Turning 65 is a significant milestone, and it’s also the age when many people become eligible for Medicare. However, not everyone is automatically enrolled in Medicare when they reach this age. Let’s explain and help you understand whether you’ll be automatically enrolled or if you need to take action.

Who Is Automatically Enrolled in Medicare?

You will be automatically enrolled in Medicare Part A and Part B if you meet one of the following criteria:

  • You are already receiving Social Security or Railroad Retirement Board benefits at least four months before turning 65.
  • You are under 65 and have been receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months.
  • You have been diagnosed with ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s disease) or if you have ESRD (End Stage Renal Disease).

If you meet any of these requirements, you will receive your Medicare card in the mail about three months before your 65th birthday or your 25th month of disability benefits.

What if I do not meet the criteria for Automatic Enrollment?

If you do not meet the criteria for automatic enrollment, you will need to manually enroll in Medicare.You can manually enroll during your 7-month Initial Enrollment Period (IEP), which begins three months before your 65th birthday, includes your birthday month, and ends three months after your birthday month.

What If I Miss My Enrollment Period?

If you miss your 7-month IEP, you may have to wait to sign up and pay a monthly late enrollment penalty. The penalty goes up the longer you wait.

What If I’m Still Working and Have Employer-Sponsored Health Insurance?

If you or your spouse are still working and have health insurance through your employer when you turn 65, you may be able to delay enrolling in Medicare without penalty. This is known as a Special Enrollment Period (SEP). However, it’s essential to check with your employer’s benefits administrator to understand how your current coverage works with Medicare and to ensure you won’t face any penalties for delaying enrollment.

The Bottom Line

Automatic enrollment in Medicare is not universal. It depends on your individual circumstances.  If you’re not automatically enrolled, it’s crucial to understand your enrollment periods and take action to sign up for Medicare when you become eligible. By doing so, you can avoid gaps in coverage and potential penalties.

Remember, if you have questions about your specific situation, you can always contact the Social Security Administration or your local Medicare office for guidance, or an independent agent that specializes in Medicare.