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New to Medicare Enrollment Criteria

Initial Enrollment Period

The Initial Enrollment Period for Medicare is any of the following:

  • Three months before your 65th birthday
  • The month of your 65th birthday
  • Three months after your 65th birthday

Social Security Information

If you are not receiving a Social Security benefit due to age or disability, you will need to contact Social Security to enroll in Medicare. To enroll, visit the Social Security Administration website, call 1-800-722-1213 or go in person to your local Social Security office (currently closed due to COVID-19). If you are a younger person receiving a Social Security Disability (SSDI) check, you will automatically receive your Medicare card about three months before the 25th month of receiving the SSDI check. If you elected to receive your Social Benefit retirement benefit prior to age 65, you will automatically receive your Medicare card about three months before your 65th birthday.

For more information, watch the ABCs of Medicare video designed for persons new to Medicare.

Special Enrollment Period

If you or your spouse (or family, if under age 65 and on SSDI) continued to work beyond your Initial Enrollment Period for a large employer (20 or more employees if 65 or older, or 100 employees if under age 65) and the employed person has decided to retire, you may sign up for Medicare Part B any time while the employed person is working, or for eight consecutive months after the group health coverage/employment has ended.

Due to COVID-19, the Social Security Administration has created a new online service. Part of the process will be to complete CMS-40B and CMS-L564 forms by paper or online. If the employer is unable to sign the CMS-L564 form to provide the evidence of group health coverage, you may complete the form and provide evidence of group health coverage and dates of employment. The online option requires your digital signature and a valid email address. Contact Social Security for more information at 1-800-772-1213.

Transitioning to Medicare Webinar

Register for these webinars by calling the State Health Insurance Assistance Program (SHIP) at 410-887-2059. On the SHIP voicemail, note the date of the webinar you wish to attend and clearly state your email address. The PowerPoint for the presentation will be sent to you prior to the event.

  • Thursday, September 9, 5 to 6:30 p.m.
  • Wednesday, September 29, 2 to 3:30 p.m.
  • Wednesday, October 13, 5 to 6:30 p.m.
  • Thursday, November 16, 5 to 6:30 p.m

For more information, email

Medicare Part A

Medicare Part A helps pay for hospital stays, skilled nursing facilities, home health care, hospice care and other services.

  • You can enroll in Medicare Part A at age 65.
  • If you have worked at least 10 years under Medicare- or Social Security-covered employment, the Part A benefit will be "free" because you paid toward Part A while you worked. If you have never worked but your spouse has worked 40 quarters (10 years), you can apply for Medicare A by using your spouse’s work record.
  • If you elected to receive your Social Security retirement benefit before you turned age 65, you will automatically be enrolled in Medicare A and B. Your card will arrive about three months prior to your 65th birthday. Likewise, you will automatically receive your Medicare card several months before you reach the 25th month of receiving your Social Security disability benefit.
  • If you are not receiving a Social Security benefit, you will need to enroll in Medicare through Social Security.
  • If either you or your spouse is actively working and the employer is providing group health coverage, you may proceed to sign up for just Part A. If you have worked 10 years and paid the FICA tax, Part A will be premium-free and will serve as a secondary insurance to your group health insurance.
    Note: If your employer has fewer than 20 employees, check with the benefits administrator. You may be required to sign up for Medicare A and B, and Medicare will be the primary insurance. Similarly, if you have a Social Security Disability benefit and the employer has fewer than 100 employees, you may be required to sign up for Medicare, in which case the Medicare will be the primary insurance.
  • Do not sign up for Part A if your employer coverage is through a Health Savings Account (HSA). You can not contribute to an HSA and receive Medicare. (If you are entitled to premium-free Part A, there is no penalty for delaying Part A enrollment.)

Medicare Part B

Medicare Part B pays for doctors and other medical services such as physical therapy, occupational therapy, lab service, home health care, outpatient hospital visits and blood.

  • If you are already receiving benefits from Social Security, you will be automatically enrolled in Medicare A and B starting the first day of the month in which you turn 65 or the 25th month you receive your Social Security Disability check. (If you elect not to receive Part B because you or your spouse is actively working and have group health insurance through an employer, you can complete the reverse side of the Medicare card and return it to SSA).
  • If you are not receiving a Social Security check, contact Social Security three months before you reach age 65 to enroll in Medicare A and B. Although you have a seven-month window (three months before, the month of, and three months after your 65th birthday) to sign-up for Medicare A and B, it is best to sign up early to avoid a delay in the start of your benefits.
  • If you did not take Part B when you were first eligible for Medicare at age 65, you may sign up during a General Enrollment Period. This period runs from January 1 through March 31 of each year. Due to the Part B penalty, the cost of your Medicare Part B may go up 10 percent for each 12-month period that you could have had Part B but did not take it. Your Part B coverage would become effective the following July and you will have to pay the extra 10 percent for the rest of your life.
  • The only time you may delay Part B enrollment without a penalty is if you or your spouse is actively employed and the employer has 20 or more employees (100 employees is younger that 65) and is providing group health insurance. You may sign up for Part B at any time while you are working and have the group health coverage. You may also sign up for Part B during a Special Part B Enrollment period, which lasts eight months from the time the employer coverage ended. You will need to contact the Social Security office or download forms CMS-40 B and CMS L-564. Once the forms have been completed, they may sent to SSA via certified mail or faxed to 1-833-914-2016.  The CMS L564 will enable your employer to certify that you have had group health coverage since age 65 or the 25th month of receiving your Social Security Disability benefit. Due to Covid, if your are unable to obtain your employer's signature for the form CMS-L564, you may apply on online at You will need to upload documentation as evidence that you have had group health insurance.

Medicare Part D

Prescription drug coverage, called Medicare Part D, is available to everyone with Medicare. Insurance companies and other private companies approved by Medicare offer the drug plans. Drug plans will vary in monthly premiums, the type of drugs covered, deductibles, co-pays and pharmacies accepting the plan.

  • The beneficiary should sign up during the seven-month Initial Enrollment Period that begins three months before the month in which the person turns age 65 and ends three months after turning age 65.
  • If you do not take Part D when you are first eligible for Medicare at age 65 and you did not have credible coverage during the interim, the cost of Medicare Part D may go up approximately $0.33 for each month one should have had the coverage and you will have to pay the penalty for the rest of your life.
  • It is important to annually review the list of drugs you take and review the plans every year because the Part D plans are permitted to change their formulary lists, premiums, deductibles, tier structures and pharmacy contracts every year. Therefore, you may change plans during the open enrollment October 15 through December 7 every year.

Medicare Prescription Drug Plans vary by the following:

  • Coverage: Medicare prescription drug plans cover generic and brand name drugs. Each plan can choose which specific drugs they cover in each drug category.
  • Cost: Monthly premiums and your share of the cost (co-payment) of your prescription vary depending on which plan you choose.
  • Restrictions: The plan may limit prescription quantities (how many pills you can get at a time), require prior authorization (before the plan will pay for your prescriptions, your doctor must show the plan that the drug is medically necessary for it to be covered) or require step therapy (the plan may require a lower cost drug to be tried before the plan will pay for the prescribed drug).
  • Convenience: Consider whether you local pharmacy accepts the plan or whether the plan has a mail-order option.

Supplementing Medicare

Medicare is the Federal health insurance program for people over age 65 or people under age 65 who qualify because of a disability. It is not designed to cover all of the cost of medical care. Deductibles, co-payments and medical services not covered by Medicare can be expensive.

Most Medicare beneficiaries select one of three options to assist with the gaps (only Medicare-approved services are covered).

Option 1

Purchase a Medigap insurance policy as a supplement to Medicare:

  • A Medigap policy supplements the Original Medicare Plan to help pay for the “gaps” like co-payments, coinsurance, and deductibles that the Original Medicare Plan does not cover.
  • The policies are standardized (A to N), with each type of policy offering the same basic benefits no matter which insurance company sells it. The only difference between policies is the cost. A policy covers only one person, so a couple must each buy separate policies. Private insurance companies sell these policies.
  • The Medicare Supplement open enrollment period lasts for six months, beginning on the first day of the month in which you were eligible for Medicare and enrolled in Medicare Part B. During this period, an insurance company:
    • Must sell you a plan
    • Cannot make you wait for coverage to start
    • Cannot charge more for a Medigap policy because of health problems
  • View the names of Medigap Policies approved to be sold in Maryland and their yearly costs. To obtain a hard copy of the Medicare Supplement Pricing Booklet call the Maryland Insurance Administration at 410-468-2244.

Medigap changes as of January 1, 2020:

  • Those who are newly eligible for Medicare as of 2020 (means an individual who before January 1, 2020 is neither 65 nor has Part A):
    • Must pay Part B deductible, which is $198 for 2020, therefore:
      • Plans C, F and High Deductible F will not be sold to them
      • Can purchase a High Deductible G
  • Those who are not newly eligible for Medicare as of January 1, 2020:
    • Will be able to keep their Plans C, F or High Deductible F plans as long as the premiums are paid on time
    • May purchase Plans C, F or High Deductible F if offered by any companies
    • May purchase a High Deductible G
    • Note: Both High F and High G have a $2,340 deductible that must be met before the plans will provide full Plan F or G coverage of the Medicare approved costs. With the High G, the first $198 of Part B expenses must be paid out of pocket and then Medicare begins to cover 80 percent of the Part B costs. With the High F, Medicare begins to pay 80 percent of the Part B Medicare-approved costs immediately.
  • Those who are newly eligible for Medicare under the age of 65:
    • Will be able to buy Plan A (all companies in Maryland must sell to those under age 65) and Plan D if sold to individuals age 65 or older
    • Premiums will be higher than for those age 65 or older
    • Medigap Open Enrollment period lasts for 6 months from the Part B start date and will occur again at the 65th birthday

Option 2

Join a Medicare Advantage plan (substitute for Original Medicare). See a list of current plans in the back of your "Medicare and You" book.

There are currently four types of Medicare Advantage Plans offered in Baltimore County. The greatest advantage these plans have over using Original Medicare is their out-of-pocket limits. As of January 1, 2021, these plans will have to accept individuals with End State Renal Disease.

  1. Medicare Health Maintenance Organizations (HMO) cover all Part A and B services and may provide extra services. People who join a Medicare HMO plan may be asked to choose a primary care doctor they see first for most health problems. They usually need a referral to see a specialist (such as a cardiologist) or to get certain services. People who are considering joining a Medicare HMO and want to keep seeing their current doctor should find out if their doctor is in the plan’s network. The plan includes prescription coverage. Kaiser, Cigna, Johns Hopkins and CareFirst have HMOs serving Baltimore County.
  1. Medicare Preferred Provider Organization (PPO) cover all Part A and B services and may provide extra services. People who join a Medicare PPO plan can go to network doctors, other health providers and hospitals, but they can also go out-of-network for covered services, usually at a higher cost. Typically, they do not need to choose a primary care doctor and in most cases do not need a referral to see a specialist. The plan includes prescription coverage. Johns Hopkins has two PPOs in Baltimore County.
  1. Medicare Special Needs Plans (SNP) membership is limited to certain groups of people, such as those with certain chronic illness such as diabetes, or have Medical Assistance and Qualified Medicare Beneficiary (QMB), or are living in a nursing home. Medicare SNPs are Medicare Advantage plans designed to provide focused-care management, special expertise of the plan’s providers and benefits tailored to enrollee conditions. These plans provide case management, care monitoring, and health education and monitoring tools, if needed, to provide specialized care. The plans include prescription coverage. Cigna Achieve is a SNP for Diabetics. Cigna Total Care and CareFirst Blue Cross Blue Shield Dual SNP HMO (was University of MD Dual Prime) serving those on Medical Assistance or QMB.
  1. Medicare Savings Account (MSA) is similar to a Health Savings Account (HSA), but for those on Medicare. Lasso Growth - Medicare deposits $2,000 into an account. The deductible is $5,000 (the beneficiary is responsible for $3,000). Lasso Growth Plus - Medicare deposits $3,000 into an account. The deductible is $8000 (the beneficiary is responsible for $5,000). The account and the beneficiary's own money pay for Medicare Part A and B costs until the deductible is met, then there is no cost sharing for the remainder of the year for Medicare covered services. Unspent funds can be rolled over to next year. Must see participating providers (if not, must pay the 15 percent excess and it is not counted toward the deductible). Must get a Part D plan. Can use MSA funds to pay for IRS Qualified Medical Expenses, but if the expenses are not covered by Medicare A or B, the costs will not apply to the deductible.

The other type of plan is Programs of All-Inclusive Care for the Elderly (PACE), which combines medical, social and long-term care services for frail, elderly people to remain in the community. You must be on Medicare and Medical Assistance, and be geographically confined to the eastern edge of Baltimore City.

Option 3

Continue health insurance coverage through an employer retirement plan such as the Federal Employee Health Benefits Program (FEHBP), State and Local government Retiree Health Plans and private companies Retiree Health Plans.

Savings Program

If a person is income-eligible, they can apply for Medicaid, the Qualified Medicare Beneficiary Program (QMB) or the Specified Low Income Medicare Beneficiary (SLMB) Program, which provides assistance to people with low income and limited assets.

  • QMB will pay the Part A ($471 in 2021 if you did not work and pay FICA tax for 10 years in the U.S.) and Part B premiums ($148.50 in 2021), deductibles and co-insurance payments of the Medicare Program for older and individuals with disabilities who are financially eligible.
  • SLMB is similar to QMB but pays only the Part B premium ($148.50 in 2021).
  • Low Income Subsidy (LIS) Medicare Beneficiaries who qualify based on low income and limited assets will receive a subsidy to pay for Medicare Part D premiums, co-payments, deductibles and coverage gap (donut hole).
  • The Maryland Senior Prescription Drug Assistance Program (MD SPDAP) will pay up to $50 each month toward the Medicare Prescription Drug plan premium.


  • Sign up for Medicare A and B at Social Security.
  • Review the eligibility for assistance in paying for Medicare Part A, Part B and Part D LIS.
  • If not eligible for assistance, get a supplement to Medicare to pay the expenses that Medicare does not pay. Choose between a Medigap policy, Medicare Advantage Plan or your company's retired employee plan if it qualifies.
  • Make sure you sign up for prescription drug coverage.
Revised September 1, 2021         


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