However, qualifying for Medicare isn’t automatic and you aren’t automatically enrolled, as there are different eligibility criteria depending on which Part (A, B, C, or D) you’re enrolling in. There are also requirements to be met depending on your unique circumstances. That’s why it’s important to know when you become eligible, and when you can enroll. Otherwise, you may not have the coverage you need when you need it, or you may face penalties for enrolling late.

Aging into Medicare

Most of the time, people meet Medicare’s eligibility requirements the year they turn 65.

If you age into Medicare and began collecting Social Security benefits at least four months before the month you turn 65, your enrollment is automatic. Otherwise, you must enroll in Medicare.

You will not be notified by Medicare that it’s time to enroll, so it’s important to know when your Initial Enrollment Period (IEP) starts and ends, and other times throughout the year when you can sign up. If you don’t enroll in Medicare when you’re eligible, you could face late enrollment penalties.

Keep in mind that your age isn’t the only eligibility requirement. You must also be a U.S. citizen or permanent, legal resident who has lived in the U.S. for at least five years.

You or your spouse must have paid the Medicare Payroll Tax for at least 10 years to earn the 40 credits necessary to qualify for premium-free Part A.

If you did not earn 40 credits, you’ll pay a monthly premium for Part A.

If you were born between 1948 and 1954, full retirement age is 66. If you were born after 1954, you won’t reach full retirement age until 67. In either case, you’ll still be eligible for Medicare once you turn 65.

When you can sign up for Medicare if you're 65

There are three periods throughout the year when you can enroll in Medicare if you’re 65:

• Your IEP begins three months before the month you turn 65 and ends three months following your birthday, for a total of seven months. So, for example, if your birthday is in February, your IEP begins in November 1 and extends through May 31. Coverage then starts the first day of the month of your 65th birthday, or in this case, February 1.
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• If you don’t enroll in Medicare during your IEP, you may qualify for a Special Enrollment Period (SEP). However, you must meet certain requirements to be eligible, such as having been covered under a group health plan based on current employment. When you enroll in Medicare during an SEP, your coverage will begin the month after Social Security gets your request.
• If you miss your IEP and don’t qualify for an SEP, you’ll have to wait for the General Enrollment Period (GEP) which happens from January 1 through March 31. Your coverage will then begin July 1 of that year. However, in most cases if you enroll during the GEP, you’ll have to pay late enrollment penalties for as long as you have Part B.

Qualifying for Medicare before age 65

There are other ways to qualify for Medicare before turning 65, such as having a qualifying disability, ESRD, or ALS (amyotrophic lateral sclerosis, more commonly known as Lou Gehrig’s disease).

While the time you can enroll in Medicare depends on the reason you qualify, the same rules apply as for an IEP. You can enroll over a seven-month period surrounding your eligibility date.

Note that while you will be enrolled in or can opt to enroll in Part A and/or Part B, you must also choose a Part D prescription drug plan unless you have creditable drug coverage elsewhere. Otherwise, you’ll have to pay a Part D late enrollment penalty.

Creditable drug coverage means it compares to Medicare in terms of both cost and coverage.

Permanently disabled and received (or been entitled to) disability benefits

You can get Medicare before you turn 65 if you have a qualifying disability. If you’ve been receiving or entitled to disability benefits for at least two years (24 months), you’ll automatically be enrolled in Part A and Part B on the first day of the 25th month. That two-year period begins the first month you receive a Social Security Disability Insurance (SSDI) check.

Related Reading:How Long It Takes to Get Medicare If You Have a Disability

End-stage renal disease

ESRD is permanent kidney failure that requires dialysis treatment or a kidney transplant. You are not automatically enrolled in Medicare, but you can sign up if you have ESRD. You must also:

• Have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
• Be getting or are eligible to receive Social Security or RRB benefits, or are the spouse or dependent child who has worked the required time/is getting Social Security or RRB benefits.

Once enrolled, your coverage begins the third month after the month in which a regular course of dialysis begins, or the first month of a regular course of dialysis (if the person engages in self-dialysis training), or the month of a kidney transplant, or two months prior to the month of a transplant (if hospitalized during those months to prepare for the transplant).

Can I enroll in a Medicare Advantage plan with ESRD?

As of 2021, you can join a Medicare Advantage plan if you have ESRD, even if you haven’t turned 65. Medicare Advantage plans offer everything Medicare Part A and Part B does and more, with extra benefits including things like hearing and vision coverage, hearing aids, travel coverage, and gym/fitness memberships.

ALS

Having amyotrophic lateral sclerosis automatically qualifies you for Part A and Part B the month your disability benefits begin. There is no waiting period or other qualifications, meaning you do not have to wait two years before starting benefits. Medicare will start when your disability benefits start.

However, if you or your spouse did not pay Medicare taxes while you worked, you must meet other eligibility criteria in order to buy Part A.

Compare your Medicare plan options

If you’d like to learn more about Medicare plans in your area, one of our licensed agents will answer your questions and help you find the right plan for you. Or, you can scroll through your options with our Find a Plan tool. Just enter your zip code to get started.