Who’s eligible for Medicare?

Medicare is for people 65 or older. It’s also for younger people with certain disabilities or health conditions. Learn more about who can enroll, what’s covered, and when to apply.

Are there any requirements to sign up?

 

To be eligible for Medicare, you must be a U.S. citizen or legal permanent resident. Legal permanent residents must live in the U.S. for at least 5 continuous years prior to the month you apply for Medicare.

 

You must also meet at least one of the following requirements:

 

  Age 65 or older

 

  Younger than 65 with a qualifying disability

 

 Any age with a diagnosis of end-stage renal disease (ESRD) or Lou Gehrig’s Disease (ALS)

 

When can you enroll in Original Medicare (Parts A and B)?

 

Most people sign up for Part A (hospital insurance) and Part B (medical insurance) when they're first eligible, typically at age 65.

 

Signing up at the right time can help you avoid gaps in coverage. However, if you're already covered through an employer group health plan, it might make sense to delay signing up for Medicare coverage. You can sign up for Medicare at these times:

 

    Initial Enrollment Period – A seven-month period that includes three months before your 65th birthday, your birthday month, and three months after.

 

    General Enrollment Period – Every year from January 1 to March 31.

 

    Special Enrollment Period – Applicable for certain life circumstances, such as if you lose your employer health insurance or are impacted by a natural disaster.

 

If you don’t enroll when you’re first eligible and don’t qualify for a Special Enrollment Period, you may have to pay late enrollment penalties. You must be enrolled in Original Medicare before you can purchase a Medicare Advantage (Part C) plan or Medicare Supplement insurance.

How do you apply for Original Medicare?

 

You can sign up for Original Medicare at any Social Security office, online at https://www.ssa.gov/medicare, or via phone at 800-772-1213 (TTY 800-325-0778). You may need the following when you apply:

 

 Your Social Security card (or record of your number)

 

 Your original birth certificate

 

 Proof of U.S. citizenship or legal residency

 

 A W-2 form if you’re still working

What is Medicare Advantage (Part C)?

 

Original Medicare includes Medicare Parts A and B, but it may not cover all your healthcare needs. A Part C (Medicare Advantage) plan offers everything included with Original Medicare, plus additional benefits such as prescription drug, dental, and vision benefits. After you enroll in Original Medicare, you can sign up for a Medicare Advantage plan through a private insurance company like Wellpoint.

When can I sign up for a Medicare Advantage plan?

 

Most people apply for a Medicare Advantage (Part C) and/or Part D (prescription drug) plan during their Initial Enrollment Period to start coverage as early as possible. Most Medicare Advantage plans include Part D coverage.

 

If you miss your Initial Enrollment Period, you can sign up for a Medicare Advantage or Part D plan during the General Enrollment Period once you have Original Medicare. Keep in mind, you may experience a gap in coverage and have late enrollment penalties.

Are there enrollment periods just for Medicare Advantage (Part C) and Prescription Drug (Part D) plans?

 

There are two enrollment periods just for Part C and Part D plans:

 

 Annual Enrollment Period (AEP): October 15 through December 7 every year. You can add, change, or drop your Part C or Part D plans during this period.

 

 Medicare Advantage Open Enrollment Period (MAOEP): January 1 through March 31 every year. If you added or changed your plan during AEP, you can change your Medicare Advantage plan just once during this period. You can also drop your Medicare Advantage plan to have only Original Medicare.

 

You can also make changes to your Part C or Part D plans during a Special Enrollment Period when certain events happen in your life, like moving or losing other coverage.

Need more help navigating Medicare?

What is Medicare Part C? 

 

Original Medicare vs. Medicare Advantage plans 

 

How much does Medicare Part C cost? 

 

Compare Medicare Advantage plans 

Wellpoint and Carelon Health plans are Medicare Advantage plans with Medicare contracts. Wellpoint and Carelon Health plans are SNP plans with a Medicare contract and a contract with the state Medicaid program. Enrollment in Wellpoint or Carelon Health depends on contract renewal.