Medicare faq's

 General Eligibility Requirements:  To qualify for Medicare, you must be a U.S. citizen or a legal permanent resident who has lived in the United States continuously for at least five years. Beyond residency, you must meet one of the following criteria: 

• Age 65 or Older: This is the most common way to qualify. Even if you are still working, you are typically eligible to enroll starting three months before your 65th birthday.
• Disability: If you are under 65 and have received Social Security Disability Insurance (SSDI) or certain Railroad Retirement Board (RRB) disability benefits for 24 months, you become eligible for Medicare in your 25th month of disability.
• Specific Medical Conditions:
  • ALS (Lou Gehrig’s Disease): Eligibility begins automatically the same month your disability benefits start.
  • End-Stage Renal Disease (ESRD): Individuals of any age with permanent kidney failure requiring dialysis or a transplant can qualify. 

Who Qualifies for Premium-Free Part A?  While Medicare eligibility is broad, receiving "premium-free" Part A (hospital insurance) depends on your or your spouse's work history. You qualify if: 

• You or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
• You are eligible for or already receiving Social Security or RRB retirement benefits.
• If you do not meet the work requirement, you can still enroll in Part A but must pay a monthly premium (up to $518 in 2025/2026 depending on work history). 

Automatic vs. Active Enrollment

• Automatic: If you already receive Social Security or RRB benefits at least four months before turning 65, you are automatically enrolled in Parts A and B.
• Active: If you are not receiving Social Security benefits, you must sign up during your Initial Enrollment Period, which begins three months before you turn 65.

 If you are turning 65, you have a 7-month window to sign up for Medicare Parts A and B. This period:

• Begins: 3 months before the month you turn 65.
• Includes: Your birth month.
• Ends: 3 months after the month you turn 65.

Note: If your birthday falls on the first day of the month, your enrollment window and coverage start date shift one month earlier.  

 1. Determine if You Are Automatically Enrolled:  You do not need to do anything to sign up if:

• You have received Social Security or Railroad Retirement Board (RRB) benefits for at least four months before turning 65.
• You are under 65 and have received disability benefits for 24 months.
• You have ALS (Lou Gehrig's disease). 

In these cases, your Medicare card will be mailed to you approximately three months before your 65th birthday or your 25th month of disability. 

2. Active Enrollment (If Not Receiving Social Security):  If you are not receiving Social Security benefits, you must manually sign up during your Initial Enrollment Period (IEP). This is a 7-month window: three months before your 65th birthday month, the month of your birthday, and three months after. How to Apply:

• Online (Fastest): Create or sign in to your personal "my Social Security" account and select "Apply for Medicare Only". The application typically takes about 10–30 minutes.
• By Phone: Call the Social Security Administration (SSA) at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday, 8 a.m. to 7 p.m..
• In Person: Visit your local Social Security office. Appointments are strongly recommended to avoid long wait times. 

3. Information and Documents You May Need:  While the SSA already has some of your information, have the following ready to ensure a smooth application:

• Personal Details: Social Security number, date and place of birth.
• Proof of Citizenship: Original birth certificate or U.S. passport (legal residents will need a Green Card).
• Work History: W-2 forms or self-employment tax returns from the last two years.
• Current Health Insurance: Details about any employer group health plans if you are still working. 

4. Special Situations (Working Past 65):  If you or your spouse are still working and have "creditable" employer health coverage, you may be able to delay Part B without penalty. When you eventually stop working, you will have an 8-month Special Enrollment Period to sign up for Part B. You will likely need to submit Form CMS-L564, signed by your employer, to prove you had prior coverage.