New to Medicare?
Everything you need to know about Medicare to make an informed decision.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
Medicare has different parts that help cover specific services. Understanding these parts will help you make the best decision for your healthcare needs.
Understanding Medicare Parts
Medicare Part A
Hospital Insurance
Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B
Medical Insurance
Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage)
Medicare Advantage Plans
An alternative way to get your Medicare benefits through private insurance companies approved by Medicare. Often includes Part D prescription drug coverage.
Medicare Part D
Prescription Drug Coverage
Helps cover the cost of prescription drugs. Available as stand-alone plans or included in Medicare Advantage plans.
Medicare Eligibility
Original Medicare Eligibility Requirements
You may qualify for Original Medicare (Part A and Part B) if you meet one of the following pathways:
Age-based pathway (most common)
- Are age 65 or older, and
- Are a U.S. citizen, or a lawful permanent resident who has lived continuously in the United States for at least 5 years
Disability pathway
- Have received Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits for 24 months (Medicare begins in the 25th month)
Special medical conditions
- ALS (Lou Gehrig’s disease): Eligible the same month SSDI benefits begin — no 24-month waiting period
- End-Stage Renal Disease (ESRD): Eligible under specific conditions, generally starting the 4th month of dialysis (or earlier with a kidney transplant or self-dialysis training)
Note on Part A premiums
Meeting the eligibility requirements above qualifies you for Medicare. Whether Part A is premium-free depends on your (or your spouse's) work history:
- •40+ quarters of Medicare-covered employment → premium-free Part A
- •30–39 quarters → reduced Part A premium ($285/month in 2026)
- •Fewer than 30 quarters → full Part A premium (up to $518/month in 2026)
Part B always requires a monthly premium ($202.90 standard in 2026, higher with IRMAA).
Citizenship & Residency Requirements
A person generally must be:
Either:
- U.S. citizen
OR
- Lawfully present permanent resident
AND
- Continuously reside in the U.S. for at least 5 years before Medicare application
Important Operational Medicare Concepts
Automatic Enrollment
Some people are automatically enrolled in Medicare if they:
- Already receive Social Security retirement benefits
OR
- Already receive SSDI (Social Security Disability Insurance)
Others must enroll manually.
Enrollment Periods
Initial Enrollment Period (IEP)
7-month period that includes the 3 months before you turn 65, your birth month, and the 3 months after.
Annual Enrollment Period (AEP)
October 15 - December 7 each year. You can make changes to your Medicare coverage, including switching to Medicare Advantage or back to Original Medicare.
Open Enrollment Period (OEP)
January 1 - March 31. If you're in a Medicare Advantage Plan, you can switch to another Medicare Advantage Plan or return to Original Medicare.
Special Enrollment Period (SEP)
Available in certain circumstances, such as moving to a new area, losing other health coverage, or qualifying for Extra Help.
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