Health Care


Some people get Part A and Part B automatically

If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically
get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month,
Part A and Part B will start the first day of the prior month.) If you’re under 65 and disabled, you’ll automatically get
Part A and Part B after you get disability benefits from Social Security for 24 months or certain disability benefits from the RRB for 24 months.

If you’re automatically enrolled, you’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or 25th month of disability benefits. If you’re going to wait to get Part B, follow the instructions that
come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums. See
pages 22–23 for help deciding if you should wait to get Part B.

If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you’ll get Part A and Part B
automatically the month your disability benefits begin.

Some people have to Sign Up for Part A and/orPart B

If you’re close to 65, but not getting Social Security or Railroad Retirement Board (RRB) benefits and you want Part A and Part B, you’ll need to sign up. Contact Social Security 3 months before you turn 65.
You can also apply for Part A and Part B at socialsecurity.gov/retirement. If you worked for a railroad, contact the RRB.

If you have End-Stage Renal Disease (ESRD), you’ll need to sign up. Contact Social Security to find out when and how to sign up for Part A and Part B. For more information, visit Medicare.gov/publications to view the booklet “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.” You can also call 1-800-MEDICARE (1‑800‑633‑4227) to find out if a copy can be mailed to you. TTY users should call 1‑877‑486‑2048.

If you live in Puerto Rico and get benefits from Social Security or the RRB, you’ll automatically get Part A the first day of the month you turn 65 or after you get disability benefits for 24 months. However, if you want Part B, you’ll need to sign up for it. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. See page 28. Contact your local Social Security office or RRB for more information.

Note: To get Part A and/or Part B, you must be a U.S. citizen or lawfully present in the U.S.

Where can I get more information?
Call Social Security at 1-800-772-1213 for more information about your Medicare eligibility and to sign up for Part A and/or Part B. If you worked for a railroad or get RRB benefits, call the RRB at 1‑877‑772‑5772.
TTY users should call 1‑312‑751‑4701. Visit Medicare.gov for general information about enrolling.
If I’m not automatically enrolled, when can I sign up?
If you want Part A and/or Part B, you can sign up during these times:

Initial Enrollment Period

You can sign up for Part A and/or Part B 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 Part A and/or Part B 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.
If you enroll in Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Medicare coverage will be delayed.

General Enrollment Period

If you didn’t sign up for Part A and/or Part B (for which you must pay premiums) when you were first eligible, you can sign up between January 1–March 31 each year. Your coverage will begin July 1 of that year. You may have to pay a higher Part A and/or Part B premium for late enrollment. See pages 26 and 28.

Special Enrollment Period

If you didn’t sign up for Part A and/or Part B when you were first eligible because you’re covered under a group health plan based on current employment (your own, a spouse’s, or a family member’s if
you’re disabled), you can sign up for Part A and/or Part B: Anytime you’re still covered by the group health plan During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first Remember, if you live in Puerto Rico, you don’t automatically get Part B. You must call Social Security at 1‑800‑772‑1213 to sign up for it. TTY users should call 1‑800‑325‑0778.

Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period doesn’t apply to people with End-Stage Renal Disease (ESRD). See page 20. You may also qualify for a Special Enrollment Period if you’re a volunteer serving in a foreign country.

COBRA coverage and retiree health plans aren’t considered coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends. To avoid paying a higher premium, make sure you sign up for Medicare when you’re first eligible. See page 100 for more information about COBRA coverage.

To learn more details about enrollment periods, visit Medicare.gov/publications to view the fact sheet “Enrolling in Medicare Part A & Part B.” You can also call 1‑800‑MEDICARE (1‑800‑633‑4227) to find out if a copy can be mailed to you. TTY users should call 1‑877‑486‑2048.

Should I get Part B?
The following information can help you decide.
Employer or union coverage—If you or your spouse (or family member if you’re disabled) is still working and you have health coverage through that employer or union, contact your employer or union benefits administrator to find out how your coverage works with Medicare. This includes federal or state employment, but not military service (unless
on active duty). It may be to your advantage to delay Part B enrollment. You can sign up for Part B without paying a penalty any time you have health coverage based on current employment. COBRA and retiree health coverage don’t count as current employer coverage. See page 24 to find out how your other insurance will work with Medicare.

Once the employment or coverage ends (whichever happens first), 3 things happen:

1. You have 8 months to sign up for Part B without a penalty. This period will run whether or not you choose COBRA. If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends, you may have to pay a penalty after you enroll for as long as you havePart B. You won’t be able to enroll until the next General Enrollment Period, and you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in your health care coverage.

2. You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan (in most cases for only 18 months) and probably at a higher cost to you. If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you’re already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare, unless you have End-Stage Renal Disease (ESRD).

3. When you sign up for Part B, your Medigap Open Enrollment Period begins. See below.
TRICARE—If you have Part A and TRICARE (insurance for active-duty military, military retirees, and their families), you must have Part B to keep your TRICARE coverage. However, if you’re an active-duty service member, or the spouse or dependent child of an active-duty service member: You don’t have to enroll in Part B to keep your TRICARE
coverage while the service member is on active duty. Before the active-duty service member retires, you must enroll in
Part B to keep TRICARE without a break in coverage. You can get Part B during a Special Enrollment Period if you have
Medicare because you’re 65 or older, or you’re disabled. You should enroll in Part A and Part B when you’re first eligible
based on ESRD.

When can I get a Medicare Supplement Insurance (Medigap) Policy?
Medicare Supplement Insurance (Medigap) policies, sold by private insurance companies, help pay some of the health care costs that Medicare doesn’t cover. You have a one-time, 6-month Medigap Open Enrollment Period that starts the first month you’re 65 and enrolled in Part B. This period gives you a guaranteed right to buy any Medigap policy sold in your state regardless of your health status. In most cases, once this period starts, it can’t be delayed or restarted. See pages 67–71 for more information about Medigap.