Do I Need to Apply To Get Medicare?
You qualify for Medicare in most cases once you turn 65 years old, but enrollment is not necessarily automatic. You need to apply for Medicare if you aren't already receiving Social Security or Railroad Retirement benefits.
For seniors looking to collect on Social Security at full retirement age (between 66 and 67 years old depending on when you were born), or those wanting to collect on SS benefits even later in life, you can still get Medicare benefits before retiring, you just have to apply.
And for those turning 65 unable to draw on Social Security due to lack of work history, you can still get Medicare, you just need to pay a monthly premium for Part A to 'buy in'. And you will need to apply. You will be given premium costs and options once you apply.
Who Automatically Qualifies for Medicare
If you're already receiving Social Security or Railroad Retirement benefits, you automatically qualify for Medicare Part A and Part B once you turn 65. No need to apply. You will receive a 'Welcome to Medicare' packet in the mail 3 months before you turn 65.
Medicare Part A and Part B enrollment is also automatic for anyone under 65 with disabilities that qualify, once they receive disability benefits for a certain period of time. That time frame is usually 24 to 30 months for qualifying disabilities but it's near automatic for ALS or ERDS patients once they have Social Security disability benefits.
** Even if you automatically qualify, you'll still need to choose your Medicare coverage. Part A is premium-free but Part B comes with a monthly premium; you can turn down Part B if you chose. You'll also need to decide if you want additional Medicare parts or plans and will need to apply to those within their enrollment periods.
When Can I Apply? - Enrollment Periods
Initial Enrollment Period (IEP) for Medicare is a 7-month window that begins three months before you turn 65 years old and ends 3 months after your 65th birthday month. Coverage can begin no earlier than the day you turn 65.
This window is the absolute best time to sign up for Medicare if you don't already automatically qualify. Applying later can result in late enrollment penalties, gaps in coverage and/or higher premiums.
General Enrollment Period (GEP) is between January 1st - March 31st of each year. You can apply for Medicare during this time if you missed out on the initial period, but you will have to pay higher premiums for Part A and Part B, up to 10% more for each 12-month period you could have been enrolled in Medicare but chose not to. Coverage would begin on July 1st.
Special Enrollment Period (SEP) exist for anyone 65 or older that chose to remain on their employer's or union group's health plan and wants or needs to switch to Medicare coverage. Employer plans must have at least 20 employees enrolled to qualify.
You can apply for Medicare Part A and B with SEP any time you are still covered by an employer's or union group's health plan, either through you or your spouse. And you have an additional 8 months to apply to Part A and B after your employer or union group healthcare coverage ends (or when the employment ends, whichever comes first).
But the window to apply for Medicare Part C (Medicare Advantage) and Part D (Prescription Drug coverage) is much smaller. You can only apply to Part C via SEP during a 63-day window once your employer/union group coverage ends, or loss of the job, whichever is sooner. And you must already have Part A and Part B.
The window for applying for Part D via SEP is the same 63-day rule but also includes loss of coverage from the VA and these circumstances:
- You relocate out of your current plan's service area
- You join, leave or currently live in a nursing home
- Your plan changes to exclude your area through no fault of your own
How Do I Apply for Medicare?
You can apply for Medicare online, by phone or in-person at your local Social Security office.
Applying over the phone: call Social Security. The phone number is 1-800-772-1213 and representatives are available Monday through Friday from 7am to 7pm ET. If you worked for the Railroad, you should instead call RRB using 1-877-772-5772. Representatives are available Monday through Friday from 9am to 3:30pm ET.
Applying in-person: visit any Social Security office - Find a local Social Security office near you. You should call first and make an appointment.
Applying online: this is the easiest and quickest way to apply for Medicare benefits. Make sure you have this info at hand before you begin:
- Date of birth
- Medicaid number and start and end dates if applicable
- Current health insurance information if applicable
- Location you were born if outside the US including a Permanent Resident Card number if you are not a U.S. citizen
The application process takes 10-30 minutes to fully complete and requires you to first create a my Social Security account, which only takes a few minutes to setup.
Once you have an account setup and are logged in, you can apply for Medicare by following the prompts on the main page; it will provide options for applying if it determines you could be eligible.
To see the full application process use the How To Apply Online For Just Medicare guide provided by the Social Security Administration website.
What Happens After I Apply?
They will review your application. They might contact you by mail or online if they need more information or if they need to see any documentation. You can check the status of your application at any time on your my Social Security account, or by calling Social Security.
If you are approved you will receive a 'Welcome to Medicare' packet in the mail, along with your Medicare card. You'll also get a Medicare & You handbook so you can decide what coverage is best for you.
If you are not approved, you can still get Medicare assuming you are at least 65 years of age. You just won't qualify for premium-free Part A coverage. You will be sent a letter in the mail explaining all your options on purchasing Part A and instructions on when and how to apply to other parts and plans of Medicare.
How Long Does It Take To Get Approved?
Typical processing time for a Medicare application is two to three weeks. If there are no issues with your application you should receive a Medicare card in the mail approximately three weeks from the time you applied, though processing times can vary.