Medicare eligibility in Washington State

The three main paths to Medicare eligibility

1. Age 65

Most Washington residents become eligible for Medicare in the month they turn 65, provided they're U.S. citizens or lawful permanent residents who have lived in the U.S. for at least 5 years in a row. You can get Medicare regardless of income. Part A with no premium requires that you (or a spouse) paid Medicare taxes for at least 40 quarters (about 10 years) of work; otherwise you can buy Part A.

2. Disability (under 65)

If you get Social Security Disability Insurance (SSDI), or a disability annuity from the Railroad Retirement Board, you're automatically enrolled in Medicare after 24 months of benefits. Your Medicare starts in the 25th month.

People who qualify through disability get the same Part A and Part B coverage as people who qualify by age, and can choose Medicare Advantage or Part D. Medigap options can be more limited under 65; see Medigap in Washington and Medicare under 65 with a disability.

3. ALS or End-Stage Renal Disease

Two conditions provide Medicare eligibility at any age:

• ALS (Lou Gehrig's disease): Medicare starts the same month your Social Security disability benefits start, with no 24-month wait.
• ESRD (permanent kidney failure needing dialysis or a transplant): Medicare usually starts the 4th month of dialysis, or earlier if you take part in home dialysis training or get a kidney transplant. You must sign up; it isn't automatic.

Initial Enrollment Period (IEP)

If you qualify at 65, your IEP is a 7-month window:

• The 3 months before the month you turn 65
• The month you turn 65
• The 3 months after the month you turn 65

If your birthday is on the 1st of a month, your IEP starts and ends one month earlier.

If you sign up during the 3 months before your birthday month, coverage starts the first day of your birthday month. If you sign up during your birthday month or the 3 months after, coverage starts the first day of the month after you sign up.

Automatic enrollment vs. signing up yourself

You're automatically enrolled in Part A and Part B if:

• You're already getting Social Security or Railroad Retirement benefits when you turn 65 (your card arrives about 3 months before your birthday)
• You've gotten Social Security or Railroad Retirement disability benefits for 24 months
• You have ALS and get Social Security disability benefits

If you're automatically enrolled, you can turn down Part B if you have other coverage that lets you delay it. If you're not getting Social Security yet, you must sign up yourself. You can do this:

• Online at ssa.gov/medicare
• By phone with Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
• At a Social Security office in Washington (find your office)

If you worked for a railroad, contact the Railroad Retirement Board instead.

Working past 65: should you delay Part B?

This is one of the most common Medicare questions for people still working at 65. The answer depends on your employer. See also working past 65 in Washington.

Employer with 20 or more employees

If you (or your spouse) are still working and the employer has 20 or more employees, the employer plan pays first and Medicare pays second. You can usually delay Part B without a penalty as long as you keep that coverage. When the job or the coverage ends, whichever comes first, you have an 8-month Special Enrollment Period to sign up for Part B without a late penalty. Many people still take Part A at 65 if it has no premium, but if you contribute to a Health Savings Account, read HSAs and Medicare first.

Employer with fewer than 20 employees

If the employer has fewer than 20 employees, Medicare usually pays first at 65 and the employer plan pays second. If you delay Part B, the employer plan may pay little or nothing for care Part B would have covered. Most people in this situation should sign up for Part B at 65 even if they keep working. See small employers and Medicare.

COBRA, retiree plans and marketplace coverage

These do not count as coverage based on current employment, so they don't let you delay Part B without a penalty. If you're on COBRA or a retiree plan at 65, sign up for Medicare on time. If you're already on COBRA when your job ends, your 8-month Special Enrollment Period still starts when the job ends, not when COBRA ends.

Washington-specific situations

PEBB and SEBB retirees

Washington's public employee and school employee programs are run by the Health Care Authority (HCA). To keep PEBB retiree insurance, retirees and their covered dependents who are eligible for Medicare must enroll in Medicare Part A and Part B and stay enrolled; HCA asks for proof. Missing this can end your PEBB retiree coverage. School employees retiring from SEBB coverage generally move to PEBB retiree insurance. More on PEBB → · More on SEBB →

Military retirees and TRICARE For Life

If you're a military retiree or family member with TRICARE, you must have Medicare Part A and Part B to keep TRICARE coverage once you're eligible for Medicare. TRICARE For Life then pays second to Medicare and covers much of what Medicare doesn't, but only if you have both parts. More on TRICARE For Life →

Federal employees and retirees (FEHB)

FEHB has more flexibility: you can keep FEHB in retirement without Part B. But if you skip Part B after your federal job ends and sign up later, you'll generally owe the late penalty, so decide when you retire. Postal Service employees and retirees in the Postal Service Health Benefits (PSHB) program have different rules, and many of them must have Part B to keep that coverage. Federal civilian workers in Washington, such as at Puget Sound Naval Shipyard, should check how their plan works with Medicare before 65. More on FEHB →

Tribal members

The Indian Health Service and tribal health programs are not insurance. American Indian and Alaska Native people can keep using them and also enroll in Medicare, and IHS and tribal facilities can bill Medicare, which brings more resources to tribal clinics. IHS coverage doesn't let you delay Part B without a penalty. More on tribal health and Medicare →

Late enrollment penalties

Missing your enrollment window can cost you for years:

• Part A penalty (only if you have to buy Part A): 10% added to the Part A premium, for twice the number of years you could have had Part A but didn't sign up
• Part B penalty: 10% of the standard premium for each full 12-month period you could have had Part B but didn't, for as long as you have Part B
• Part D penalty: 1% of the national base beneficiary premium for each full month you went without creditable drug coverage, for as long as you have Part D

The Part B penalty hurts most: someone who delays Part B for 5 full years without other qualifying coverage pays 50% more than the standard premium for as long as they have Part B. At the 2026 standard premium of $202.90, that's about $304.35 a month. How late penalties work →

Citizenship and residency

Medicare requires U.S. citizenship or lawful permanent residence with at least 5 years in a row living in the U.S. Federal law changed in 2025 to narrow which other lawfully present immigrants can get Medicare, so if you're not a citizen, confirm your status with Social Security well before 65. Washington has large Korean, Vietnamese, Russian, Ukrainian, Filipino, Chinese and Spanish-speaking communities; Social Security and 1-800-MEDICARE offer interpreters at no cost. See Medicare help in other languages.

Sources

• Medicare.gov — Get started with Medicare
• Medicare.gov — When does Medicare coverage start?
• Medicare.gov — How do I sign up for Medicare?
• Medicare.gov — Working past 65
• Medicare.gov — COBRA coverage
• Medicare.gov — Avoid late enrollment penalties
• Social Security — Sign up for Medicare
• HealthCare.gov — Medicare and the Marketplace
• Washington Health Care Authority — Medicare and turning age 65 (PEBB retirees)
• Washington Health Care Authority — PEBB retiree eligibility
• TRICARE — TRICARE For Life
• Congress.gov — H.R. 1 (Public Law 119-21), section 71201, limiting Medicare coverage of certain noncitizens

Frequently asked questions

When does Medicare eligibility start?

For most people, the month they turn 65. People who get Social Security disability benefits usually get Medicare in their 25th month of benefits. People with ALS get Medicare the month their disability benefits start, and people with End-Stage Renal Disease usually qualify in the 4th month of dialysis, or sooner with home dialysis training or a transplant.

Can I delay Medicare if I'm still working?

You can usually delay Part B if you or your spouse are still working and have group health coverage from an employer with 20 or more employees. When the job or the coverage ends, whichever is first, you have an 8-month Special Enrollment Period to sign up for Part B without a penalty.

What if I have a Washington Healthplanfinder plan at 65?

Marketplace coverage doesn't let you delay Medicare without a penalty. Sign up during your Initial Enrollment Period, and end your Healthplanfinder plan so it stops when Medicare starts. Once you're eligible for Part A with no premium, you generally can't get help paying for a marketplace plan.

Do I have to enroll in Part B at 65 if I have VA benefits?

VA health care and Medicare are separate, and VA coverage doesn't let you delay Part B without a penalty. Many veterans sign up for Part B so they can also use non-VA doctors and hospitals. If you're a military retiree with TRICARE, you must have Part A and Part B to keep TRICARE For Life.

What's the Part B late enrollment penalty?

10% of the standard Part B premium for each full 12-month period you could have had Part B but didn't, added to your premium for as long as you have Part B. Delaying because you had group coverage from your own or your spouse's current job doesn't count against you.

Medicare in your Washington county

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