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Medicare Eligibility

Most people who’ve worked and paid taxes become eligible for Medicare when they turn 65. Some people may qualify before age 65 due to illness or disability.

If you’re ready to explore your Medicare options, you can visit Medicare.gov to verify your eligibility. It’s quick and easy.

A couple enrolling in medicare

How to Enroll in Medicare

Some people are automatically enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), while others have to sign up for it. In most cases, it depends on whether you’re getting Social Security benefits.

While Medicare is managed by the Centers for Medicare & Medicaid Services (CMS), Social Security works with CMS by enrolling people in Medicare.

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Change From
Original Medicare to
Medicare Advantage

Medicare Advantage continues to grow rapidly throughout the country.

One reason is the low premiums—as low as $0 for plans that may include coverage for prescription drugs and dental, vision and hearing care—all benefits that are not provided by Original Medicare.

If you’re thinking about changing from Original Medicare to a Medicare Advantage plan such as Clear Spring Health, keep the dates listed below in the “Medicare at a Glance” section in mind.

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Options if you’re disabled or under 65

Even if you’re under 65, you may still qualify for Medicare benefits. Most people assume you must be 65 to sign up for Medicare, but there are exceptions:

  • If you’re under age 65 and have received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months, you’ll automatically get Medicare Part A and Part B.
  • If you’re a disabled federal, state or local government employee who is not eligible for Social Security or Railroad Retirement Board benefits, you may be eligible for Medicare 24 months after you qualify for disability.
Options if you’re disabled or under 65

Most people who’ve worked and paid taxes for a certain amount of time don’t have to pay a premium for Medicare Part A (hospital coverage).

With Part B, which covers things like doctor visits, lab tests and preventive services, most people have to pay a monthly premium.

If you’re disabled but still covered under your own or a qualified family member’s employer plan, you may want to keep that coverage and postpone enrolling in Medicare Part B to postpone paying the premium. Your Part B premium won’t begin until your Part B benefits do.

Learn more about your options at HealthCare.gov.

If you’re still working, you may still be eligible for Medicare

Many people keep working after they turn 65 and choose to keep their coverage under their employer’s group plan. But if you’ve been paying into Medicare via payroll deductions, you should consider enrolling in Medicare Part A (hospital insurance) when you first become eligible, as you’ll pay no premium.

For Part B (medical insurance), most people need to enroll when they turn 65 to avoid a late-enrollment penalty. Those who have health insurance from their (or their spouse’s) current employer may be able to delay enrolling in Part B – and delay having to pay the monthly Part B premium. In 2022, that premium is $144.60 per month (or higher depending on your income).

If you’re still working, you may still be eligible for Medicare

Before making any decisions, talk with your company’s benefits administrator to find out if and how your current health plan coordinates with Medicare.

Know When You
Can Enroll

There are three enrollment periods during which you can enroll in a Medicare Advantage Prescription Drug (MAPD) plan or a stand-alone Prescription Drug Plan (PDP) for the first time or change your plan.

know when you can enroll

Annual Election Period (AEP) – October 15 Through December 7

During this time, you can:

  • Switch from Original Medicare to a Medicare Advantage plan
  • Change from a Medicare Advantage plan back to Original Medicare
  • Switch from one Medicare Advantage plan to another Medicare Advantage plan

Initial Coverage Election Period (ICEP)

The “Initial Coverage Election Period” begins 3 months before the month of your 65th birthday, includes your birthday month, and continues through the 3 months after the month of your 65th birthday.

If you enrolled in a Medicare Advantage plan when you first became eligible for Medicare (your Initial Coverage Election Period), you can change to another Medicare Advantage plan or go back to Original Medicare within the first 3 months after you enrolled.

Medicare Advantage Open Enrollment Period (OEP) – January 1 through March 31

During this time, you can:

  • Switch from a Medicare Advantage plan without drug coverage to a Medicare Advantage plan with drug coverage
  • Switch from a Medicare Advantage plan with drug coverage to a Medicare Advantage plan without drug coverage
  • Switch from your Medicare Advantage plan and return to Original Medicare, with the option to join a stand-alone Medicare Prescription Drug Plan (PDP)

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Request a PDF Directory

Our MAPD Provider Directory includes thousands of primary care physicians (PCPs) and specialists across our service area of select counties in Colorado, Georgia, Illinois, South Carolina, and Virginia.

Due to the directory size we recommend using the Provider Search above to more accurately locate the providers in your area. However, if you still prefer a printed copy, please contact Member Services at 1 (877) 364-4566.