Getting Medicare Part A And Part B
How clients get A and B, which of four routes fits each client, and how to walk a confused client through it until their plan is active.
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Why A And B Matter
A Medicare Advantage plan only starts if the client has both Part A and Part B active on the plan's start date. Missing either one, Medicare rejects the enrollment or removes them later.
Social Security takes the sign-up for almost everyone, not Medicare and not the insurance company. Railroad retirees go through the Railroad Retirement Board at 1-877-772-5772.
A Medicare Supplement also needs both. A standalone drug plan needs only one.
Who Gets It Automatically
First question on every call: is the client already getting a Social Security check?
| Client's Situation | How A And B Start | What They Do |
|---|---|---|
| On Social Security 4+ months before 65 | Automatic, 1st of the birthday month | Nothing |
| Under 65 on disability | Automatic after 24 months of checks | Nothing |
| Under 65 with ALS | Automatic when disability checks start | Nothing |
| Turning 65, not on Social Security yet | Not automatic | Must Sign Up |
| Kidney failure on dialysis | Not automatic | Must Sign Up |
| Lives in Puerto Rico | A automatic, B is not | Sign Up For B |
| Has A only | B not active | Sign Up For B |
The Sign-Up Windows
Free Part A can be added any time after 65. Part B only inside a window. Coverage always starts on the 1st of a month.
| Window | Who It's For | Open When | Late Fee |
|---|---|---|---|
| Initial | Turning 65 | 7 months: 3 before the birthday month, that month, 3 after | No |
| Job Coverage | Kept working, or a spouse did, with that employer's plan | While covered, plus 8 months after the job or coverage ends | No |
| Lost Medicaid | Medicaid ended on or after 1/1/2023 | Until 6 months after Medicaid ends | No |
| Bad Advice | Employer or plan gave wrong information | 6 months from telling Social Security | No |
| Other Hardship | Disaster, emergency, released from jail | Usually 6 to 12 months | No |
| General | Missed every window above | Jan 1 to Mar 31 each year | Usually |
Picking The Route
Ask top to bottom. The first yes is the client's route. One route per call.
- 1Turning 65 within 3 months, or up to 3 months after the birthday month?
Route 1: apply with Social Security online or by phone.
No late fee - 2Had job coverage in the last 8 months?
Their own or a spouse's current job, not COBRA. Route 2: forms CMS-40B and CMS-L564.
No late fee - 3A hardship reason?
Lost Medicaid, disaster, wrong advice, left jail. Route 3: form CMS-10797.
No late fee · 2 months to pick a plan after - 4Low income and savings?
Single under $1,816 a month and $9,950 saved. Apply for a Medicare Savings Program at the state Medicaid office.
State adds B and pays it · no late fee
How Each Route Works
Turning 65
- Online at ssa.gov/medicare/sign-up, about 10 minutes
- Or call 1-800-772-1213, Monday to Friday, 8am to 7pm
- Or book a local office appointment
Losing Job Coverage
- CMS-40B: the client fills out and signs
- CMS-L564: the employer proves the coverage and dates
- Upload both at ssa.gov/medicare/sign-up/part-b-only, any time of year
- Employer won't sign: client fills Section B unsigned and adds pay stubs, W-2s or the insurance card
Hardship
- CMS-10797, faxed or mailed to the local office
- Once B is approved, 2 months to join a plan
General Window
- Only January 1 to March 31
- CMS-40B faxed or mailed, or call and ask for the General Enrollment Period
- Expect a late fee
Have Ready
- Social Security number, date and place of birth
- Medicare number, if they have Part A
- Employer name and coverage start and end dates
- Proof of coverage if the employer won't sign
Keep Proof It Was Sent
- Fax confirmation page
- Certified mail receipt
- Dated office receipt
After They Apply
- 1Social Security works on it
Usually 4 to 6 weeks, longer by mail.
Follow up at 2 weeks - 2Approval letter arrives
New clients also get the red, white and blue card with the Medicare number and A and B start dates. The benefit verification letter in their my Social Security account shows the same.
- 3Enroll in the plan
Window runs from 3 months before B starts to 2 months after. Before B starts, the plan starts with B. After, the 1st of the next month.
Never before B is approved - 4Keep B paid
Lose B and they lose the plan.
2026 Costs And Help Paying
| Cost | 2026 |
|---|---|
| Part A premium, 10+ years of work | $0 |
| Part A premium, 30 to 39 work credits | $311 a month |
| Part A premium, under 30 credits | $565 a month |
| Part A hospital deductible | $1,736 |
| Part B premium | $203 a month |
| Part B deductible | $283 a year |
Late Fees
- Part B: an extra 10% for every full year without B, for life. Two years late is about $244 a month.
- Part A (only if they pay for A): an extra 10%, for twice the years they waited.
- No late fee with a special window or a Medicare Savings Program.
Medicare Savings Programs
| Program | Pays For | Monthly Income Limit (Single / Couple) |
|---|---|---|
| QMB | A and B premiums, deductibles and copays | $1,350 / $1,824 |
| SLMB | Part B premium | $1,616 / $2,184 |
| QI | Part B premium, renewed every year | $1,816 / $2,455 |
What Clients Say
What Agents Can And Can't Do
Can
- Explain A, B, the windows and costs
- Help fill out the forms line by line
- Stay on the line while the client applies online
- Three-way call Social Security
- Fax or mail signed forms and keep the confirmation
- Point them to the state Medicaid office
Can't
- Sign any form for the client
- Type their Social Security password or make their account
- Promise an approval date or no late fee
- Submit the plan before B is approved
- Tell a client to drop job coverage
- Decide savings program eligibility
Talk Track
- 1Name It
"Your Medicare card shows hospital coverage, Part A. To keep the plan we set up, Medicare also needs Part B, which covers your doctors. Right now Medicare doesn't show it, so the plan can't start."
- 2Find The Route
"Are you still working, or covered through a job or a spouse's job? When did that coverage end? Have you had Medicaid recently?"
- 3Ease The Cost Worry
"Part B is $203 a month in 2026. If money is tight, your state may pay it for you, and I can tell you where to apply."
- 4Set The Steps
"Here's exactly what we'll do today. I'll stay on the line while you do the online part."
- 5Lock The Follow-Up
"I'll call you in two weeks to check it went through. When your approval letter comes, call me and we'll get your plan started."
Words To Know
- Initial Enrollment Period
- The 7-month window around turning 65
- Special Enrollment Period
- A window opened by a life event, like losing job coverage or Medicaid
- General Enrollment Period
- January 1 to March 31, for anyone who missed every other window
- CMS-40B
- The Part B application the client signs
- CMS-L564
- The employer's proof of job coverage and its dates
- CMS-10797
- The hardship sign-up form
- Benefit Verification Letter
- The letter in my Social Security that shows the Medicare number and A and B dates
- Medicare Savings Program
- State help that pays the Part B premium (QMB, SLMB, QI)
- Medicare Easy Pay
- Automatic monthly payment of the Part B bill from the bank