Medicare Application

Medicare is the federal government’s health insurance program for people aged 65 and older or with certain disabilities or end-stage renal disease. It provides hospital, medical, and prescription drug coverage to eligible individuals. The program is funded and run by the government, but some aspects of health care delivery are left to private companies. Most people automatically get Part A of Medicare, hospital insurance, because they or their spouse paid into it through Social Security taxes while working. They may choose to sign up for Part B, medical insurance, during the Initial Enrollment Period, which begins three months before they turn 65, includes their birthday month, and ends three months after. People can also choose to enroll during a Special Enrollment Period, which is an eight-month period that starts the month after their employer group health plan coverage ends or the month they are no longer employed.

Most people pay a monthly premium for Part B coverage, and the amount can change each year. The Medicare program does not cover all of a person’s health care costs; out-of-pocket expenses include deductibles and copayments. People with low incomes can get help paying for these expenses through the Medicaid and Medicare Savings programs, both of which are administered by states. Individuals with a traumatic injury or illness requiring immediate medical attention can apply for emergency coverage under Medicare, regardless of age.

Who Can Qualify?

You are eligible for Medicare if you are 65 or older and have worked enough quarters to qualify for Social Security benefits. You also are eligible for Medicare if you are disabled (permanent kidney failure requiring dialysis or a kidney transplant or ALS, Lou Gehrig’s disease) and have received Social Security disability benefits for 24 months. You may enroll in premium Part A and B coverage and pay monthly payments, or you can choose a private Medicare Advantage plan, also known as Part C, that provides all of your Parts A and B benefits plus prescription drug coverage (Part D).

People who are still working when they reach age 65 can sign up for Part A and Part B during the three months before their birth month, the month of their birthday, and the three months after. They will be charged a late enrollment penalty if they do not enroll during this window. You can also sign up for Medicare during this window if you or your spouse is covered by an employer group health plan and continue to work at that job or if you were a worker who earned disability benefits under the Railroad Retirement Board for 24 months.

Individuals whose income is low and who meet other criteria can apply for Medicare Savings Programs to help with the cost of Parts A and B monthly premiums, co-pays, and deductibles. To apply for these programs, complete Form CMS-L564 or download it from the links on this page.

How to Apply for Medicare?

The vast majority of people get Medicare automatically at age 65, but some have to sign up. You can do so during your initial enrollment period, which runs from the month of your birthday until three months after it. If you miss this window, you’ll have to wait until the general Medicare open enrollment period. Here is the step-by-step application process for Medicare:

• Check Eligibility
  • Prepare required documents
• Submit application
• What to expect after applying
• Keep up with ongoing requirements
• Appeal a decision
• Report changes

Generally, it’s a good idea to apply for Medicare as soon as you can. You’ll receive a package with your Medicare card in the mail about three months before your coverage begins. This will include important information about your options and costs.

If you plan to continue working and have group health insurance through your employer, ask about how Medicare and your company’s coverage work together. You may be able to stay on your company plan and enroll in Medicare Part B at the same time. But be sure to check with your HR department for details. If you decide to forgo Medicare Part B, keep in mind that if your company health coverage ends and you don’t sign up for Medicare within eight months, you’ll have to pay a life-long penalty.

You only need to submit basic identifying information when applying for Medicare. The Social Security Administration uses verification from other sources to make sure you qualify. You can complete your application online, by phone, or in person at a local SSA office.

Medicare Part D Coverage

If you want to add Medicare Part D, an optional prescription drug coverage, you will need to fill out an additional form that can be obtained from the company offering the coverage. Most private companies will offer a plan finder tool that you can use to compare plans and choose the one that’s right for you.