Learn about Eligibility and Enrollment

Not sure if you qualify for Medicare? Blue Cross Blue Shield of Michigan can help you understand who’s eligible and how you can sign up.

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Medicare eligibility

You're eligible for Medicare if any of these apply:

  • You're 65 or older. 
  • You have a long-term disability and have been on Social Security for more than two years. 
  • You have end-stage renal disease. 
  • You have Lou Gehrig’s disease, also known as ALS. 

Once you're eligible for Medicare, you can choose what parts and coverage you want to enroll in. Signing up for certain parts of Medicare may not make sense if you're still working and have insurance through your employer or your spouse’s. However, you may have to pay a penalty if you miss your enrollment period and don't meet certain requirements.

Make sure to talk to your employer, or a licensed agent, about the pros and cons of staying on your current medical benefits or switching to Medicare.

Then you should talk to your employer before you turn 65. Depending on the size of the company, some employers may require you to take full Medicare benefits when you turn 65. With others, you can wait until you retire to enroll in Medicare.

If your employer doesn't require you to take full Medicare benefits, you may still want to enroll in Medicare Part A. That's because if you or your spouse paid Medicare taxes for at least 10 years while working, then you qualify for free Part A. It can serve as secondary insurance which may cover things your primary insurance does not.

You should make that decision about enrolling in Part A carefully though because once you enroll in Medicare, you can no longer contribute to a health savings account, also known as an HSA. So if you have a high deductible health plan through your employer and an HSA that you still want to contribute money to, then you should delay enrolling in Part A.

You may have heard about penalties for late enrollment in Medicare. In most cases, those won't apply if you're still working and covered by a group health plan or if you qualify for free Medicare Part A. 

Yes, you can receive Medicare benefits through means other than your own employment history if you:

  • Meet the eligibility requirements and your spouse receives Medicare benefits
  • Are the dependent parent of a deceased child who was fully insured under Medicare
  • Have certain qualifying disabilities, which may allow you to qualify before age 65

If you don't fall in one of these groups, you can pay a monthly premium to receive Medicare Part A, in addition to your Part B premium, once you are 65. You may qualify for financial assistance to help pay premiums and out-of-pocket costs.

If you start working again after 65, you can continue receiving Medicare. You also may have the option to get coverage through your employer. If you're under 65 but receive Medicare because of a qualifying disability, you can keep your Medicare coverage for at least eight and a half years after you return to work, as long as your qualifying disability still meets Medicare standards.

You may be able to stay on your spouse’s insurance depending on the employer’s insurance policy. Even if you stay on their insurance, you may want to enroll in Part A and only delay signing up for Part B. When your spouse retires, you will have a special enrollment period and can sign up for Medicare. As long as you enroll in Part B during your special enrollment period, you won’t incur a late penalty. Make sure to check with your spouse’s employer for more information.

The eligibility requirements are the same as Original Medicare. Private insurers may have additional eligibility requirements when purchasing a Medicare Advantage, Medicare supplement or prescription drug coverage plan.

No, your spouse can't be added to your Medicare coverage — only one person can be on a Medicare plan, no matter the part. So your spouse can only enroll in Medicare if they also meet the eligibility requirements. If your spouse is younger than you when you turn 65, they are not eligible. If your spouse turns 65 before you and they don’t work, they may qualify to pay Part A without premiums based on your work record if you are at least 62.

When to enroll

Your initial enrollment period is the first opportunity to sign up for Medicare and lasts for seven months. It begins three months before your 65th birthday and ends three months after your 65th birthday. For example, if your birthday is in May, you could sign up between February and August.

During this time, you can sign up for Medicare Parts A and B and add on Part D prescription drug coverage, a Part C Medicare Advantage plan or a Medicare supplement plan.

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Initial enrollment period

If you miss your chance to sign up during your initial enrollment period, you can sign up for Parts A and B during the open enrollment period, which is Jan. 1 to March 31, although you may have to pay a late enrollment penalty. You can then sign up for Medicare Advantage or a prescription drug plan during the annual enrollment period, which is Oct. 15 to Dec. 7.

You may also qualify to enroll during a special enrollment period. There are many scenarios that warrant a special enrollment period, but the most common is that you were still working and had creditable coverage through your employer, or had coverage through your spouse’s employer, when you first turned 65. You can sign up for Parts A and B as well as add on additional coverage during that time.

You will be enrolled automatically in Original Medicare if:  

  • You're turning 65 and are receiving Social Security or Railroad Retirement Board benefits.  
  • You're under 65 and have received disability benefits for at least 24 months. Note that these do not have to be consecutive payments.  
  • You have Lou Gehrig’s disease, also known as ALS, and are receiving disability benefits. 

You’ll receive a Medicare card in the mail if you fall under one of those three categories. Keeping the card means you accept Original Medicare coverage, and you also agree to pay Part B premiums, unless you live in Puerto Rico.

You must tell Medicare if you decide to refuse or delay your Part B coverage by following the instructions on the back of your Medicare card. 

There may be penalties for enrolling late in Parts A, B and D. However, there's no penalty for enrolling late in a Medicare Advantage plan. If you didn't sign up for a Medicare Advantage plan during your initial enrollment period, you can do so each year during the annual enrollment period from Oct. 15 to Dec. 7.

Most penalties won't apply if you or your spouse are still working and are covered by an employer health plan.

You're not required to enroll in Medicare, but there are penalties if you don’t enroll when you become eligible. If you reject Medicare Part A, you may forfeit your Social Security benefits. If you delay enrolling in Parts B or D, you may have to pay higher premiums if you sign up later.

You only need to enroll in Original Medicare once. If you purchase additional coverage — Medicare Advantage, prescription drug coverage or Medicare supplement — through private insurance, you don't need to re-enroll in those plans each year. Your coverage will continue unless you disenroll or sign up for another plan.

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How to enroll

You can sign up for Original Medicare online or enroll in person at a Social Security office.

You can also make an appointment or enroll by phone:

1-800-772-1213
7 a.m. to 7 p.m.
Mondays through Fridays
TTY users call 1-800-325-0778.

You can choose to enroll in a Medicare Advantage, Medicare supplement or prescription drug plan through a private insurance provider after you sign up for Parts A and B. Each option has specific times that you can sign up after you become eligible and enroll in Medicare.

Some parts of Medicare may change from year to year, such as your monthly premium and deductible amounts. However, your Part B can’t exceed the amount that your annual Social Security cost of living adjustment increases, unless you pay a higher premium for having a higher income.

If you're enrolled in a Medicare Advantage or a prescription drug plan, your plan benefits and costs may change from year to year. Your insurer will send you a notification of these changes each fall, and you'll have the option to enroll in a different Medicare Advantage or prescription drug plan during the annual enrollment period from Oct. 15 to Dec. 7 each year. Your Medicare supplement plan premiums may also go up once a year.

During the annual enrollment period, which is from Oct. 15 to Dec. 7, you can change your Medicare Advantage or prescription drug coverage. If you only have Original Medicare, you can add on Medicare Advantage or prescription drug coverage during this time. 

There are also special enrollment periods if you need to make a change due to certain life events, like a move or losing employer insurance. These periods allow you to enroll outside of the designated initial enrollment period or general enrollment period without paying a penalty.

Medicare and Medicaid are two separate government-run programs that serve two different groups of people.

Medicare is a U.S. federal program that provides health coverage if you’re 65 and over, have a qualifying disability under the age of 65, end-stage renal disease, or Lou Gehrig’s disease, also known as ALS, no matter your income.

Medicaid is a state-run program that provides health coverage if your household income is below a certain level. Check with your local Social Security office to find out if you qualify for Medicaid or both Medicare and Medicaid.

Eligibility for Medicaid changes from state to state. In all states, Medicaid provides health coverage to qualifying low-income people at or below the federal poverty level.

If you're eligible for both Medicaid and Medicare, in most states you can enroll in a Dual Eligible Special Needs Plan, which offers the combined benefits available through both programs.

Coverage eligibility and income limits vary by state so it’s important to learn your state’s policy, which you can find at medicaid.gov.

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