Medicare Initial Enrollment Period
Your first chance to enroll in Medicare is around age 65 when you have a seven-month window to apply. During the Medicare Initial Enrollment Period, you can enroll in Original Medicare Parts A and B. You can look at plans or sign up at any time during the three months before, the month of, and the three months after your 65th birthday. Need coverage the month you turn 65? Sign up in the three-month window before your birthday.
Take a deeper dive in our related article about all-things Medicare Initial Enrollment Period.
How Does Medicare Work With Other Types Of Insurance
It isnt uncommon to have both Medicare and another plan, such as one sponsored by your employer. As Medicare.gov explains, in this scenario, each provider is considered a payer. The primary payer pays first, up to the limits of the coverage provided. If there are remaining costs, the secondary payer pays them up to the coverage limits.
Keep in mind that the secondary payer wont necessarily cover all of the remaining costs. If youre considering getting Medicare and another plan, talk with a knowledgeable advisor or your benefits administrator to understand what each payer covers.
Now that you understand the basics of Medicare while working, you can make an informed decision about timing enrollment. Spread the knowledge and share this article with family or friends who are also considering Medicare options as they approach retirement age.
Sign Up: Within 8 Months After You Or Your Spouse Stop Working
- Most people dont have to pay a premium for Part A . So, you may want to sign up for Part A when you turn 65, even if you or your spouse are still working.
- Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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Im Working Past 65 But My Health Coverage Is From My Spouses Employer
A pretty common situation to face, if your health care coverage is from a spouses employer, you may be able to delay Medicare or you may need to enroll when you first become eligible. In this case, the employer still needs to have 20 or more employees. However, the big difference is that employers can have rules for covered dependents 65 and older that may require the individual to get Medicare at 65 in order to remain on the employer plan.
Therefore, if you have employer coverage through a spouses employer, you need to ask the employers benefits administrator directly about your Medicare enrollment choices.
Things To Do Before Signing Up For Medicare
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When Will My Medicare Coverage Start
When you choose to apply for Medicare will affect your effective date.
Understanding when your Medicare Part A and Part B will be effective is key to coordinate cancellation of your current insurance and enrollment into Medicare Supplemental Insurance plans.
While most people will be automatically enrolled in Original Medicare, those who are born on the 1st of the month or those who enroll themselves can have different Medicare effective dates. You can calculate your enrollment dates here.
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MedicareInsurance.com, DBA of Health Insurance Associates LLC, is privately owned and operated. MedicareInsurance.com is a non-government asset for people on Medicare, providing resources in easy to understand format. The government Medicare site is www.medicare.gov.
This website and its contents are for informational purposes only and should not be a substitute for experienced medical advice. We recommend consulting with your medical provider regarding diagnosis or treatment, including choices about changes to medication, treatments, diets, daily routines, or exercise.
This communications purpose is insurance solicitation. A licensed insurance agent/producer or insurance company will contact you. Medicare Supplement insurance plans are not linked with or sanctioned by the U.S. government or the federal Medicare program.
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Original Medicare And Medicare Advantage
Original Medicare, a government program, consists of the combination of Part A hospital insurance with Part B medical insurance.
However, if you sign up for Medicare Part A only, then you do not qualify for other helpful benefits through Medicare health plans, which require having Original Medicare.
A central choice that Medicare beneficiaries make lies between getting health insurance through the government Medicare program, or through a private plan that provides equal or greater coverage than the government program.
Without both Medicare Part A and Part B, a person cannot get any benefits from Part C: Medicare Advantage plans, or the added protection of Medigap.
Medicare Advantage plans can offer more benefits than Original Medicare while possibly costing less. These Part C can even build in the prescription coverage of Part D.
Comparison shopping will help subscribers compare Original Medicare to Medicare Advantage.
When Should I Sign Up For Medicare
Generally, we advise people to file for Medicare benefits 3 months before age 65. Remember, Medicare benefits can begin no earlier than age 65. If you are already receiving Social Security, you will automatically be enrolled in Medicare Parts A and B without an additional application. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will receive a Medicare card about two months before age 65. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. Our representatives there can make an appointment for you at any convenient Social Security office and advise you what to bring with you. When you apply for Medicare, we often also take an application for monthly benefits. You can apply for retirement benefits online.
If you didnt sign up when you were first eligible for Medicare, you can sign up during the General Enrollment Period between January 1 and March 31 each year, unless you are eligible for a Special Enrollment Period.
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Applying For Medicare By Phone
Just like applying online, applying for Medicare by phone is easy. You can contact a representative at 1-800-772-1213.
Depending on the volume of calls, there might be a wait time. If the wait time is above average, you can schedule an appointment to have a representative call you.
The only downfall with applying for Medicare by phone is that it can take longer compared to online. If youre ahead of the game and start well before your birthday, then applying by phone shouldnt cause any issues. If you do not wish to apply online or by phone, you can choose to do so in person.
Top 5 Things You Need To Know About Medicare Enrollment
1. People are eligible for Medicare for different reasons.
Some are eligible when they turn 65. People under 65 are eligible if they have received Social Security Disability Insurance or certain Railroad Retirement Board disability benefits for at least 24 months. If they have amyotrophic lateral sclerosis , theres no waiting period for Medicare. Some people with End Stage Renal Disease may be eligible for Medicare. Its important to know the different ways that people qualify for Medicare so you can help current and former employees and their dependents anticipate their eligibility for Medicare so they can make timely and appropriate decisions about their enrollment.
2. Some people get Medicare Part A and Part B automatically and some people need to sign up for them.
People living in the United States and U.S. Territories who are already collecting Social Securityeither disability or retirementare automatically enrolled into Part A and Part B when theyre first eligible. These people will get a packet of information a few months before they turn 65 or receive their 25th month of Social Security Disability or Railroad Retirement Board benefits. At that time, they can choose to keep or decline Part B, but cant decline Part A unless they withdraw their original application for Social Security and pay back all Social Security cash benefits.
3. Enrolling in Medicare can only happen at certain times.
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If You Have A Disability Esrd Or Als
Americans with a disability who have received Social Security disability benefits for 24 months are automatically enrolled in Medicare Part A and Part B. Automatic enrollment also applies to beneficiaries who have serious illnesses such as end-stage renal disease, ESRD, and amyotrophic lateral sclerosis, ALS. Youll receive your card when you qualify.
You dont need to do anything to sign up.
Similarly, if youve received disability benefits from the Railroad Retirement Board for 24 months, youll be enrolled automatically in Medicare Parts A and B.
Medigap Open Enrollment Period
Your Medigap Open Enrollment Period is the six-month window that begins the first day of the month you turn 65 and are enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in January, you can buy a Medigap policy between January and June. This enrollment window cant be changed or repeated.
During this open enrollment period, you can buy any Medigap policy sold in your state, even if you have health problems.
But after your open enrollment period, you may not be able to buy a Medigap policy depending on your health status and may be subject to a health review.
Your new coverage begins on the first day of the month after you sign up.
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You Automatically Get Medicare When You Turn 65
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
When Are You Eligible For Each Part Or Plan In Medicare
Here is an at-a-glance overview of when youll be eligible for each part of Medicare:
- Part A. Youre eligible to enroll for Medicare Part A during the initial enrollment period. Youll automatically be enrolled at age 65 for Medicare Part A if youre currently receiving Social Security disability benefits or railroad retirement board disability benefits.
- Part B. As with Medicare Part A, youre eligible to enroll for Medicare Part B during initial enrollment, and youll be automatically enrolled if you receive disability or retirement benefits.
- Part C . To enroll in Medicare Part C, you must first have parts A and B. You sign up for Medicare Part C during initial enrollment or other enrollment periods.
- Part D. You can enroll in a Medicare Part D prescription drug plan when you first get Medicare during initial enrollment. If you dont sign up for Medicare Part D within 63 days of your IEP, you may incur a late enrollment penalty.
- Medicare supplement . The initial enrollment period for Medigap is triggered by the start of the month when you turn 65 years old and sign up for Part B. Initial enrollment for Medigap lasts for 6 months from that date.
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How To Sign Up For Medicare Advantage: When Can I Enroll
Medicare Advantage, also known as Medicare Part C, is another way to receive Original Medicare benefits and is offered through private insurance companies that have contracts with Medicare. At minimum, all Medicare Advantage plans must offer the same Medicare Part A and Part B benefits as Original Medicare. Some Medicare Advantage plans also include additional benefits, such as prescription drug coverage. You must have Original Medicare, Part A and B, to enroll in a Medicare Advantage plan through a private insurer.
You can enroll in a Medicare Advantage plan during two enrollment periods, the Initial Coverage Election Period and Annual Election Period.
Penalty Fees For Late Enrollment
Medicare charges penalty fees for those who do not enroll in their Initial Enrollment Period, or they do not qualify for an exception due to employer insurance or other coverage.
Unless a person qualifies for a special exception, they will pay a monthly premium that is 10% higher for every 12-month period they were eligible for Medicare but did not sign up.
A person can qualify for a Medicare plan before 65 years of age if they meet certain criteria:
- They have end stage renal disease and need dialysis or are on the kidney transplant list.
- They have amyotrophic lateral sclerosis .
- Their doctor confirms that they have a disability.
An estimated 6.2 million people qualify for Medicare because they are disabled, according to the Medicaid and CHIP Payment and Access Commission. However, significantly fewer people use these benefits.
A doctor may declare a disability for people due to several types of medical conditions, including:
- Intellectual or developmental disabilities: These might include Down syndrome, cerebral palsy, or autism.
- Physical conditions: Traumatic brain injury, severe back injuries, or quadriplegia qualify as disabilities.
- Severe behavioral or psychological disorders: People with bipolar disorder or schizophrenia can qualify for Medicare early.
A doctor must submit paperwork to Medicare, declaring that a person has a disability. The individual may have a waiting period before they qualify for full Medicare benefits.
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When Do I Need To Sign Up For Medicare Part A
As stated above, if youre collecting Social Security benefits, youll automatically get Part A and Part B. If youre not automatically enrolled, the best time to enroll in Part A is during your Initial Enrollment Period.
As long as you worked a minimum of ten years, Part A will be premium-free. Even if youre still working, it makes sense to join Part A to help keep your out-of-pocket medical costs to a minimum.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
Note: When completing the forms CMS-40B and CMS-L564
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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When And How To Apply For Medicare
Learn about Medicare enrollment periods and how to sign up for all the coverage you need.
Youre about to get Medicare! Thats great news because the program helps pay for your health care costs and brings peace of mind. But learning how Medicare works and how to apply can be overwhelming. This article breaks down the key Medicare enrollment periods, how they work, and helps you plan for your big enrollment day.
