Medicare Requirements

Medicare is America’s federal health insurance program for people 65 or older and younger people with certain disabilities and End Stage Renal Disease. Learn more about specific eligibility requirements and what you should do to enroll.

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Original Medicare

Original Medicare consists of two parts, Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).  

You’re eligible for premium-free Medicare Part A if you’ve paid enough Medicare taxes (10 years or 40 quarters worth) while working.

Medicare Part B, on the other hand, requires that you pay a premium. If you don’t want Part B, may decline it. If you decide later that you do want it, however, you may have to pay a penalty for as long as you have it.

Enrollment

Your Medicare Initial Enrollment Period is a seven-month period to sign up and begins three months before your 65th birthday, includes your birth month and lasts for another three months.

If you or your spouse are still working and have health insurance coverage — or are eligible because of another circumstance — you may qualify for a Special Enrollment Period. This may allow you to sign up for Medicare without penalty after your Initial Enrollment Period expires.

If you miss your Initial Enrollment Period and don’t qualify for special enrollment, you can sign up for either Medicare Part A or Part B during the General Enrollment Period, which runs each year from January 1 to March 31. Keep in mind that your coverage won’t begin until July 1 and you may have to pay a penalty if you wait too long.

If you’ve turned 65 and are already receiving Social Security benefits or have applied for them, the Social Security Administration will notify you that you're automatically being enrolled.

If you’re under 65, you’ll be automatically enrolled in Original Medicare when your 25th month of Social Security disability benefits (or certain Railroad Retirement Board benefits) begins. If you have ALS, your benefits begin the same month you start receiving disability benefits.

If you have End Stage Renal Disease, you’ll need to manually enroll.

You can enroll in Medicare one of four ways:

Medicare Advantage plans

Medicare Advantage plans are an alternative to Original Medicare. Private insurance companies sell Medicare Advantage plans, which offer the same benefits that are offered by Original Medicare (Part A and Part B)**. Medicare Advantage plans may also provide additional benefits, such as prescription drug and dental coverage, wellness programs and hearing and vision care.

Call a licensed insurance agent

For assistance enrolling in a Medicare Advantage plan, speak with a licensed insurance agent at TTY Users: 711.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

**Medicare Part A still covers hospice care, even if you are enrolled in a Medicare Advantage plan.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.