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As of March 2023, over 65 million people are enrolled in Medicare, according to the Centers for Medicare and Medicaid Services (CMS). If you’re approaching the age of 65 or have been diagnosed with an eligible disability, you may have plans to enroll in Medicare for access to affordable and convenient health insurance.
Below we dive deep into what you need to know about when Medicare coverage starts.
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What Is Medicare?
Medicare is a health insurance program funded and operated by the federal government for U.S. citizens and legal residents who are at least 65 years old. It’s also available for younger individuals who have a qualifying disability or illness, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). The program includes a variety of health insurance options, including Original Medicare (Part A and Part B), Medicare Advantage, Medicare Supplement and Medicare Part D.
“As the baby boomer generation ages, it’s estimated that over 80 million people will be eligible for Medicare by 2030,” says Jeff Collins, vice president of government programs at MVP Health Care in New York. “Ensuring that people have access to affordable care will play a critical role in the financial and health security of millions of older Americans and younger people with disabilities.”
When Does Medicare Coverage Start?
A number of factors determine when your Medicare coverage begins.
Turning 65
“Your initial enrollment period is your first chance to sign up for Medicare, typically when you turn 65,” says Yvonne Tepsick, owner of Tepsick Insurance Agency in Florida. “This period lasts for seven months: the three months before your 65th birthday month, the month of your 65th birthday and the three months following your 65th birthday.”
Once you request enrollment, in most cases, coverage begins the first day of the month following when you completed the enrollment process. Therefore, coverage could begin any time during a person’s seven-month initial enrollment period, as well as the one month following it.
Living With a Qualifying Disability
If you’re not yet 65 but have a disability that qualifies you for Social Security Disability Insurance (SSDI), you’re automatically eligible to receive Medicare coverage after you receive SSI benefits for 24 months. If you have ALS, you become eligible to request Medicare coverage at the same time you become eligible for disability benefits. If you’ve been diagnosed with ESRD, you can usually apply for Medicare on the first day of the fourth month of your dialysis treatments.
Once you request enrollment, you can expect your coverage to start the first day of the following month.
Missing Your Initial Enrollment Period
If you miss your initial enrollment period, you can still enroll in Medicare Part A at any time. However, to enroll in other parts of Medicare, such as Part B or Medicare Advantage, you must wait until the general open enrollment period, which runs from from October 15 to December 7, or pay a monthly late enrollment fee (unless you qualify for a special enrollment period.
Once you request enrollment, your coverage begins the first day of the subsequent month.
Qualifying for a Special Enrolment Period
A special enrollment period allows you to enroll in premium-free Medicare Part A and Part B after certain life events, such as moving, getting married or losing other health coverage, without incurring a late fee.
Coverage typically begins the first day of the month after you complete the enrollment process.
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- Compare plans online
- Plan options from Aetna, Anthem, BCBS, Cigna, Humana, and more
- Call to speak to a licensed insurance agent. TTY 711, Mon-Sun 8 am - 11 pm EST
Who Is Eligible for Medicare Coverage?
You must be at least 65 years old to qualify for Medicare unless you have a qualifying disability or illness.
“If you worked at least 40 quarters (or 10 years) where you paid Social Security taxes, you qualify for premium-free Part A coverage, which means you don’t owe a monthly premium for this portion of your insurance,” says Tepsick. “If you collect Social Security, you’re automatically be enrolled in both Medicare Part A Part B. Otherwise, you need to contact your local Social Security office to sign up.”
How to Enroll In Medicare
If you start collecting Social Security benefits when you turn 65, you’re automatically enrolled in Medicare and receive your card in the mail. Otherwise, you need to request enrollment.
Visit the Social Security Administration’s website and complete the online application. Once you submit your application, you can track its status online via the same website. You can also apply for Medicare benefits by calling 1(800) 772-1213 or visiting a Social Security office near you to apply. If you prefer the in-person route, it’s best you make an appointment.
“A licensed insurance agent can assist you with adding to or replacing your Original Medicare [coverage] with a Medicare Advantage plan or a Medicare Supplement plan for more [comprehensive] coverage,” adds Tepsick.
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