What Documents Do I Need When Applying for Medicare?

Turning 65 opens the door to Medicare for many Americans. If you're receiving Social Security or Railroad Retirement benefits, you're in luck — Medicare Parts A and B will come to you automatically. But if you're not receiving those benefits, you'll need to apply for Medicare coverage. This means you’ll need to prove you're eligible for Medicare. So, where do you start, and what documents do you need to apply? Here’s what you need to be prepared for when the time comes.

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How to qualify for Medicare

Most people consider Medicare health insurance for those 65 and older, but there are several ways to become eligible. Plus, there are times when you might be automatically enrolled in Medicare and others when you’ll need to take the initiative to apply. Here's a quick breakdown of the enrollment scenarios:

When you’re automatically enrolled in Medicare

If you’re getting Social Security or Railroad Retirement benefits starting at age 62 and continuing until at least four months before you turn 65, you'll be automatically enrolled in Medicare Parts A and B at 65.

For those on Social Security disability benefits, Medicare Parts A and B kick in automatically after 24 months of receiving those benefits.

If you have a disability such as Lou Gehrig's Disease (ALS), you'll get Medicare Parts A and B right away when you start receiving Social Security disability benefits.

When you need to apply for Medicare

If you're within three months of turning 65 and not yet receiving Social Security benefits, you'll need to apply for Medicare when you sign up for Social Security. Your Medicare Initial Enrollment Period (IEP) starts three months before you turn 65 and ends three months after; this is called a seven-month Initial Enrollment Period. Missing this period could mean paying late enrollment penalties, so mark your calendar.

Still working at 65 and not ready for Social Security? In this case, you can apply for Medicare only online, or you might be able to wait until retirement and use a special enrollment period.

For patients with end-stage renal disease (ESRD), there are specific options. You may qualify for retroactive coverage for up to 12 months, or you might face a four-month waiting period if you're on dialysis. Kidney transplant recipients also have distinct eligibility rules under Medicare.

What documents do I need to apply to Medicare when I turn 65?

If you don’t meet the criteria for automatic enrollment, you’ll need to apply for Medicare. Let’s go over the documents you'll need when applying for Medicare Part A and Part B or only Part A when you turn 65:

• Birth records. You'll need to provide your date and place of birth, and your birth certificate may be required. If you were born outside the U.S., you'll need to share the name of your birth country and your Permanent Resident Card number if you're not a U.S. citizen.
• Social Security number. This is a must-have for your application.
• Current health insurance info. If a group health plan covers you through your or your spouse's job, you'll need to provide employment dates and the start and end dates of that coverage.
• Medicaid details. If you're on Medicaid, have your Medicaid number handy, along with the start and end dates of your coverage.

How to apply

The easiest and fastest way is to apply online through the Social Security Administration's website. Here's how it works:

1. First, you'll create your my Social Security account.
2. Once that's set up, you can use that account to sign up for Medicare or even apply for Social Security benefits.

What documents do I need to apply for Medicare if I missed enrolling at 65?

You might be eligible for a Special Enrollment Period (SEP) if you missed your initial enrollment period. Here's what you'll need to get back on track:

• Your Medicare Number (if you have Part A) or your Social Security number
• Your current contact details (address and phone number)
• Documentation that shows you're eligible for a SEP. This is done by filling out form CMS-10797. On the last page of this form, you'll need to explain, in detail, what exceptional circumstances prevented you from enrolling on time. The most common reasons include continuing to work past age 65, having a disability, or serving as an international volunteer, but other qualifying reasons exist. Whatever your situation, be prepared to provide a clear, thorough explanation.

How to apply

The process is pretty straightforward:

1. Download and complete form CMS-10797. Be sure to write out your explanation for missing the initial enrollment.
2. Once everything is ready, print the completed form and send it to your local Social Security office. You can do this by fax or mail, whichever works best for you.

What documents do I need to apply for Medicare if I lose my job insurance?

If you already have Medicare Part A and want to add Part B because your employer-based coverage ended, you'll need a few items:

• Your Medicare number (you can find this on your Medicare card)
• Your current contact information (address and phone number)
• A valid email address
• Proof of your group health plan coverage through your or your spouse's recent employment. You’ll do this by getting Form CMS-L564, "Request for Employment Information," filled out by your or your spouse’s employer. This form verifies your previous coverage and allows you to sign up during a Special Enrollment Period.

In addition to the above, you might need to provide additional proof of your job-based health insurance. The goal is to show that you had qualifying health coverage through your job, so you can enroll in Part B without late enrollment penalties. Forms of proof could include:

• Your health insurance card with the policy start date
• Recent pay stubs showing health insurance payments
• W-2 forms showing health insurance payments taken from your paycheck
• Explanation of benefits from your work health plan showing what they paid
• Receipts showing you paid premiums for health insurance
• Tax papers that show how much you paid for health insurance

How to apply

1. Start by applying online for Part B. You can do this through your Social Security account. If you don’t want to apply online, you can download and complete the CMS-40B form. This is your application for Medicare Part B.
2. After applying for Part B, you must send the completed CMS-L564 form to your local Social Security office. You can do this by fax or mail, whichever is more convenient.

What documents do I need to apply for Medicare during the General Enrollment Period?

If you missed your IEP and aren't eligible for a SEP, you can sign up for Medicare Part B during the General Enrollment Period (GEP). This window runs from January 1 to March 31 each year. Here's what you'll need:

• Your Medicare number (you can find this on your Medicare card if you have Part A)
• Your current address and phone number

If you live in Puerto Rico and are in your Initial Enrollment Period, you'll need to use this process to sign up for Part B as well.

How to apply

1. First, you'll need to download Form CMS-40B. This is the "Application for Enrollment in Medicare – Part B (Medical Insurance).”
2. Once you've filled out the form, send it to your local Social Security office, either by fax or mail.

What documents do I need to apply for Medicare if I have a disability?

If you're eligible for Medicare due to a disability, the process is simple, but it's good to understand how it works. Generally, you don’t need to do anything if, over the last 24 months, you've been getting Social Security Disability Insurance (SSDI) or railroad disability annuity checks. Here’s what happens:

• You'll be automatically enrolled in both Medicare Parts A and B.
• This enrollment starts at the beginning of your 25th month of receiving disability benefits.
• About three months before your Medicare coverage starts, you'll get a welcome package in the mail.
• This package will include your new Medicare card and a letter explaining how Medicare works.

However, if you have Medicare due to a disability but didn’t sign up for Part B during your IEP because you had group health plan coverage through your own, your spouse's, or a family member's current employment, you'll need to take action. In this case, you'll need to complete form CMS-40B to apply to Medicare Part B and form CMS-L564 to provide proof of group health plan coverage.

Applying for Medicare doesn't have to be complicated if you know what documents you need and when to apply. No matter your situation, you can still apply, and being prepared with the correct information can make the process smoother. It helps to keep track of important dates, and if you ever need help, contact the Social Security Administration.

Article history

Our experts strive to provide up to date information and update articles when new information becomes available

September 06, 2024

Fact checked by Ashley Lumpkin, MS

September 06, 2024

Updated by Maggie Aime, MSN, RN

August 25, 2023

Fact checked by Ashley Lumpkin, MS

August 25, 2023

Written by Joseph Arroyo