Turning 65: We’re Here to Help

When to apply for Medicare

Are you eligible?

You can apply for Medicare if you are a U.S. citizen or legal resident and meet one of the following criteria:

• Age 65 or older
• Younger than 65 with a qualifying disability
• Any age with a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) 
   

Legal residents must live in the U.S. as a lawful permanent resident for the five years prior to applying for Medicare.

Initial Enrollment Period (IEP)

You have a seven-month window, called the Initial Enrollment Period, to apply for Medicare. This window includes:

• The three months before the month you turn 65.
• The month you turn 65.
• The three months after the month you turn 65. 
   

If you don’t sign up within this window and don’t qualify for a Special Enrollment Period later, you may face late enrollment penalties for Parts A, B, and/or D.

Automatic enrollment

If you are already receiving Social Security or Railroad Retirement Board benefits four months before you turn 65, you will be automatically enrolled in Original Medicare Part A and Part B. Social Security will send you Medicare information and a Medicare card before your 65th birthday.

If you’re permanently disabled and you’ve been receiving Social Security Disability Insurance (SSDI) benefits for at least two years, you’re eligible for Medicare and you’ll be automatically enrolled in Medicare Parts A and B.

If you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, you’ll be automatically enrolled in Medicare Parts A and B the month your disability benefits begin, no matter your age.

If you have end-stage renal disease (ESRD), you’ll qualify for Original Medicare (Parts A and B), no matter your age. However, you’ll need to sign up for Medicare when you first become eligible, as enrollment is not automatic.

Key points to remember

Are you still working and have employer healthcare coverage?

If you plan to keep working and have healthcare coverage from your employer, the number of people who work for your company matters.

20 or more: When you work for a larger employer, you have choices. It’s a good idea to compare Medicare plans with what your employer offers. Remember to always check with your company’s benefits administrator before making any changes. In some instances, if you leave employer coverage for Medicare, you may not be able to return to your company’s plan.

Fewer than 20: In most cases, switching to Original Medicare will be your best option. First, you'll want to sign up during your Initial Enrollment Period. Then talk to us about Simply Medicare Advantage plans with benefits that include prescription drug and routine dental, vision, and hearing coverage.

Self-employed: If you're self-employed or on an individual plan, chances are you'll want Original Medicare when you turn 65, even if you're still working. Sign up during your Initial Enrollment Period. Then you can find the right Simply Medicare Advantage plan to add more coverage for prescription drugs, dental, vision, and hearing. Our plans typically cover the copays, coinsurance, and medical deductibles of Original Medicare.

Medicare is not Medicaid

Medicare is run by the federal government, and most people over 65 or those younger with certain conditions can enroll. Medicaid is mainly a state-run program for people of all ages with limited income or resources. It’s possible to have both.

If you already have Medicaid and are now eligible for Medicare, look into joining a Simply Dual Eligible Special Needs Plan (D-SNP). Our D-SNPs have $0 monthly premiums and include prescription drug and routine dental, vision, and hearing coverage.

They also include transportation¹ to plan-covered services and allowances for over-the-counter (OTC) health-related items, utilities,^2,3 and groceries.^2,3 Depending on your level of Medicaid assistance, most or even all your healthcare costs might be covered.

Plan availability, benefits, and benefit amounts may vary based on where you live, the plan you choose, and your eligibility.

¹ Transportation services are issued as one-way trips and provided on an annual basis. Benefits vary by plan.

² Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved groceries and utilities. Unused amounts will expire at the end of the month or quarter. Benefits vary by plan.

³ Depending on your plan, the benefits listed may be available through the Medicare Advantage Value-Based Insurance Design Model or to eligible members as Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as chronic kidney diseases, chronic lung disorders, cardiovascular disorders, chronic heart failure, or diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan's Evidence of Coverage.

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Y0114_25_3015400_0000_U_M CMS Accepted 4/7/2025