Who Is Eligible for Medicare?

Before you can apply for Medicare, you need to confirm that you qualify. Most people become eligible when they turn 65, but there are other qualifying conditions as well.

You are eligible for Medicare if you meet one of the following criteria:

• You are 65 or older and a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five consecutive years
• You are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months
• You have been diagnosed with End-Stage Renal Disease (ESRD), regardless of age
• You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. Medicare begins the same month your SSDI starts

If you are turning 65 and already collecting Social Security benefits, you will be automatically enrolled in Medicare Parts A and B. If you are not yet collecting Social Security, you will need to sign up on your own.

Understanding the Four Parts of Medicare

Before you apply, it helps to understand what you are actually signing up for. Medicare has four main parts, each covering a different area of your healthcare.

Medicare Part A — Hospital Insurance

Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while working.

Medicare Part B — Medical Insurance

Part B covers doctor visits, outpatient care, preventive services, and medical equipment. Unlike Part A, Part B requires a monthly premium. In 2026, the standard Part B premium is $202.90 per month. Higher-income beneficiaries may pay more due to IRMAA surcharges.

Medicare Part C — Medicare Advantage

Medicare Advantage plans are an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans bundle Parts A and B and often include Part D drug coverage and extras like dental, vision, and hearing. You must be enrolled in Parts A and B to join a Medicare Advantage plan.

Medicare Part D — Prescription Drug Coverage

Part D covers prescription drugs and is offered through private insurance companies. You can add a standalone Part D plan to Original Medicare, or get drug coverage through a Medicare Advantage plan that includes it.

When to Apply: Your Initial Enrollment Period

Timing your Medicare enrollment correctly is one of the most important steps you can take. Missing your window can result in permanent late enrollment penalties that follow you for the rest of your life.

When you turn 65, you have a 7-month Initial Enrollment Period (IEP) that breaks down as follows:

• 3 months before your 65th birthday month
• Your birthday month
• 3 months after your birthday month

Enrolling during the first three months of your IEP — before your birthday month means your coverage starts on the first day of your birthday month. If you wait until your birthday month or after, your coverage start date is delayed.

For a complete breakdown of all Medicare enrollment periods, including the Special Enrollment Period, General Enrollment Period, and Annual Election Period, see our Medicare Enrollment Periods Explained guide.

Step-by-Step: How to Apply for Medicare

Step 1 — Confirm Your Enrollment Status

If you are already receiving Social Security benefits before turning 65, you will be automatically enrolled in Medicare Parts A and B. Your Medicare card will arrive in the mail approximately three months before your 65th birthday. You do not need to take any additional action to enroll.

If you are not yet collecting Social Security at 65, you will need to actively enroll.

Step 2 — Apply Online, by Phone, or In Person

There are three ways to apply for Medicare:

• Online: Visit ssa.gov/medicare/sign-up. The online application takes about 10 minutes and is available 24/7. This is the fastest and most convenient option for most people.
• By phone: Call the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 8 AM to 7 PM.
• In person: Visit your local Social Security office. If you are in New York City, you can find your nearest office at ssa.gov/locator. An appointment is recommended.

Step 3 — Decide Whether to Keep or Decline Part B

If you are still working at 65 and covered by an employer group health plan, you may be able to delay Part B without penalty. The key question is whether your employer has 20 or more employees. If it does, your employer coverage is primary, and you can safely delay Part B until you retire.

If your employer has fewer than 20 employees, Medicare becomes primary, and you should enroll in Part B during your IEP to avoid a late enrollment penalty.

This is an important decision; if you are unsure, call me before making it. A mistake here can result in a permanent penalty added to your Part B premium.

Step 4 — Choose Between Original Medicare and Medicare Advantage

Once you are enrolled in Parts A and B, you have a fundamental choice to make: do you want Original Medicare with a Medigap supplement and a standalone Part D plan, or do you want a Medicare Advantage plan that bundles everything together?

Both paths have real advantages and tradeoffs. In New York, you have access to some of the largest and most competitive Medicare markets in the country, with dozens of Advantage plans available by ZIP code and multiple Medigap carriers offering Plan G at competitive rates.

As an independent Medicare broker, I compare every plan available in your ZIP code at no cost to you. I am not tied to any single carrier, so my only job is to find you the best fit for your health needs and budget.

Step 5 — Add Prescription Drug Coverage

If you choose Original Medicare with a Medigap supplement, you will need to add a standalone Part D prescription drug plan. If you choose Medicare Advantage, your plan likely already includes drug coverage.

Either way, it is important to enroll in creditable drug coverage when you first become eligible. Waiting without a qualifying reason results in a permanent Part D late enrollment penalty calculated at 1% of the national base beneficiary premium for every month you went without coverage.

Step 6 — Review Your Coverage Every Year

Medicare is not a set-it-and-forget-it decision. Plan benefits, premiums, and drug formularies change every year. The Annual Election Period runs from October 15 through December 7 each year and allows you to make changes to your Medicare Advantage or Part D plan for the following year.

As my client, I proactively review your coverage every year and reach out if a better option is available in your area.

Special Considerations for New York Residents

New York has some unique rules and market conditions that affect your Medicare decisions.

• Guaranteed issue for Medigap: New York is one of a small number of states that requires Medigap insurers to accept all applicants year-round, regardless of health history. This means you can switch Medigap plans at any time without medical underwriting, a significant advantage compared to most other states.
• Large Medicare Advantage market: New York City and surrounding areas have one of the most competitive Medicare Advantage markets in the country, with many plans offering $0 premium options and rich extra benefits. However, network restrictions are an important consideration, especially in Manhattan, where many top specialists do not participate in HMO networks.
• IRMAA surcharges: Higher-income New Yorkers often trigger IRMAA surcharges on their Part B and Part D premiums. Use our Medicare IRMAA Calculator to see if your income affects your premiums.

What Happens After You Apply?

After submitting your Medicare application, here is what to expect:

• You will receive a confirmation from the Social Security Administration
• Your red, white, and blue Medicare card will arrive in the mail within a few weeks
• You can check your application status at ssa.gov or by calling 1-800-772-1213
• Once you have your Medicare number, you can begin comparing Medigap and Medicare Advantage plans for your ZIP code

Do You Need Help Applying for Medicare in New York?

Applying for Medicare Parts A and B through Social Security is straightforward. The harder decisions come after — choosing between Medigap and Medicare Advantage, selecting the right Part D plan, and understanding what your coverage actually pays for.

That is where I come in. As an independent Medicare broker serving New York City, Long Island, Westchester, and clients nationwide, I help you compare every plan available in your ZIP code at no cost to you. My services are completely free of charge. I am paid by the insurance carriers, not by you.

If you are turning 65 or approaching Medicare eligibility, start with our Turning 65 in New York Medicare Guide or schedule a free consultation directly below.

📅 Schedule Your Free Medicare Consultation

Craig Smith Insurance Group
📍 260 Madison Avenue, 8th Floor, New York, NY 10016
📍 1 Welwyn Road, Great Neck, NY 11022
📞 917-740-1895
✉️ craigsmith@csmedicare.net

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We are not connected with or endorsed by the United States Government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.