Medicare Eligibility and Enrollment

Who can get Medicare? Basically,three groups are eligible:

1. Most people 65 and older
2. People younger than 65 who have certain disabilities and illnesses
3. People of any age with kidney failure that requires dialysis or a kidney transplant and people with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease)

You might assume that signing up for a big government program like Medicare would be confusing. But it's usually easy. Most people are signed up automatically for Original Medicare (Parts A and B).

For People Ages 65 and Older

If you're already getting Social Security checks, you will be automatically enrolled in traditional Medicare. You'll get your Medicare card three months before your 65th birthday. The benefits kick in on the first day of the month of your 65th birthday. Traditional Medicare, which is also called Original Medicare, includes Medicare Parts A and B. Part A is hospital coverage. Part B covers doctor visits, lab tests, and other outpatient services.

If you're not getting Social Security payments already, you have to enroll in Medicare. The Social Security Administration (SSA) handles the enrollment process for Medicare. Call SSA at (800) 772-1213, visit the web site (www.ssa.gov), or apply at your local Social Security office. You have a 7-month enrollment period, beginning 3 months before your 65th birthday, your birthday month, and 3 months after your birthday. Apply early in your enrollment period to be sure that your benefits will start on time.

If you live in Puerto Rico and want Medicare, you need to sign up for Medicare Part B.

For People With Disabilities and Illnesses

No matter how old you are, if you have Lou Gehrig's disease, kidney failure, or certain other disabilities, you are eligible for Medicare. But you might have a waiting period before you can get Medicare benefits. Here are the details.

Lou Gehrig's disease (ALS). As soon as you get Social Security Disability benefits for ALS, you should be automatically enrolled in Medicare. There is no waiting period.

Kidney failure. To qualify, you must have end-stage renal disease and need dialysis or a kidney transplant. Usually, you can't get Medicare until three months after you start dialysis. Once you've been diagnosed with kidney failure, call the Social Security administration at (800) 772-1213 to enroll in Medicare.

Other disabilities for which you get Social Security Disability benefits. You can't get Medicare until two years after you qualify for Social Security Disability. At that point, the Social Security Administration should sign you up automatically.

If you are not getting Medicare coverage and feel that you should, call the Social Security Administration at (800) 772-1213.

Medicare Enrollment Periods

Medicare limits your ability to add or drop coverage after official enrollment periods. So pay close attention to Medicare enrollment deadlines. Here are some details:

Initial Enrollment Period. If you are not automatically enrolled, you must sign up during your "initial enrollment period" for Part A with or without Part B. This initial sign-up lasts 7 months, starting 3 months before the month of your 65th birthday and ending 3 months after. During this time, you can sign up for any Medicare coverage you would like. However, if you wait to sign up the month of your birthday or the 3 months that follow, you will have to wait 1 to 3 months for coverage to begin.

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