepresentation by a Group Health Plan or Employer Health Plan 
  

• Formerly Incarcerated Individuals 
  

• Other Exceptional Conditions 
  

An individual who did not sign up for Medicare during their IEP can sign up for Medicare Part B (and Part A if they have to pay a premium for it) during the General Enrollment Period from January 1 – March 31 of each year. Coverage will start the first of the month following enrollment. They may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

While some individuals need to sign up for Medicare Parts A and B, others may be automatically enrolled. In most cases, it depends on whether a person is receiving their Social Security money benefits.

If a person is receiving benefits from Social Security (SSA) or the Railroad Retirement Board (RRB) at least 4 months before turning 65, they will automatically be enrolled in Parts A and B starting the first day of the month they turn 65. (Note: If a person’s birthday is on the first day of the month, Parts A and B will start the first day of the prior month.)

An individual over age 65 can enroll at any time after age 65 for premium-free Part A if eligible for retirement benefits (SSA or RRB) but not yet receiving them. Part A coverage will backdate up to six months (but not earlier than the first month eligible for Medicare).

If an individual is under age 65, deemed disabled, and has received benefits from the Social Security Administration or the Railroad Retirement Board for 24 months, they will automatically be enrolled in Parts A and B. If a person has ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease) they will automatically be enrolled in Parts A and B the month disability benefits begin.

​

If a person has End Stage Renal Disease (ESRD), enrolling in Medicare is an option. If entitled to Medicare because of ESRD, an individual can enroll in Part A and Part B. They may be retroactive in some cases. When their coverage begins depends on their treatment plan. Enrolling in Part B is a choice, but a person will need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services. Remem​ber, there is no Special Enrollment Period for Part B with ESRD.

​