If you're a U.S. citizen aged 65 or older, you can get Medicare with or without Social Security.
The short answer to this question is yes, you can get Medicare even if you don’t receive Social Security benefits. The situation and enrollment process can be a bit different compared to those who are already receiving Social Security benefits when they become eligible for Medicare, so there is still more to say on this topic.
In this article, we explain everything you need to know about how Social Security and Medicare interact, so enrollment can be easy for you no matter your situation.
How are Social Security and Medicare related?
Medicare and Social Security offer different types of benefits, so how are they related? Medicare enrollment is actually processed by the Social Security Administration, or SSA.
Although the Centers for Medicare & Medicaid Services (CMS) oversees the Medicare program, they do not handle Medicare enrollment. Instead, CMS is in charge of various features of Medicare, such as the structure of Medicare benefits and overseeing insurance companies that provide Medicare plans.
In addition to handling enrollment, the Social Security Administration also processes Medicare payments. Many people who qualify choose to have their Medicare Part B premiums taken directly out of their Social Security benefit checks rather than paying them online or using another method.
In general, the way to think of these programs is that CMS decides what healthcare benefits Medicare beneficiaries receive as well as how much everything costs. The Social Security Administration processes Medicare applications and payments. SSA also administers the benefits and tracks eligibility of the relevant population.
If you want to know what’s going on with Medicare, you go to CMS, but if you have questions about your specific enrollment, you go to the SSA.
A note on the Railroad Retirement Board
The Railroad Retirement Board (RRB) is a government agency that provides benefits to retired railroad workers. Although it is distinct from Social Security, the RRB can also play into many of the Medicare eligibility requirements.
In most cases, when a Medicare guideline is contingent on receiving Social Security benefits, it is more accurate to say that it depends on Social Security or Railroad Retirement Board benefits.
Eligibility for Medicare
You are eligible for Medicare health insurance coverage if you are 65 or older and are a U.S. citizen or permanent legal resident. If you are already receiving Social Security retirement benefits at age 65, then you will also be eligible for premium-free Part A coverage. If you do not yet receive retirement benefits, you still qualify for premium-free Part A as long as you or your spouse worked and paid Medicare taxes for around 10 years.
Medicare is also available to individuals who have end-stage renal disease (ESRD). This is a type of kidney failure that requires dialysis or a kidney transplant.
Social Security Disability Insurance
When people discuss Social Security benefits, they are usually referring to retirement benefits. However, Social Security also administers disability benefits to qualified individuals.
A full discussion of this insurance program is outside of the scope of this article, but you can find some more details from the Social Security Administration page on disability insurance.
People who have received Social Security Disability Insurance (SSDI) benefits for 24 months are eligible for Medicare Part A and Part B, even if they aren’t yet 65 and don’t receive Social Security retirement benefits.
Individuals who qualify for SSDI coverage and have Lou Gehrig's disease (amyotrophic lateral sclerosis, or ALS) qualify to receive Medicare benefits sooner, starting on the first month of their SSDI coverage.
Enrolling in Medicare coverage after receiving Social Security benefits
If you began receiving Social Security benefits at least 4 months before turning 65, Medicare enrollment occurs automatically during your Initial Enrollment Period (IEP), which lasts for 7 months. It begins 3 months before the month you turn 65 and ends 3 months after your birth month. So, if you turn 65 on May 12, your IEP begins February 1 and ends on August 31. Move those dates forward one month if your birthday falls on the first (January 1 through July 21 if your 65th birthday is May 1).
Around the time that your Initial Enrollment Period begins, you should receive a package in the mail containing your Medicare card and other details about enrollment. This includes information on how to reject Medicare coverage. Be aware that in some cases, doing so may result in a late enrollment penalty.
The IEP is still important to remember, even if you're automatically enrolled, because this is also your opportunity to sign up for a Medicare Advantage, Part D, or Medigap plan.
How do I enroll in Medicare if I don’t receive Social Security benefits?
If you aren’t yet receiving Social Security benefits, you can still enroll in Medicare health insurance. To do this, you have to enroll manually, as there is no automatic enrollment for those who aren’t already receiving Social Security or Railroad Retirement Board benefits before they turn 65. Let's take a look at what your options are.
Remember the Initial Enrollment Period
It is important to remember that you will still have an Initial Enrollment Period in this situation. It is the same 7-month period that surrounds your 65th birthday.
Unless you have creditable health insurance elsewhere, your IEP is the best time to sign up for Medicare Part A and/or Part B (known as Original Medicare). This is also when you may join a Medicare Advantage or Part D prescription drug plan. If you choose to stay with Original Medicare plus Part D, you may also apply for a Medigap policy during your IEP.
What should I do during the Initial Enrollment Period?
If you don't already receive Social Security benefits when your Initial Enrollment Period comes around, you will have to contact the SSA to manually enroll. This can be done in three ways: online, in person, or by phone.
If you want to enroll by phone, you can call Social Security at 1-800-772-1213, or 1-800-325-0778 for TTY users. The SSA will walk you through what you need to enroll. Just make sure to have your identifying materials like your Social Security number at hand. Agents are available from 7 AM to 7 PM Monday through Friday.
The fastest, easiest way is to enroll online at the central Medicare page from the SSA. If you scroll down the page, you will find a link titled “Apply for Medicare Only”. This will take you through the application process. It takes less than 10 minutes and is available 24 hours a day, 7 days a week.
Lastly, you can enroll in person by visiting your local Social Security office. These, however, are closed due to the COVID-19 pandemic and have been since March of 2020. After they reopen, if you want to sign up in person, you should call ahead to schedule an appointment.
Each option provides the same result, so just choose whichever works best for you.
Enrolling outside of the Initial Enrollment Period
Medicare enrollment is restricted to specific periods. If you miss your Initial Enrollment Period, you may sign up during either the General Enrollment Period or a Special Enrollment Period, if you qualify for one.
The General Enrollment Period lasts from January 1 through March 31 each year and allows you to enroll in Part A and/or Part B for the first time. You then have from April 1 through June 30 to choose a Part D or Medicare Advantage plan. Your coverage begins on July 1, which may result in a late enrollment fee if you went 12 months without creditable health insurance (i.e. insurance that compares to Medicare in terms of cost and benefits).
You may also be eligible for a Special Enrollment Period (SEP). There are many ways to qualify for a Special Enrollment Period. For example, if you defer your coverage because you want to keep the medical insurance from your group health plan and are still working, then you should qualify for an SEP when that coverage ends. Find the full list of qualifying special circumstances on Medicare.gov.
If you are already enrolled in Medicare, you may make changes to your coverage during the Annual Enrollment Period (AEP), which lasts from October 15 through December 7. This includes:
- Signing up for an Advantage or Part D plan
- Switching to a different plan
- Leaving Part C to return to Original Medicare
In addition, if you already have a Medicare Advantage Plan, you may switch to a new one or return to Original Medicare during the Medicare Advantage Open Enrollment Period, which lasts from January 1st to March 31st. This will allow you to change to another Medicare Advantage plan or to Original Medicare.
Can I enroll in a Medicare Part D plan?
Original Medicare refers to Medicare Parts A and B, which cover hospital care and outpatient services, respectively.
Most Medicare beneficiaries also want prescription drug coverage, and a Part D prescription drug plan fills that need. These plans are offered by private insurance companies instead of the federal government, although CMS oversees the providers.
If you are eligible for Medicare, then you are eligible to buy a Part D plan. You have to shop for one of these plans on your own and compare benefits as you would another private plan. Our Find a Plan tool makes it easy to compare your Medicare plan options.
No one is automatically enrolled in a Part D plan, even if they are receiving RRB or Social Security benefits.
What about Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, is a way to receive your Medicare benefits through a private insurance company. Part C insurance plans have distinct pros and cons; only you know whether this is the best option for your unique needs.
If you have Medicare Parts A and B, you can buy a Medicare Advantage plan, even if you don’t receive Social Security benefits. As with Part D plans, our Find a Plan tool makes it easy to research your options.
Like Part D, there is no automatic enrollment for Medicare Advantage plans.
Whether you choose Medicare Advantage, Part D, or Medigap, you can compare your options with our Find a Plan tool. Just enter your zip code to review Medicare plans in your area.
Can I get a Medicare Supplement plan, too?
Medicare Supplement Insurance, also known as Medigap, helps pay your out-of-pocket costs under Original Medicare. Rather than covering healthcare directly, these plans help pay your share of costs for services covered by Medicare Part A and Part B.
These plans are also offered by private insurance companies. As with the other private Medicare offerings, you can buy these plans if you are eligible for Medicare, even if you don’t receive Social Security benefits of any kind.
It is relevant to note that if you want one of these plans, buying it during your Medigap Open Enrollment Period (OEP) is your best option. It's one of the rare times you have guaranteed issue rights. Your Medigap OEP begins the day you're both age 65 or older AND enrolled in Original Medicare.
When you have guaranteed issue rights, you don’t have to deal with medical underwriting. This means that the insurance company cannot deny you coverage or charge you more, even if you have pre-existing medical conditions. Unless you qualify for guaranteed issue rights, Medigap insurers do not have to sell a plan to you.
Medicare Supplement plans are only available to people with Original Medicare. If you have Medicare Advantage, you cannot purchase a Medigap plan.
Key things to remember
The main thing you need to keep in mind if you do not receive Social Security benefits but are eligible to enroll in Medicare is of your enrollment periods. Although you won’t be enrolled automatically, you will still be able to sign up for any part of Medicare in the same way that Social Security beneficiaries can.
You should also remember that you can have your Medicare premiums deducted automatically from your monthly benefit checks, greatly simplifying your Medicare experience. If you do not collect Social Security benefits, you can also do automatic billing with Medicare Easy Pay.
ClearMatch Medicare: Find a Medicare Plan
Find a Medicare plan in your area
It's FREE with no obligation