Signing up for Part B: special conditions

Under certain special conditions, you may be able to sign up for Part B outside of regular enrollment periods.

I'm over 65 and I or my spouse is still working 

You may want to delay Part B if you or your spouse still work and have employer or union group health plan coverage. If you drop Part B, you can sign up for it again in the future during a Special Enrollment Period.

Make sure your group health plan coverage is in effect before you drop Part B. In this case, you won't have to pay a late enrollment penalty. Remember, when you drop Part B, your coverage ends the next month. Also, if you drop Part B after you turn 65, you won’t get another Medigap open enrollment period when you restart Part B. Get more information about Medigap.  

I'm under 65 and I or my spouse is still working 

If you're at least 62 and have worked at least 10 years in Medicare-covered employment, your spouse can get Part A and Part B at 65.

If you've worked at least 10 years in Medicare-covered employment but aren't yet 62 when your spouse turns 65, they won't be eligible for premium-free Part A until your 62nd birthday. In this case, your spouse should still apply for Part B at 65, so they can avoid paying a higher Part B premium.  

However, if you're still working and your spouse is covered under your group health plan, they could delay their Part B enrollment without paying higher premiums.  

Yes, you can enroll in Medicare. But if you've worked less than 10 years in Medicare-covered employment, you'll have to pay a monthly premium for Part A. If you choose Part B, you’ll also have to pay the Part B premium.

Enroll in Part A and Part B or find out how much your Part A premium will be.  

Generally, no. You can't get Medicare until you're 65. However, you may qualify for Medicare coverage if you're less than 65 if you have a disability or End-Stage Renal Disease (ESRD).  

I have End-Stage Renal Disease (ESRD)

You can get Part A and Part B no matter how old you are if your kidneys no longer work and you need regular dialysis or have had a kidney transplant, and one of these applies to you:

  • You've worked the required amount of time* under Social Security, the Railroad Retirement Board (RRB), or as a government employee.
  • You’re getting or are eligible for Social Security or Railroad Retirement benefits.
  • You’re the spouse or dependent child of a person who has worked the required amount of time* to be eligible for Medicare, or who is getting Social Security or Railroad Retirement benefits.

*Contact Social Security for more information about the amount of time required to be eligible for Medicare. If you get benefits from the Railroad Retirement Board (RRB), contact the Railroad Retirement Board.

If you're eligible for Medicare because of End-Stage Renal Disease (ESRD), you can enroll in Part A and Part B by contacting Social Security.

Enrolling in Medicare is your choice. However, you'll need both Part A and Part B for Medicare to cover certain dialysis and kidney transplant services.  

When you first enroll in Medicare based on End-Stage Renal Disease (ESRD) and you're on dialysis, your Medicare coverage usually starts the fourth month of dialysis treatments.

If you're covered by an employer group health plan, your Medicare coverage will still start the fourth month of dialysis treatments. Your employer group may pay the first 3 months of dialysis.

In some cases, your Medicare coverage can start earlier. For example, if you take a course in self-dialysis training or get a kidney transplant during the 3-month waiting period, your Medicare coverage may start earlier.  

If you have Medicare only because of kidney failure, your Medicare coverage will end during one of these periods:

  • 12 months after the month you stop dialysis treatments
  • 36 months after the month you had a successful kidney transplant

Your Medicare coverage won't end if either of these happen:

  • You have to start dialysis again or get a kidney transplant within 12 months after the month you stopped getting dialysis
  • You continue to get dialysis or get another kidney transplant within 36 months after a transplant
Note

For Medicare to pay for kidney dialysis and some transplant services, you need both Part A and Part B.  If you don't pay your Part A premium or if you choose to cancel it, your Part B will end.  

Yes. You can enroll in Part B without paying a late enrollment penalty if you apply for Medicare and are approved based on End-Stage Renal Disease (ESRD). Contact Social Security to enroll.

I'm under 65 and have Medicare because of a disability 

If you're under 65 and have a disability, you're automatically enrolled in Part A and Part B after you get Social Security or Railroad Retirement benefits for 24 months. Your Medicare card will be mailed to you about 3 months before your 25th month of disability benefits. If you don't want Part B, follow the instructions that come with the card.  

If you're under 65 and have ALS, you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.  For more information about disability benefits, contact Social Security or the Railroad Retirement Board.  

If you're still getting disability benefits when you turn 65, you won't have to apply for Part B. Medicare will enroll you in Part B automatically. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If you don't want Part B, follow the instructions that come with the card.  

If you're not getting disability benefits and Medicare when you turn 65, contact Social Security to sign up for Medicare.

You should get the "Initial Enrollment Package" that includes your Medicare card about 3 months before your 65th birthday. If you don't want Part B, follow the instructions that come with the card. If you're covered under your working spouse's (or family member's) employer large group health plan (the employer has at least 100 employees), you may want to delay enrolling in Part B.    

A family member includes domestic (or life) partner, as long as you have large group health plan coverage through your partner’s current employer. 

Yes. You can keep your Medicare coverage for as long as you’re medically disabled. If you return to work, you won't have to pay your Part A premium for the first 8 ½ years. After that, you’ll have to pay the Part A premium.  

If you can't afford the Part A premium, you may be able to get help from your state. You may be eligible for the Medicare Savings Program called Qualified Disabled and Working Individuals Program (QDWI).

Get more information about Medicare coverage for working people with disabilities.

If you have a disability, have Part A, and have current employer or union group health coverage, you can sign up for Part B during the Special Enrollment Period.  

This period is available if you waited to enroll in Part B because you, your spouse, or family member were working and had large group health coverage through an employer or union (with at least 100 employees) based on this current employment.  

Getting Supplemental Security Income (SSI) doesn't make you eligible for Medicare. SSI provides a monthly cash benefit and health insurance coverage under Medicaid.

Your spouse may qualify for Medicare the same way as if they didn't have SSI. Your spouse may qualify for Medicare when they turn 65 or have been receiving disability benefits for 24 months.  

If there are 100 employees or more in your spouse's company, you can sign up for Part B during the Special Enrollment Period without paying a penalty anytime you're still covered by an employer or union group health plan, through your or your spouse (or family member's) current employment, or during the 8 months following the month that the employer or union group health plan coverage ends, or when the employment ends (whichever is first).

If there are less than 100 employees in your spouse or family member's company, you may not be eligible to enroll during the Special Enrollment period, and you may have to wait until the General Enrollment Period to enroll in Part B. You may have to pay a 10% Part B premium surcharge (penalty) for each 12-month period that you could have had Part B but didn't take it, except in special cases. You'll have to pay this extra amount as long as you have Part B.  

When you sign up for Part B, you automatically begin your Medigap open enrollment period.  

I have retiree coverage

Yes. When you become eligible for Medicare, you'll need to enroll in both Part A and Part B to get full benefits from your retiree plan. Your retiree plan usually offers benefits that fill in Medicare's gaps in coverage and sometimes include extra benefits, like prescription drugs. Remember, retiree coverage is not a Medigap policy.

If you're not sure how your plan works with Medicare, get a copy of your plan's benefits booklet. For more information how your retiree coverage works, call your benefits administrator.  

Enrolling in Part B is your choice. Federal retirees are offered the same benefits as all other retirees. You can enroll in Part B during your Initial Enrollment Period. Get more information about how FEHBP works with Medicare from the U.S. Office of Personnel Management.

I live outside the U.S.

In some cases, you may have to pay a higher premium. It will depend on your situation. Listed below are 3 possible situations:

Example

You're over 65, currently getting Social Security retirement benefits and Part A, and you didn't take Part B when you were first eligible. You may only apply for Part B from January 1–March 31 each year, and you may have to pay higher premiums.  

Example

If you're over 65, and are eligible for Social Security benefits, you may file an application for monthly benefits and Part A.You'll have to file for Part B from January 1–March 31 and you may have to pay higher premiums.  

Example

If you're a U.S. citizen, over 65, not eligible for Social Security benefits, and you lived in a foreign country when you turned 65, you must live in the U.S. to file for Part B. You're first eligible to enroll in Part B the month you return to the U.S. to establish your new residence. You won't have to pay a higher premium if you enroll in Part B when you first return to the U.S.

I have coverage through the Health Insurance Marketplace

No. It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. This is true even if you have only Part A or only Part B. If you want coverage designed to supplement Medicare, learn more about Medicare supplement (Medigap) insurance policies. You can also learn more about other Medicare options, like Medicare Advantage Plans.

You can get a Marketplace plan to cover you before your Medicare begins. You can then cancel the Marketplace plan once your Medicare coverage starts.

Once you’re eligible for Medicare, you’ll have an initial enrollment period to sign up. In most cases it’s to your advantage to sign up when you’re first eligible because:

  • Once you’re eligible for Medicare, you won’t be able to get lower costs for a Marketplace plan based on your income.
  • If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty for Part A and/or for Part B for as long as you have Medicare.
Note

You can keep your Marketplace plan after your Medicare coverage starts. However, once your Part A coverage starts, any premium tax credits and reduced cost-sharing you get through the Marketplace will stop.

Coverage from an employer through the SHOP Marketplace is treated the same as coverage from an employer group health plan. If you’re getting health coverage from an employer through the SHOP Marketplace based on you or your spouse’s current employment, Medicare Secondary Payer rules apply.

Yes. You can delay enrollment if you’re getting health coverage from an employer through the SHOP Marketplace based on you or your spouse’s current employment. You have a Special Enrollment Period to sign up for Part B without penalty.