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Medicare Eligibility

Most people are eligible to get Medicare when they reach the age of 65. Some people who are younger (ages 18 to 65) and have certain disabilities that prevent them from working can also get Medicare. To get Medicare Parts A & B (Original Medicare), you must meet the following criteria.

Citizenship

You must:

  • Be a United States citizen OR
  • Have been living in the United States legally for at least 5 years nonstop.

At What Age Can I Get Medicare?

You must be:

  • Age 65 or older, OR
  • Over 18 and under age 65 AND meet one of these conditions:
    • Have received Social Security disability benefits, or SSDI, for at least 2 years, OR
    • Have been diagnosed with Lou Gehrig’s Disease, also called Amyotrophic Lateral Sclerosis (ALS), AND
      • Are starting to get Social Security disability. Usually you can get Medicare the 6th month after Social Security found that your disability started, OR
    • Have been diagnosed with End Stage Renal Disease, sometimes called ESRD, AND
      • Have been on dialysis for 3 months OR
      • Have had a kidney transplant.

The details of Medicare eligibility go beyond just turning 65 and being a United States citizen. Your situation is unique, but you may find one or more of the scenarios below apply to you.

I’m eligible for Medicare, but need coverage for my non-working spouse.

Medicare is individual, not group/family, insurance. To get Medicare, a person must be eligible based on age or disability. Therefore, anyone who qualifies to receive Medicare can get it – regardless of work history.

However, Medicare is not free. Everyone pays premiums for Part B and for Part C (Medicare Advantage), Part D (drug coverage) and for Medigap (supplemental insurance) if you choose that coverage.

Most people can enroll in Part A premium-free, based on work history, since Part A is paid for through payroll taxes. Under certain conditions, a spouse, divorced spouse, widow or widower or a dependent parent may be eligible for Medicare premium-free Part A when they turn 65, based on their spouse’s work record.

I’m about to turn 65 and retire. My wife, who doesn’t work, is currently covered under my employer insurance, but she’s only 62. What will she do for insurance when I enroll in Medicare?

Because your wife is only 62, she cannot enroll in Medicare yet. She will need to buy some other form of coverage until she becomes eligible for Medicare.

One option is for your wife to explore buying coverage through the Health Insurance Marketplace in your state. Depending on your household income, she may qualify for subsidies that can help offset the cost of insurance.

You may also want to speak with your current insurance plan about obtaining COBRA (continuation coverage) for your wife.

My non-working husband is about to turn 65 (I’m 63). Can he still get Medicare before me on my work record?

If you have worked for at least 10 years and paid Medicare (FICA) taxes, AND you are at least age 62, your spouse can get Medicare Parts A & B when he turns 65. If you have worked at least 10 years but are not yet age 62 when he turns age 65, he will not be eligible for premium-free Part A until you are age 62. He should still enroll in Medicare Parts B and D, however, in order to avoid a penalty later on.

However, if you are still working and your husband is covered under your group health plan, he could delay enrollment in Part B to avoid paying higher premiums.

I’m turning 65 and still working.

More and more people are working past the age of 65. This is especially true now that people turning 65 this year must wait until they are 66 years old to collect full retirement benefits from Social Security.

Whether or not you continue to work, you can still get Medicare when you turn 65, and you still need to make some important decisions about enrollment. You should start to think about these decisions at least 3 months before your 65th birthday.

Do I need to take Medicare now?

If you are still working after you turn 65 (or your spouse is still working) for a company with 20 full-time workers AND you get health insurance from them, you may not need all of Medicare when you turn 65. You can delay Part B or Part D and get them later on when you retire or if you lose your job-related insurance.

Most people should enroll in Medicare Part A when they turn 65, even if they have employer health insurance, because it is free for most people. It’s free because you’ve paid in through payroll deductions while you work. If you have insurance through a job, Medicare Part A may not pay much toward your healthcare costs because Part A generally pays after your job’s insurance.

If you get insurance from your (or your spouse’s) job, be sure and talk with them first. See how your job’s insurance may change when you get Medicare, even Medicare Part A.

Should I delay Part B?

Most people should enroll in Part B when they first become eligible for Medicare both to have coverage and to avoid having to pay a late enrollment penalty. But there is one reason to consider waiting. You may want to wait if:

  • You or your spouse is still actively working for a company with 20 or more workers when you turn 65 (or 100 or more workers if you are under 65 and receiving Social Security Disability payments) and
  • You get health insurance through your job or your spouse’s job. In this instance, your employer coverage will be primary to Medicare coverage.

What is the effect of delaying Part B?

  • You may save money. There is a monthly premium for Part B. If you already get health coverage through your job or your spouse’s job, you may not need Part B coverage. Check with your human resource department to find out, or get personal help.
  • You can delay your Medigap Open Enrollment Period. Many people without retiree coverage purchase supplements to Medicare that cover some or all of Medicare’s deductibles and coinsurance. This is called Medigap insurance. When you first sign up for Part B, you are entitled to a six-month Open Enrollment Period to purchase Medigap insurance without any reference to your health status, including pre-existing conditions. After that Open Enrollment Period, Medigap insurers can charge you more or deny you coverage based on your health status. You only get one Open Enrollment Period, so be sure not to miss it.

Who should not enroll in Part A when they turn 65?

Some people have a kind of health insurance through their work called a Health Savings Account (HSA). If you have an HSA, you may not want Medicare Part A right away because neither you nor your employer can contribute to your HSA account once you enroll in Part A. It is really important for you to speak with your job’s human resources department to see how Medicare may change your benefits.

What if I have a Health Savings Account (HSA)?

Some people have a kind of health insurance through their work called a High-deductible Health Plan with a Health Savings Account (HSA). Funds contributed to an HSA are not subject to federal income tax and must be spent on qualified medical expenses. You cannot contribute to an HSA after enrolling in Medicare Parts A and/or B. However, you can continue to withdraw accumulated funds and spend them on qualified medical expenses, including Medicare deductibles and coinsurance.

If you contribute to an HSA and are eligible to join Medicare Part A, you need to know about receiving Social Security (SS) benefits (a check), Part A retroactive coverage, and an IRS tax penalty. Receiving SS benefits triggers Part A enrollment, which cannot be declined. You can, however, delay receiving SS benefits and therefore Part A enrollment.

An IRS penalty applies if you enroll in Part A more than 6 months after your 65th birthday. You will be automatically and retroactively enrolled in Part A for 6 months. The retroactive coverage results in a tax penalty for any HSA contributions made during the automatic 6 month retroactive coverage period. To avoid this penalty, stop contributions to your HSA 6 months prior to joining Medicare Part A.

For more detail about HSA rules, visit the HSA IRS website.

What if I work for a small company or am self-employed?

If you work for a small company (less than 20 employees) or are self-employed, you will probably need to take Medicare Part B in addition to Part A when you turn 65.

If you are buying insurance through the Health Insurance Marketplace, you will no longer be eligible for a subsidy to help pay your insurance premium once you become eligible for Medicare.

I have Medicare. How does it work with my employer insurance?

If you have Medicare and other health insurance or coverage, each type of coverage is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide which one pays first.

If the group health plan didn’t pay all of your bill, the doctor or healthcare provider should send the bill to Medicare for secondary payment. Medicare will look at what your group health plan paid and pay any additional costs up to the Medicare-approved amount. You’ll have to pay whatever costs Medicare or the group health plan doesn’t cover.

I am a veteran with VA benefits.

If you are a veteran or family member of a veteran, you may have healthcare coverage either through VA benefits (administered through the Department of Veterans Affairs), TRICARE (administered through the Department of Defense) or CHAMPVA (administered by the Department of Veterans Affairs Chief Business Office Purchased Care). Medicare coordinates with these programs in different ways. See sections below for TRICARE and CHAMPVA information.

How do Medicare and VA benefits work together?

Though veterans with VA benefits are encouraged to get Medicare Parts A & B, Medicare and VA benefits do not cover the same services together. With extremely limited exceptions, the VA will not pay for services obtained from non-VA providers (doctors and hospitals). Likewise, Medicare will not pay for care received at VA facilities. Veterans who want treatment or care from non-VA providers should join Medicare Parts A & B.

Not all veterans are eligible for the same level of VA services. VA priorities may shift based on congressional appropriations, and veterans in lower-level priorities could see changes (possibly decreases) in their benefits over the years. If a veteran were to lose their VA coverage and join Medicare Parts A & B, then 10% late enrollment penalties apply for both Parts A & B for each year of delayed enrollment.

I have VA benefits. Do I need to enroll in Medicare Part A?

Medicare Part A covers inpatient hospitalizations, hospice and skilled nursing care from non-VA providers. Veterans who worked and paid Federal Insurance Contributions Act (FICA) tax for 40 quarters (about 10 years) qualify for Medicare Part A with no monthly premium cost because they paid for it while working.

Be sure to join Part A if you’re eligible for it premium free at age 65 because there are Part A late enrollment penalties.

I have VA benefits. Do I need to enroll in Medicare Part B?

Medicare Part B pays for outpatient care from non-VA providers and has a monthly premium. Medicare assigns a 10% late enrollment penalty when people do not join Part B when they’re first eligible, generally at age 65. The penalty grows every year a person waits to enroll; for example, waiting four years results in paying 40% more each month.

There are three ways to avoid the penalty:

  • Sign up when first eligible
  • Qualify for a Medicare Savings Program to pay the premiums and penalties
  • Those under age 65 eligible for Medicare due to a disability get a “do-over” when they turn 65 and can join Part B during their Initial Enrollment Period

Medicare allows enrollment delays for persons currently working with employer insurance or with insurance through their spouse’s employer. Be sure to check the rules about the number of employees and enrollment periods. Eligible veterans can delay enrollment and avoid penalties (different rules apply for TRICARE and CHAMPVA).

To learn more about your VA benefits and Medicare enrollment, contact the Department of Veterans Affairs online or at 1-877-222-8387.

I have both Medicare and VA coverage. Who pays first?

If you have or can get both Medicare and VA benefits, you can get treatment under either program. You must choose which system to use each time you see a doctor or get healthcare. Medicare only pays for care delivered by Medicare-certified facilities. To get the U.S. Department of Veterans Affairs (VA) to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility.

If the VA authorizes services in a non-VA hospital but doesn’t pay for all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered part of the services the VA doesn’t pay for. Medicare may also be able to pay all or part of your copayment if you’re billed for VA-authorized care by a doctor or hospital who isn’t part of the VA.

I get my prescriptions from the VA. Do I need Medicare Part D prescription drug coverage?

Persons enrolled in Medicare Part A and/or B (you are not required to have both A & B to get D) can join Medicare Part D. Typically, veterans use the VA prescription drug benefits because it has lower out-of-pocket costs than Medicare Part D. However, you may want to join Part D to obtain prescription drugs in these situations:

  • Your prescriptions are not listed on the VA formulary (or available through the VA)
  • You take prescription drugs prescribed by non-VA physicians and fill the prescriptions at a local retail pharmacy
  • You qualify for Extra Help, and therefore Part D offers drug copayments lower than VA copayments

If you want to join a Part D plan, you can sign up during your Initial Enrollment Period. If you want to join after your Initial Enrollment Period, you can sign up during the Open Enrollment Period, which runs Oct. 15 – Dec. 7 every year.

VA coverage is creditable coverage, meaning there are no late enrollment penalties for joining Part D later. You will need to provide a letter of creditable coverage to the Part D Private Insurance Company if you join Part D outside your Initial Enrollment Period.

To print a copy of the letter, visit the Veterans Administration website for the VA Creditable Coverage Letter. Download the letter

I’m turning 65 and NOT working.

If you retire or are unemployed before you turn 65, there are some things you need to know about your eligibility to join Medicare. You cannot get Medicare until you turn 65, unless you cannot work because of an illness or medical condition and have received Social Security disability benefits (SSDI) for two years, or you have been diagnosed with Lou Gehrig’s disease or End Stage Renal Disease.

If you are already getting Social Security benefits, like early retiree or disability benefits, when you turn 65:

  • You will be automatically enrolled in Medicare Parts A & B. You do not need to do anything. Your Medicare card and “Welcome to Medicare” kit will come in the mail usually the month before your 65th birthday.

If you are not yet getting Social Security benefits when you turn 65:

  • You must apply for Medicare. It is wise for you to enroll during your Initial Enrollment Period. If you wait to sign up, you may have to pay penalties in the form of higher monthly premiums when you do join.

Either way, once you enroll in Medicare Parts A & B, you should also review the other options in Medicare, such as Part D prescription drug coverage. You can also choose to enroll in a Part C plan or Medigap plan. You may also want find out more about programs to help you cover your Medicare costs.

I am a veteran with TRICARE.

If you are eligible for both TRICARE and premium-free Medicare Part A, you will need to have Medicare Part B in most cases to remain eligible for TRICARE. The only exceptions are if:

  • Your sponsor is on active duty
  • You’re enrolled in the US Family Health Plan
  • You’re enrolled in TRICARE Reserve Select

If you fall into one of these categories, you are not required to have Medicare Part B to remain eligible for TRICARE.

When you have Medicare Parts A & B, you will be covered by TRICARE For Life (TFL), TRICARE’s Medicare-wraparound coverage available to all Medicare-eligible TRICARE beneficiaries, regardless of age or place of residence.

When you first become eligible for Medicare, it is important that you talk to your TRICARE benefits administrator to learn how Medicare enrollment affects your coverage.

Find out more about eligibility for both Medicare and TRICARE on the TRICARE site. Or contact your DMDC Support Office at 1-800-538-9552.

I have TRICARE For Life. Who pays first: TFL or Medicare?

For services covered by both Medicare and TRICARE, Medicare pays first and TRICARE For Life pays your remaining coinsurance for TRICARE-covered services.

For services covered by TRICARE but not by Medicare, TRICARE For Life pays first and Medicare pays nothing. You must pay the TRICARE fiscal year deductible and cost shares.

Be aware, though, that by law, Medicare cannot pay for care at a government facility. When you use TRICARE For Life to receive care for a non-service-connected condition from a VA facility, even when the VA facility is in the TRICARE network, the VA cannot bill Medicare.

Tricare pays for my prescription medications. Do I need Medicare Part D prescription drug coverage?

The prescription coverage through Tricare does not change after a veteran, or eligible family members, join Medicare Part A & B and switch to Tricare For Life (TFL). Most prefer to use TFL prescription drug benefits because it has lower out-of-pocket costs than Medicare Part D.

TFL coverage is creditable coverage for Medicare Part D, meaning there are no late enrollment penalties for joining Part D after your Initial Enrollment Period. If you want to join a Part D plan, you can sign up during your Initial Enrollment Period or during the Open Enrollment Period, which runs Oct. 15 – Dec. 7 every year. You will need to provide a letter of creditable coverage to the Part D Private Insurance Company if you join Part D outside your Initial Enrollment Period.

I’m losing my existing coverage.

If you are about to lose your current coverage but are not yet eligible for Medicare, you may be able to buy insurance through the Health Insurance Marketplace in your state. In the Marketplace, you can shop for affordable plans and find out whether you qualify for subsidies that can help you pay for your coverage or Medicaid.

If you buy a plan through the Marketplace, you should receive a notice before you turn 65 letting you know when to enroll in Medicare.

I’m already eligible for Medicare, but didn’t sign up because I was working and had employer coverage. But I’m about to retire. Am I going to be penalized for signing up now?

If you delayed taking Medicare when you were first eligible because you were actively working and had employer-based coverage, you can still enroll later on. You should have a Special Enrollment Period in which to enroll without a penalty.

COBRA and retiree health plans are not considered coverage based on current employment. That means that you are not eligible for a Special Enrollment Period when your COBRA ends.

I am a veteran with CHAMPVA.

Determining whether you need to join Medicare Parts A & B with CHAMPVA varies based on your circumstances as follows:

  • Persons with disabilities under age 65 eligible for Medicare and CHAMPVA must join Medicare Parts A & B to keep CHAMPVA, and
  • Rules about keeping CHAMPVA after age 65 are based on the year of your birth and eligibility for Medicare Part A.

More details are available on the CHAMPVA and Medicare Fact Sheet. Download the fact sheet.

CHAMPVA always pays secondary to (or after) Medicare Parts A & B.

To avoid late enrollment penalties for Medicare Parts A & B, sign up during the first time available to you, usually your Initial Enrollment Period.

How does CHAMPVA work with Medicare Part D?

Persons enrolled in Medicare Part A and/or B (you are not required to have both A & B to get D) can join Medicare Part D. Typically, CHAMPVA prescription drug coverage has lower out-of-pocket costs than Medicare Part D. However, you may want to join Part D to obtain prescription drugs in these situations:

Be sure to review this CHAMPVA and Part D Fact Sheet to learn more about the impact on CHAMPVA Meds by Mail too.
Read the facts

  • Your prescriptions are not listed on the VA formulary (or available through the VA)
  • You take prescription drugs prescribed by non-VA physicians and fill the prescriptions at a local retail pharmacy.

If you want to join a Part D plan, you can sign up during your Initial Enrollment Period. If you want to join after your Initial Enrollment Period, you can sign up during the Open Enrollment Period, which runs Oct. 15-Dec. 7 every year.

CHAMPVA coverage is creditable coverage, meaning there are no late enrollment penalties for joining Part D later. You will need to provide a letter of creditable coverage to the Part D Private Insurance Company if you join Part D outside your Initial Enrollment Period.

To print a copy of the CHAMPVA Creditable Coverage Letter, download a copy.

I’m under 65 and have a disability.

Some people living with a disability who are under age 65 may be able to enroll in Medicare. These are people who:

  • Receive Social Security Disability Insurance (SSDI)
  • Have been diagnosed with Lou Gehrig’s Disease, also called Amyotrophic Lateral Sclerosis (ALS)
  • Have end-stage renal disease (ESRD)

I get SSDI. Does that mean I can enroll in Medicare?

First, make sure to check your benefits—SSDI and SSI are two different programs.

Social Security Disability Insurance (SSDI) gives income to people who are found disabled and unable to work. People who have worked long enough are eligible to get this benefit from Social Security. SSDI benefits usually start 6 months after you are found disabled.

People who have not worked long enough to be eligible for SSDI may be eligible for SSI or Supplemental Security Income. The SSI program also gives income to people who have very limited resources to help them meet their daily needs. You can usually get Medicaid from your state when you get SSI but you do not qualify for Medicare until you turn 65.

After you get SSDI benefits for 2 years (24 months), you can get Medicare. You do not have to do anything to enroll in Medicare. You will automatically be enrolled. Your Medicare card should arrive usually around the 23rd month that you get disability benefits. Your Medicare benefits begin the 25th month you get SSDI.

If your Medicare card does not come by the 24th month, contact Social Security at 1-800-772-1213.

Once you are enrolled in Medicare Parts A & B, you should review the other options, such as getting Part D prescription drug coverage.

I have (or may get) COBRA coverage.

If you have COBRA, you should plan to enroll in Medicare during your Initial Enrollment Period when you turn 65. Or if you (or your spouse) delayed taking Medicare at age 65 because you were actively working and covered under group insurance, you should plan to enroll in Medicare when you stop actively working, as you will have a Special Enrollment Period then.

COBRA and retiree health plans are not considered coverage based on current employment. That means that you are not eligible for a Special Enrollment Period into Medicare when your COBRA ends.

Should I get COBRA coverage?

Whether and when you should elect COBRA coverage can be a very complicated decision. When you lose employer coverage and you have Medicare, you need to be aware of your COBRA election period, your Parts B and D enrollment periods and your Medigap Open Enrollment Period. These may all have different deadlines that overlap, so be aware that what you decide about one type of coverage (COBRA, Part B, Part D and Medigap) might cause you to lose rights under one of the other types of coverage.

I have Medicare and COBRA continuation coverage. Who pays first?

If you or your spouse are retired and have COBRA continuation coverage, Medicare pays first.

If you have Medicare based on End-Stage Renal Disease (ESRD), COBRA pays first. Medicare pays second to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD.

I’m under 65 and am living with ALS.

The 24-month “waiting period” for someone to receive Medicare after getting Social Security Disability Insurance (SSDI) does not apply to people with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease).

If you are diagnosed with Lou Gehrig’s disease, you will receive SSDI benefits 6 months after being found disabled by Social Security. Your Medicare benefits will also start at this time.

You do not have to do anything to enroll in Medicare. You will automatically be enrolled. Your Medicare card should arrive usually around the 4th month that you get disability benefits. Your Medicare benefits begin the 6th month you get SSDI.

If your Medicare card does not come by the 5th month, contact Social Security at 1-800-772-1213.

Once you are enrolled in Medicare Parts A & B, you should review the other options, such as getting Part D prescription drug coverage.

Will Medicare cover home healthcare for ALS?

Medicare covers home healthcare services only under specific conditions. A doctor must certify that you need occupational therapy, speech therapy, physical therapy or intermittent skilled nursing care.

Many people with ALS have a need for one or more of these types of therapies. If you do, you may be able to get some care at home.

I am living in a nursing home.

Medicare helps pay for the costs of many services, however, it pays a limited amount of long-term support services and generally doesn’t pay for most nursing home care.

Under certain limited conditions, Medicare will pay some nursing home costs for those who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare-certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least 3 days.

Do I need to apply for or keep my Medicare if I’m entering a nursing home?

You will want to enroll in or keep your Medicare coverage if you’re entering a nursing home. Even if it does not cover nursing home care, you’ll need health coverage for hospital care, doctor services, rehabilitation services and medical supplies while you are in the nursing home.

If you have Medicare and live in a nursing home or other institution, you may still want to enroll in a Part D plan to cover the costs of your drugs. If you aren’t able to join a Part D plan on your own, your authorized representative can enroll you in a plan that meets your needs.

If you’re in a skilled nursing facility getting Medicare-covered skilled nursing care, your medical care and prescriptions generally will be covered by Part A.

Long-term care pharmacies contract with Medicare prescription drug plans to provide drug coverage to nursing home residents. If you’re entering, living in or leaving a nursing home, you’ll have the opportunity to choose or switch your Medicare drug plan. This allows you to choose a plan that contracts with your nursing home’s pharmacy.

How do I pay for long-term nursing home care?

There are several ways to pay for long-term nursing home care:

  • Personal resources: You can use your savings to pay for care. You may also want to check with your life insurance company to see if your policy can help pay for long-term care.
  • Medicaid: People with limited incomes and resources may be able to get Medicaid. Not all nursing homes accept Medicaid payment. To find out if you can get Medicaid, contact your state Medicaid office.
  • Long-term care insurance: Long-term care insurance can vary widely. Some policies may cover only nursing home care. Others may include coverage for a whole range of services, like adult day care, assisted living, medical equipment and informal home care.

I’m under 65 and am living with ESRD.

Regardless of age, if you have been diagnosed by your doctor with end-stage renal disease (ESRD) and are on dialysis for 3 months or have had a kidney transplant, you are automatically eligible for Medicare.

You do not have to collect Social Security Disability Insurance (SSDI) benefits to get Medicare if you have ESRD. This is because some people with ESRD continue to work and never apply for disability benefits. Either way, you are eligible for Medicare. The start date of your Medicare benefits depends on the type of treatment you get.

If you get health insurance through your job (or your spouse’s job), you should talk with your human resources department to find out how your benefits may change if you enroll in Medicare. In general, your job’s health insurance will continue to pay first for 30 months (2.5 years). You may want to delay Medicare.

Once you are enrolled in Medicare Parts A & B, you should review the other options, such as getting Part D prescription drug coverage.

Can I join a Medicare Advantage plan?

If you have ESRD, you’ll usually get your healthcare through Medicare Parts A & B (Original Medicare). You can only join a Part C (Medicare Advantage) plan in certain situations:

  • If you’re already in a Medicare Advantage Plan when you develop ESRD, you may be able to stay in your plan or join another plan offered by the same company.
  • If you’re already getting your health benefits (for example, through an employer health plan) through the same organization that offers the Medicare Advantage Plan.
  • If you had ESRD but have had a successful kidney transplant and you still qualify for Medicare benefits (based on your age or a disability), you can stay in Original Medicare or join a Medicare Advantage Plan.
  • You may be able to join a Medicare Special Needs Plan (SNP) for people with ESRD if one is available in your area.

Does Medicare cover kidney dialysis and transplants?

Medicare covers a wide range of services related to kidney dialysis and transplants. To get this coverage, most people must be enrolled in Original Medicare.

Learn about these services and their costs in the official Medicare publication,
Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.
Download the publication.

I receive Railroad Retirement (RR) Benefits.

If you receive RR benefits, you will automatically be enrolled in Medicare when you turn 65. Your monthly Part B premium will be taken out of your Railroad Retirement benefit check each month. (If you receive RR disability benefits, you will be auto-enrolled into Medicare after 24 months on disability.)

If you do not want to enroll in Part B at that time, you will have to inform Social Security of that, following instructions that are included on the letter you will receive with your Medicare card. (A reason to delay Part B enrollment is, for example, that you or your spouse is working and has coverage through a large employer that will remain primary until the work ends.)

To learn more about Medicare and your RR benefits, contact your local office of the Railroad Retirement Board or 1-877-772-5772, or visit them online.

I’m a federal, state or local government worker.

Employees and retirees of the federal, state and/or local government have special considerations to make around Medicare. These considerations may be affected by when you were hired, what state you live in and whether you paid into Medicare through your payroll taxes.

You can learn more about how your government employee/retiree coverage coordinates with Medicare in the official Medicare publication Who Pays First.
Download the publication

I’m a federal employee/retiree with Federal Employee Health Benefits (FEHB) or the spouse of such an employee/retiree. Should I enroll in Medicare when I turn 65?

Medicare decisions for federal employees/retirees with FEHB and their spouses may differ depending on their work status (currently working or retired). The Office of Personnel Management encourages both workers and retirees to enroll in Part A, since they paid for it while working, and there is no additional premium. In most cases, FEHB will pay first and Part A second for those still working; the reverse will generally be true for those who are retired.

You have the option to enroll in other parts of Medicare. It is worth your time to review the financial considerations of enrolling in different parts of Medicare, including whether you will incur any penalties for late enrollment.

The Office of Personnel Management has a helpful list of questions and answers for how to weigh those options and how Medicare coverage and FEHB coverage work together.
Learn about Medicare and FEHB coverage

What if I work for a state or local government?

If you are a state or local government employee/retiree who was hired after March 31, 1986, then you are eligible for Medicare coverage. Before this date, state and local government employees were exempt from paying Federal Insurance Contributions Act (FICA) payroll taxes that help to pay for Medicare Part A. Therefore, if you were hired after this date, as long as you have enough working credits, you will be eligible for premium-free Part A.

Prior to March 31, 1986, state and local government employees were exempt from paying the FICA tax. Some states entered into agreements (called Section 218 Agreements) with Social Security, essentially to pay toward the Part A portion so these employees would be eligible for Medicare.

Social Security lists all states that currently have a Section 218 Agreement in place; the extent of coverage, however, varies. If you were employed or retired prior to March 1986, you should contact your local Social Security Administration office or your state Office of Personnel to find out the extent of the agreement in your state.

You can learn more about this in the Social Security publication How State and Local Government Employees Are Covered by Social Security and Medicare Download the publication

I have Medicaid.

You can get both Medicaid and Medicare, as long as you continue to qualify for both programs. Medicaid will act as your supplemental coverage for Medicare.

In addition, because you have Medicaid, you also will be able to get help with costs through other programs, such as Extra Help, which helps to pay for your prescription drug costs. You may also be eligible for having your Part B premium paid.

Some states are now beginning programs that provide additional, more flexible services, including a personal case manager, for persons who have both Medicare and Medicaid (known as “dual eligibles”). Be sure to read the mail that you receive describing these programs.

Your local Medicaid agency can give you additional information about whether these programs are right for you. If you join and are not satisfied, you are free to disenroll at any time, with the disenrollment becoming effective the month following the month in which the disenrollment request is received.

I am a U.S. citizen living outside of the United States.

Medicare provides coverage for services within the United States. It does not generally cover any care outside of the country. If you live outside of the United States, you should look into purchasing insurance that covers the cost of care in the country in which you live.

Be aware that if you plan to move back to the United States in the future, it may advisable to sign up for Medicare when you are first eligible. In most instances, if you do not sign up for Part B then and subsequently move back and want to enroll, you may have to pay a penalty based on the time you went without Part B. You will have to continue to pay this penalty for as long as you have Medicare.

I live in Puerto Rico.

If you live in Puerto Rico and receive Social Security or Railroad Retirement benefits at age 65, you will automatically be enrolled in Part A. However, if you wish to receive Part B, you must apply for it. You must elect Part B during your Initial Enrollment Period, or you will pay a higher premium due to a penalty, unless you qualify to have a Special Enrollment Period later on.

I have retiree coverage.

If you have other retiree coverage that is not from the federal/state/local government, you’ll need to enroll in both Part A and Part B to get full benefits from your retiree plan. Your retiree plan usually offers benefits that fill in Medicare’s gaps in coverage and sometimes includes extra benefits, like prescription drugs. Remember, retiree coverage is not a Medigap policy.

If you’re not sure how your plan works with Medicare, get a copy of your plan’s benefits booklet. For more information about how your retiree coverage works, call your benefits administrator.

I am going to be released from the prison system soon.

The Social Security Administration (SSA) suspends Social Security benefits (checks) for persons incarcerated more than 30 days in a row in jail or prison due to a criminal offense. Medicare Part A continues for incarcerated Medicare beneficiaries at no cost for most people (no withholding from the SSA check).

However, your Medicare Part B will end if you don’t pay your monthly premiums directly to SSA. If Medicare Part B ends, then you have the following rights on release:

  • Join Medicare Part B during the General Enrollment Period between January 1 – March 31, with coverage starting July 1. If the break in Medicare coverage lasted longer than a year, then a penalty will be assessed for each year.
  • Contact the Social Security Administration to restart Social Security benefits. If your institution has a pre-release agreement with the local Social Security office, you can apply prior to your release date to allow time for application processing.
  • If you kept Medicare Part A during your incarceration, then you have a Special Enrollment Period for 2 months following your release to join a Medicare Part D (prescription drug plan).
  • If you kept Medicare Part A and paid premiums to keep Medicare Part B during your incarceration, then you have a Special Enrollment Period for 2 months following your release to join a Medicare Part D (prescription drug plan) or a Part C (Medicare Advantage) plan.

For additional information, see SSA’s publication What Prisoners Need to Know. Download the publication.

If you’re a recently released Medicare beneficiary, you should check your eligibility for Medicare Savings Programs to help pay the Medicare Part B premium and penalties and Extra Help to help pay for the costs of Medicare Part D.

Next Steps:

Learn When to Enroll  or  Learn How to Enroll