Many people mistakenly believe that when they turn 65, they automatically get Medicare. That’s a myth. There are eligibility requirements and insurance and employment scenarios that make every individual’s situation unique. This is why you need to apply for Medicare. To do this, you need to have specific information and certain documents.
Let’s look at what documents and information are needed to apply for Medicare coverage and then complete your enrollment.
Medicare Eligibility: Automatic Enrollment vs. Submitting an Application
There are some people who are automatically enrolled in Medicare based on medical disability. Individuals who are receiving disability benefits or are already receiving Social Security or Railroad Retirement Board benefits when they turn 65 are automatically enrolled in federal Original Medicare coverage. You can learn more about disability status with Medicare benefits here.
Most people are eligible for Medicare based on age. You apply for Medicare benefits through the Social Security Administration (SSA) during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday month, includes your birthday month, and continues for three months after your birthday month.
Applying for Medicare is essentially proving and verifying your eligibility. This is why you’ll complete your application and initial enrollment for Medicare at the same time. You can also apply for retirement (or Social Security) benefits and spousal benefits at this time, all through the SSA.
The Documents and Information You Need to Apply for Medicare
There are several options of how and where to apply for Medicare: in person at your local SSA office, on the phone with the SSA’s toll-free number, or online through the SSA website. However you choose to apply, you’ll want to follow this checklist of information to create your Social Security account and complete your Medicare application:
Personal Identifying Information
- Full name: As listed on legal identification documents (e.g. your birth certificate, driver’s license, etc.)
- Social Security Number: You are applying through the Social Security Administration, so this is essential for setting up your Social Security account and Medicare application.
- Contact information: This would be your current U.S. mailing address, phone number (suggested) and email address (required if applying online).
Proof of Age
Your date of birth is personal identifying information, but it also determines when you are eligible to enroll in Medicare. Your original birth certificate or a certified copy are required for proof of age.
Proof of Citizenship or Legal Residency
To be eligible for Medicare benefits, you must be a legal U.S. citizen. Your birth certificate or U.S. passport can be used for proof of citizenship. If you are a U.S. citizen born outside of the U.S., proof of citizenship can be a Naturalization Certificate, Certificate of Citizenship, U.S. Consular Report of Birth Abroad, or U.S. passport. If you were born outside the United States and are not a U.S. citizen, you’ll need to provide your Permanent Resident Card number along with proof of having lived in the U.S. for at least five continuous years.
The Documents and Information You Need to Enroll in Medicare
America’s seniors are the primary beneficiaries of Medicare—retirees aged 65 and older whose health insurance coverage through an employer has likely ended. This is why information like your employment/retirement status, current health insurance coverage, and income are all relevant for enrolling in Medicare.
In addition to what you’ve already provided for your application eligibility, you’ll also need these documents and information to complete your initial enrollment for Medicare:
Work and Income History
Your work history is crucial for determining your eligibility for premium-free Medicare Part A, which covers inpatient hospitalization care. If you worked and paid Medicare tax for 10 years or more you’ll qualify for premium-free Part A coverage. Your income then determines what you’ll pay for Medicare Part B, medical insurance coverage. The Part B premium, deductible, and coinsurance rates are set annually based on income.
To prove your employment history and income earnings, you’ll need:
- W-2 forms or self-employment tax information from the past year
- A record of any earnings, including benefit payments
Additionally, your line of work and current benefits can impact how your Medicare benefits are implemented, as well as additional benefits you may be entitled to.
If applicable, you’ll need to disclose and provide documentation of the following:
- Railroad industry work: Applicable if you or a spouse has had any employment in the railroad industry. You may be eligible for railroad retirement benefits, which could impact how your Medicare benefits are coordinated. The Railroad Retirement Board manages and administers Railroad Medicare, while the Centers for Medicare & Medicaid Services manages Original Medicare, though the coverage and costs are the same.
- Federal pension payments: If you currently receive or expect to receive a federal pension, you’ll need to disclose this and provide relevant employment information. This can impact how your Medicare benefits are coordinated with your Federal Employees Health Benefits (FEHB) plan. Federal pensioners who choose to enroll in Medicare will have their benefits implemented through their FEHB plan.
- Social Security payments and benefit claims: You can access your Social Security statement by setting up a “My Social Security” account, which you’ll do if completing your Medicare application online. If you’re not already collecting Social Security, you still need to disclose if you have previously applied for Social Security benefits or if anyone has applied on your behalf.
- Military service: This information is needed for Social Security income earnings credits and is not required for Medicare enrollment. The Social Security Administration automatically adds extra earnings credits for military service after 1968. For service before 1968, the SSA needs documentation to prove service, such as discharge papers (DD-214).
Health Insurance Information
Medicare ensures you continue to have healthcare coverage as you age, but what if you still have health insurance when you turn 65? Perhaps you’re still working and covered by your employer’s plan, or you’re on your spouse’s plan.
This is why you’ll need to provide details about any current healthcare coverage:
- Current health insurance: Provide employment start and end dates with your (or your spouse’s) employer who is providing health insurance coverage through a Group Health Plan, and the start and end dates for this insurance coverage. For proof of coverage, you can provide your health insurance card with your name and employer’s name, or a letter from your employer stating your dates of employment and health coverage through them.
- Medicaid coverage: This is the government program providing health coverage to low-income individuals, regardless of age. If you currently have or previously had Medicaid coverage, provide your Medicaid number and the dates of coverage. You may be eligible for both Medicare and Medicaid as a low-income senior.
If you continue to have other healthcare coverage, you can defer your Medicare coverage during this Initial Enrollment Period and be eligible for a Special Enrollment Period later when your existing coverage ends. Even if you defer coverage, be sure to fully complete your initial enrollment. Missing your Medicare enrollment period timelines and deadlines can result in premium penalties, some of which you’ll pay for the life of your Medicare coverage.
Marital and Dependent Information
Medicare eligibility and coverage is on an individual basis; there are no family plans covering spouses and children. However, your marital status can impact your eligibility status and cost of Medicare coverage.
Therefore, you’ll need to provide information on your spouse and marital status, including:
- Current spouse’s information: Provide the name, Social Security number, and date of birth of your current spouse.
- Former spouse(s) information: Provide the name, Social Security number, date of birth, date and place of marriage, date of divorce or death for each former spouse. If your marriage lasted for more than 10 years or ended with the death of your spouse, you may be able to apply your former spouse’s work record to qualify for premium-free Part A coverage. A death certificate or divorce decree/divorce certificate may be needed to prove former marital status.
You cannot add dependents to your personal Medicare plan coverage, but you still need to provide your children’s information when enrolling in Medicare. This is to identify if there are any dependent children who might be able to qualify for Medicare independently based on your work record due to a disability or end-stage renal disease.
Children’s information: Provide the names and ages of any children under 18, children aged 18-19 still in high school, or children who had a disability before age 22.
Wandacare Can Assist with Your Medicare Application and Enrollment
If all this feels like a lot of information and documentation to pull together, well, it is! Here are some quick tips for preparing your paperwork:
- Start early! Begin gathering the needed docs and information before you turn 65.
- Be sure you have original documents (especially identifying and proof of citizenship docs like birth certificate, U.S. passport, or naturalization certificate) and make photocopies.
- Verify all document information is correct and matches Social Security records. The SSA can assist with this and advise on getting certified copies or requesting originals.
- Organize documents in a physical or digital folder, categorizing them with labeled sections or subfolders (e.g., birth certificate in “Identifying Docs,” W-2s in “Work History”).
- Review with a Medicare advisor who can double-check your documents and ensure you have everything needed to successfully verify, apply, and enroll!
Wandacare’s experienced Medicare advisors can assess your documentation to verify your eligibility and walk you through the application and enrollment process, ensuring your Medicare coverage.
