How To Apply For Medicare

Medicare is a type of federal health insurance available for people over 65 years old or who have certain disabilities or health conditions. To sign up for Medicare, there are set enrollment periods to keep in mind. Learn more about the periods you can apply for Medicare below.

When Should You Begin Thinking About Signing up for Medicare?

To be eligible for Medicare, you need to meet one or more of the following requirements:

• Be at least 65 years old
• Have a disability for which you’ve received Social Security Disability benefits for at least 24 months
• Have End-Stage Renal Disease or Amyotrophic Lateral Sclerosis

Many people who may be eligible for Medicare due to age actually don’t need to sign up at all because they are automatically enrolled in the insurance when they apply for their Social Security or Railroad Retirement Board benefits. Though you can typically apply for those benefits at 62 years old, your Medicare coverage will not activate until the day you turn 65.

You may also receive your Medicare card up to 3 months before your birthday, but your Medicare coverage will not kick in until the day you turn 65. Another thing to keep in mind is that Medicare Part A coverage is free for many people, but you may need to pay a premium for Part B. 

That said, if you are delaying on applying for your Social Security benefits, you may not be automatically enrolled in Medicare. In these instances, or if you’re already enrolled in Medicare and want to make changes to your plan, you can still sign up manually during one of the enrollment periods.

Enrollment Periods for Original Medicare

Medicare Part A and Part B are also known as Original Medicare. There are set time frames for initial enrollment in Original Medicare, as well as for making changes to your plan, including adding or dropping a plan. However, there are exceptions, which you can learn more about below.

Initial Enrollment Period

This is 3 months before and 3 months after your 65th birthday, for a total of 7 months. It is the standard timeframe for enrolling in Medicare. If you sign up in the months before your birthday, your coverage starts on your birthday. If you wait until your birthday month, coverage will begin the following month. The same goes for the 3 months after your birthday — coverage begins the month after you enroll. For example, if your birthday is in June, but you did not enroll until July, your coverage will begin in August.

General Enrollment Period

This is from January 1 to March 31 every year. When you sign up during this period, your coverage begins July 1. If you missed signing up for Original Medicare during your initial enrollment period, this could be another chance to sign up. However, you cannot make changes to your existing Medicare coverage during this period.

Annual Enrollment Period

This is from October 15 to December 7 each year. Coverage for enrollments in this period begins on January 1. During this period, you can enroll in a Medicare Advantage Plan, which is managed by private companies and provide Medicare Part A and Part B with some additional coverages. You can also switch, add, or drop plans at this time. 

Special Enrollment Period

Unlike the General or Annual Enrollment Periods, this does not have a set date for enrollment or change. Instead, Special Enrollment Periods are triggered by specific events in your life, such as if you lost employer-sponsored health insurance, are volunteering or serving in a foreign country, or have TRICARE (the uniformed services health care program). For example, after losing healthcare coverage, you have 8 months to sign up for Medicare, and coverage starts the following month. 

During a Special Enrollment Period, you cannot sign up for free Medicare Part A, but you may be eligible to sign up for a premium-based Part A and Part B, or a Medicare Advantage Plan. Enrolling in this period would also prevent a late enrollment penalty. 

What If You Miss an Enrollment Period?

If you have missed your initial enrollment period, check to see if you are eligible for a Special Enrollment Period. Signing up in that period eliminates potential late penalties. Other options are to wait for the Annual Enrollment Period or Open Enrollment Period, which may trigger late enrollment penalties.

In these cases, when you do eventually sign up, your Part A penalty is a 10% charge on top of your monthly payment. You may have to pay this penalty for twice the number of years you avoided signing up. For example, if you signed up for Medicare Part A this year, but you first became eligible for it 3 years ago, you may need to pay a 10% penalty every month for 6 years.

The late enrollment penalty for Part B is slightly different. The fine is still 10% for every year you delay in signing up, but it is a permanent penalty. Using the same example, if you signed up for Medicare Part B this year, but you first became eligible for it 3 years ago, your penalty is 30% of your standard premium, and it will last the entirety of the time you have Part B coverage.

However, this Part B penalty only includes full 12-month periods. This means if you waited 35 months to get covered, it would only count as two 12-month periods and incur a 20% penalty.

Applying for Original Medicare

Applying for Medicare requires you to have a few details about yourself and verification documents ready:

• Your date and place of birth, which is usually verified by showing your birth certificate or Permanent Resident Card if you are not a U.S. citizen
• If applicable, your Medicaid number, along with start and end dates for coverage
• If applicable, your current health insurance, including start and end dates for both coverage and your employment if it’s a group health plan
• Your Social Security number, which is verified by showing your Social Security card
• W-2s or other tax forms

With all of this in hand, you can choose to apply online, by phone, or in person at your local Social Security office. For in-person applications, you may need to call ahead and make an appointment.

Apply Online

You must have a my Social Security account to apply for Medicare online. Once you’ve signed up, the application takes between 10 to 30 minutes to complete. You can fill it out all at once or a little at a time, saving your progress along the way. Once you’re done, you can check your application status in your account.

Apply By Phone

To apply by phone, call 1-800-772-1213. For the TTY number for the hard of hearing, call 1-800-325-0778. Make sure you have your documents ready when you call. This option may take longer than the others, as you may have to wait for forms to be sent to you so you can fill them out. 

Apply In Person

Applying in person requires you to head to your local Social Security office. Please note, however, that some local Social Security offices may have suspended in-person Medicare enrollment because of the COVID-19 pandemic. Call ahead to see if your office has resumed in-person enrollment. If so, schedule an appointment time and date to submit your application in person. 

Should You Apply for Medicare Every Year?

For many people, it is not necessary to apply for Medicare every year. Their coverage rolls over until they decide to switch plans. Even if you have a paid plan, your coverage could continue as long as you keep paying your premiums.

But there are some cases where you might have to reapply. Generally, this only applies to people who are enrolled in a Medicare Advantage or Part D plan. While rare, some reasons you may have to apply again include:

• Medicare decided to end its agreement with your current plan
• Your insurance company decided to end its agreement with Medicare
• Your plan changed its service area, and you may no longer be eligible for coverage
• You aren’t happy with the insurance company managing your Medicare services

If this happens to you, you won’t face any penalties as long as you choose a new plan during the Annual Enrollment or Open Enrollment periods. Additionally, if you lose coverage in the middle of the year because of your insurance company, you might be eligible for a Special Enrollment Period.

How to Apply for Medicare Advantage

Medicare Advantage is not the same as Original Medicare. While Original Medicare is completely managed on the federal level, Medicare Advantage is managed by private insurance companies. You still receive Part A and Part B like you would with Original Medicare, but they’re bundled together with additional services. Costs vary depending on the plan you choose and whether or not you seek care from healthcare providers within your insurance network.

To join a Medicare Advantage plan, have your Medicare number and the date your coverage started. Each plan has slightly different requirements, but you may need to fill out an application form and show other forms of ID to enroll.

Enrollment Periods for Medicare Advantage

Initial Enrollment

Just like with Original Medicare, you have the 3 months before and after your 65th birthday to sign up for a Medicare Advantage plan. If you choose a Medicare Advantage plan during your initial enrollment period and find you don’t like it, you have 12 months after signing up to go back to Original Medicare.

Open Enrollment

From October 15 to December 7 each year, you can have the opportunity to join a Medicare Advantage plan. This is the only period when you can switch from Original Medicare to Medicare Advantage. All changes take effect on January 1.

Medicare Advantage Open Enrollment

This period is only for people already enrolled in Medicare Advantage Plans and lasts from January 1 to March 31 of each year. During this period, you can switch plans or drop Medical Advantage to return to Original Medicare (managed federally instead of a private company) instead. You cannot switch from Original Medicare to a Medicare Advantage Plan, however. Coverage starts the month after you enroll in the plan.

How to Apply for Medicare Part D

Medicare Part D is a prescription drug coverage plan offered by private insurers that have been approved by Medicare. While Original Medicare may cover some prescriptions, Part D offers much broader coverage. If you decide not to sign up for Part D when you are first eligible for Medicare, you may have to pay a late enrollment penalty later on.

To be eligible for Medicare Part D, you need to be a citizen or legal resident of the United States, and may be asked to show proof of your existing Medicare coverage and proof of identity. Your provider may also ask you to fill out an application with personal details.

Enrollment Periods for Medicare Part D

Initial Enrollment

Like all of the other initial enrollment periods for Medicare, Part D gives you 7 months to sign up for coverage, which are the 3 months before and after the month of your 65th birthday.

Open Enrollment

The Open Enrollment period for Part D is from October 15 to December 7. Any coverage you select during this time begins on January 1. You can select a new Medicare drug plan, switch Medicare drug plans, or drop your Medicare drug coverage entirely.

How to Apply for Medigap

Medigap — also known as Medicare Supplement Insurance — offers additional coverage for the gaps in Original Medicare coverage. It’s not a full Medicare Advantage plan, meaning you are receiving the federally managed Original Medicare. However, Medigap can help you cover additional copayments, coinsurance, and deductibles. These plans can only be used with Original Medicare. Medigap does not pair with Medicare Advantage plans.

These plans are managed by private companies, so the application process could vary depending on the plan and insurer you choose. However, most insurers will ask for documents verifying your identity and active Original Medicare enrollment, such as your Social Security card, Medicare card, ID, and more.

Enrollment Periods for Medigap

Initial Enrollment

The initial enrollment period for Medigap is slightly different than that of Original Medicare, Medicare Advantage, and Part D. Instead of focusing on your 65th birthday, this enrollment period spans the first 6 months after you enroll in Medicare Part B. During this time, you can buy any available Medigap plan regardless of your current health status. If you wait until after this period, your options may become much more limited. Insurers may also charge more based on health issues, including pre-existing conditions, if you apply for Medigap after your initial enrollment period.

Open Enrollment

Some states do have additional open enrollment periods for Medigap insurance, but this isn’t a federally mandated requirement. In these cases, you can buy a type of Medigap policy called Medicare Select. This is a stricter policy that requires you to stay in network for all hospital and doctor visits to receive coverage.

If you decide you do not like your Medicare Select plan, you typically have 12 months to change your mind and switch to a more traditional Medigap policy. However, as Medigap programs can be subject to state-specific guidelines, different states may have different requirements when it comes to changing Medigap plans. Contact your state’s Department of Insurance or Office of the Insurance Commissioner to learn about the Medigap enrollment and change rules for your area.