Medicare Eligibility and Enrollment

Medicare is a federal health insurance program for U.S. citizens and legal residents. Legal residents must have been living in the U.S. for at least five years in a row. In addition, you must be:

• Age 65 or older.
• Younger than 65 with a qualifying disability.
• Any age and have End Stage Renal Disease. (This is permanent kidney failure requiring dialysis or a kidney transplant. It’s also called ESRD.)

You can enroll in Medicare during specific times called enrollment periods. Some enrollment periods are for people joining Medicare for the first time. Others are for people already enrolled in Medicare who want to change their coverage.

When can you first enroll in Medicare?

You can join Medicare during designated enrollment periods. Each has a specific purpose.

• Initial Enrollment Period (IEP): This is when you are first eligible to enroll in Medicare. The timing of your personal IEP is based on the date of your 65th birthday. If you become eligible due to disability, then the timing is based on your disability date.
• General Enrollment Period (GEP): This is a set period of time for people who did not enroll during their IEP. It runs from January 1 to March 31 every year.
• Special Enrollment Period (SEP) for new beneficiaries: This is for people who choose not to or who are unable to enroll during their IEP. You must meet certain requirements to qualify for a SEP. The timing is based on the specific situation.
• Medicare Supplement Open Enrollment Period: This is the time when you can buy a Medicare supplement insurance plan. It starts the first month you’re 65 and enrolled in Part B. You have a guaranteed right to buy any plan sold in your state during this time, regardless of your health status. Once this period starts, it can’t be delayed or replaced.

You may be automatically enrolled in Original Medicare Parts A and B when you turn 65. This happens if you are already getting benefits from Social Security or the Railroad Retirement Board (RRB). You can change or postpone your enrollment, or you can do nothing and accept the automatic enrollment as is.

You will receive a letter and informational materials from Medicare three months before your 65th birthday. The materials will explain what your choices are, what you need to do if you want to change your coverage and how to do it.

If you are not receiving Social Security or RRB benefits when you turn 65, then you won’t be notified that you are eligible for Medicare. You will need to contact a Social Security office for information and to enroll. It’s best to do this well before your 65th birthday so you can start getting benefits right when you become eligible.

When can you change your Medicare coverage?

You have the chance to change your Medicare coverage once a year, if needed. It’s a good idea to review your plan every year to make sure that you always have the right coverage for your situation. You may be able to change your coverage at other times under certain circumstances, such as when you move.

Here is a brief description of the three time periods when you can change your coverage.

• Medicare Open Enrollment Period (OEP): This is when you can make new Medicare choices to better meet your needs in the coming year. It occurs every year from October 15 through December 7. You might also see this called the Annual Enrollment Period (AEP).
• Special Enrollment Period (SEP) for current beneficiaries: This is provided so that you can change your coverage outside the OEP under certain circumstances. You must meet certain requirements to qualify for a SEP. The timing is based on the specific situation.
• Medicare Advantage Disenrollment Period (MADP): This is provided to allow you to drop your Medicare Advantage plan and return to Original Medicare. It occurs every year from January 1 through February 14. If your Medicare Advantage plan includes drug coverage, then you can also join a standalone prescription drug plan at this time. If you already have Original Medicare, then you can’t switch your coverage at this time.