Medicare eligibility FAQ

You must meet certain criteria to enroll in Medicare. Below are a few common examples of how people qualify. You may be eligible for Medicare if:
 

• You are age 65 or older.
• You have a qualifying disability for which you have been receiving Social Security Disability Insurance (SSDI) for more than 24 months.
• You have been diagnosed with end-stage renal disease (permanent kidney failure requiring a kidney transplant or dialysis).
• You have been diagnosed with ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease).  

Medicare enrollment can be a different process depending on the benefits you receive leading up to your 65^th birthday. If you received Social Security or Railroad Retirement benefits outside of 4 months before turning 65, you have automatic enrollment in Medicare. If not, you’ll have to sign up for Medicare on your own.

Medicare Part C (Medicare Advantage) builds on the Medicare benefits of Parts A and B, combining existing benefits and adding new ones. To be eligible for Medicare Advantage enrollment, you must be enrolled in Parts A and B (Original Medicare) and live inside the plan’s service area. If you do qualify, a private company like Aetna® will manage your benefits after enrollment.

Once you are enrolled in Medicare Part A or Medicare Part B, you are also eligible for Medicare Part D. You are encouraged to enroll in a Medicare prescription drug plan unless you have other creditable prescription drug coverage. If you don’t enroll during your Initial Enrollment Period, and do not have creditable prescription drug coverage, Medicare may add a Part D late enrollment penalty to your monthly Part D premium.

If you have limited income and resources you may qualify for the Extra Help program to pay for your prescription drug costs. Extra Help members do not pay any late enrollment fee.

Medicare supplement (Medigap) eligibility depends on age and current plan enrollment. If you’re 65 or older and enrolled in Medicare Part B, you are eligible for Medigap. You may also qualify for a Medicare Supplement plan if you are under 65 and have a disability.

Medicare’s Initial Enrollment Period is a 7-month window that starts 3 months before you’re first eligible. As an example, you can first sign up for Medicare during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you sign up for Medicare during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.

Yes, you can enroll in Medicare while still working. You can keep your employer’s group health plan after age 65 and enroll in Medicare part A as soon as you become eligible. This will help you avoid the premium through payroll deductions. Once you turn 65, you should also enroll in Medicare Part B to avoid the late-enrollment penalty.