When Would My Medicare Coverage Start
If you enroll during the first three months of your IEP, your Medicare coverage begins on the first day of the month you turn 65 or the first day of the previous month if your birthday falls on the first day of a month.
If you sign up for Part B during the fourth month your birthday month coverage begins the first day of the following month.
If you dont enroll in Part B until later, in the fifth, sixth or seventh month of the IEP, coverage will be delayed by two or three months. However, those rules change in 2023, when the coverage will take effect the next month when you enroll after your birthday month.
You can sign up for premium-free Part A any time after your IEP starts. Your coverage will take effect six months retroactively, but no earlier than the month you turn age 65.
The best way to sign up for Medicare during your initial enrollment period is online at the Social Security website.
What Does Medicare Cover
Medicare helps pay for certain health care services and durable medical equipment. To have full Medicare coverage, Medicare beneficiaries must have Part A and Part B .
The following is a partial list of Medicare-covered services. The covered services listed below may require payment of deductibles and Co-Payments.
If you have questions about covered services, call Medicare at 1-800-633-4227.
Medicare Advantage Open Enrollment Period
Medicare Advantage Open Enrollment happens every year from Jan. 1 to March 31. If youre enrolled in a Medicare Advantage plan and want to make changes, you can do one of these:
- Switch to a different Medicare Advantage plan with or without drug coverage
- Go back to Original Medicare and, if needed, also join a Medicare prescription drug plan
Your new coverage begins on the first day of the month following the month you make a change and will be in effect for the rest of the year.
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Sign Up: Within 8 Months After You Or Your Spouse Stopped Working
Your current coverage might not pay for health services if you dont have both Part A and 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?
Do I Qualify For A Medicare Special Enrollment Period
Perhaps, if you or your spouse is still working and you have health insurance from that employer. The special enrollment period allows you to sign up for Medicare Part B throughout the time you have coverage from your or your spouses employer and for up to eight months after the job or insurance ends, whichever occurs first.
If you enroll at any point during this time, your Medicare coverage will begin the first day of the following month. And you will not be liable for late penalties, no matter how old you are when you finally sign up.
Your decision also depends on the size of your employer and whether the employers plan is first in line to pay your medical bills or second.
Larger companies. If you or your spouse work for a company with 20 or more employees, you can delay signing up for Medicare until the employment ends or the coverage stops, whichever happens first. These large employers must offer you and your spouse the same benefits they offer younger employees and their spouses, which means that the employers coverage can continue to be your primary coverage and pay your medical bills first.
Many people enroll in Medicare Part A at 65 even though they have employer coverage, because its free if they or their spouse has paid 40 or more quarters of Medicare taxes. But they often delay signing up for Part B while theyre still working so they dont have to pay premiums for both Medicare and the employer coverage.
Keep in mind
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How Does Tricare Work With Medicare Advantage
Tricare for Life is the health insurance program for qualified military retirees and their eligible dependents. This is different than Medicare, which is the national health care system for many people age 65 and older and for people with certain disabilities. Medicare beneficiaries who have Medicare Part A and Part B have the option of enrolling in a Medicare Advantage plan offered by a private insurance company contracted with Medicare. Its possible to have both Tricare and Medicare Advantage and have the two plans work together.
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Who Is Automatically Enrolled In Medicare
If youre already receiving Social Security or Railroad Retirement Board benefits at least four months before your 65th birthday, youll be enrolled automatically in Medicare Part A and Part B. If you live in Puerto Rico and are receiving those benefits, only Part A will come to you automatically youll need to take extra steps to enroll in Part B.
Youll receive your Medicare card in the mail and can start using it the beginning of the month you turn 65. If your birthday is on the first day of a month, your coverage will start a month earlier.
Part A, which covers hospitalization, is free if you or your spouse has paid Medicare taxes for 40 quarters, the equivalent of 10 years. Part B, which covers doctor and outpatient services, has a monthly premium of $170.10 for most people in 2022, and the Social Security Administration will automatically deduct the premium from your monthly benefit.
But if you or your spouse is still working and you have health insurance from that employer, you may not have to enroll in Part B yet. You can send back the card and enroll in Part B later. Follow the instructions on the back of the card to delay enrolling in Part B if youre already receiving Social Security or Railroad Retirement benefits.
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Ways To Apply For Disability Benefits:
- If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
Once your disability benefits start, well mail you a welcome package with your Medicare card.
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 after your Part A starts, you might have to wait to sign up for Part B and pay a monthly late enrollment penalty.
What Other Important Information Do You Need To Know About Medicare Enrollment In Parts A And B
- You can sign up for both Medicare Parts A and B but you dont have to sign up for Part B.
- If you want to enroll in Part B later on, you may sign up during the SEP if your circumstances qualify as an eligible life event. If not, you can wait for the General or Open Enrollment Period and receive delayed benefits, pay a late enrollment fee or be charged a higher premium.
- If you live in Puerto Rico, theres no automatic enrollment for Part B. You will have to sign up during your Initial Enrollment Period or you will be charged a penalty.
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Is Tricare For Life Right For You
TRICARE For Life is the plan for you if:
- Youre eligible for TRICARE
- You have both Medicare Part A and B
Coverage is available worldwide and you can see any provider you want. However, youll pay more if you get care from Veterans Administration providers or providers who opt-out of Medicare, because theyre not allowed to bill Medicare.
When retired service members and their families become eligible for TRICARE For Life, typically at 65, they are no longer able to enroll in TRICARE Prime.
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Signing Up For Original Medicare
There are a few different ways to sign up for Medicare Part A and Medicare Part B if you are not automatically enrolled.
Medicare Part A and Part B are also called Original Medicare.
3 Ways to Sign Up for Medicare Part A and Part B
If you worked at a railroad, call the Railroad Retirement Board at 1-877-772-5772 to sign up.
If you are not automatically enrolled, the best time to sign up for Medicare is during your initial enrollment period.
This is a seven-month window that begins three months before the first day of the month of your 65th birthday, includes your birth month and ends three months after your birthday.
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When Should You Sign Up For Medicare Benefits
Before I answer the question about when to sign up for Medicare benefits, let me assure you that enrolling in Medicare and understanding how it works doesnt have to be complicated. Ill show you how easy it is to figure out when to sign up for Medicare benefits. Keep in mind, there are three Medicare enrollment opportunities and its important to know which one apply to you.
If Youre Not On Active Duty
As a general rule, Medicare will be the primary payer or the policy that pays first for all Medicare-approved services from non-VA providers. Medicare will pay up to its defined coverage limits.
TRICARE will usually act as the secondary payer. If there are costs remaining that TRICARE covers, TRICARE will help pay for them. Having both forms of insurance can significantly reduce your out-of-pocket costs. Its important to know that just because TRICARE pays for some of the costs Medicare doesnt cover, it may not pay for all of them.
An exception is when you receive care from a military hospital or any other federal healthcare provider. TRICARE will usually be the primary payer for these services.
How to get your questions answered
If at any time you have questions about who pays for what, you can call Medicares Benefits Coordination & Recovery Center at 855-798-2627 . You can also call TRICARE for Life at 866-773-0404.
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Medicare Prescription Drug Coverage
Medicare Prescription Drug Plans are sold by private insurance companies approved by Medicare. All people new to Medicare have a seven-month window to enroll in a PDP three months before, the month of and three months after their Medicare becomes effective. The month you enroll affects the PDPs effective date. All people with Medicare are eligible to enroll in a PDP however, unless you are new to Medicare or are entitled to a Special Enrollment Period, you must enroll or change plans during the Open Enrollment Period for Medicare Advantage and Medicare Part D, Oct. 15 through Dec. 7. There is a monthly premium for these plans. If you have limited income and assets/resources, assistance is available to help pay premiums, deductibles and co-payments. You may be entitled to Extra Help through the Social Security Administration. To apply for this benefit contact SHIIP at 1-855-408-1212 or the Social Security Administration at 800-772-1213 or www.socialsecurity.gov.
If You Disagree With Our Decision
If you disagree with the decision we made about your income-related monthly adjustment amounts, you have the right to appeal. The fastest and easiest way to file an appeal of your decision is online. You can file online and provide documents electronically to support your appeal. You can file an appeal online even if you live outside of the United States.
You may also request an appeal in writing by completing a Request for Reconsideration , or contact your local Social Security office. You can use the appeal form online, or request a copy through our toll-free number at 1-800-772-1213 . You dont need to file an appeal if youre requesting a new decision because you experienced one of the events listed and, it made your income go down, or if youve shown us the information we used is wrong.
If you disagree with the MAGI amount we received from the IRS, you must correct the information with the IRS. If we determine you must pay a higher amount for Medicare prescription drug coverage, and you dont have this coverage, you must call the Centers for Medicare & Medicaid Services to make a correction at 1-800-MEDICARE . We receive the information about your prescription drug coverage from CMS.
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Scenario #: You Are Turning 65 And Are Not Receiving Social Security But You Want To Sign Up For Medicare
This is an increasingly-common scenario as more people are choosing to delay their Social Security. In this case, there are actions that you must take to enroll in Medicare, if you wish to have Medicare start at age 65.
You will still be automatically enrolled into Medicare Part A . However, Medicare does not assume that you want Medicare Part B if you are not receiving Social Security. You will still receive a Medicare card automatically about 3 months before you turn 65 however, the card will only reflect Medicare Part A. You will need to proactively sign up for Medicare Part B.
To do this, you can go on Social Securitys website to apply for Medicare online OR you can visit a local Social Security office to enroll in Medicare without taking Social Security benefits. This should be done 2-3 months before your Medicare start date, which will be the 1st day of the month that you turn 65.
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Applying For Medicare As Your Primary Coverage
If Medicare will be your primary coverage, you should enroll in Medicare in the 3 months before your birth month. Your Medicare will start on the first of the month in which you turn 65. Enrolling prior to your birthday will ensure your benefits begin on the first of your birthday month.
If you register for Medicare in the 3 months after your 65th birthday, then your start date will be later. People unaware of this could end up with a few months of no health coverage. Its important to realize that your application date affects your start date.
Also, if you are leaving employer coverage in the middle of your Medicare Initial Enrollment Period, then your IEP trumps any other election period. Weve seen this a number of times where people assume their Medicare coverage will start immediately after the group coverage ends.
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However, if you are in your IEP and your birth month has already passed, this chart demonstrates that you must wait for your coverage.
Its easy to see why applying for Medicare prior to your 65th birthday month is generally in your best interest. Although, it is ultimately your choice on when to apply.
Applying During the General Enrollment Period
Medicare Enrollment and Small Employer Coverage
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I Want To Sign Up For Only Part A Or Both Part A & Part B
Once youre eligible to sign up for Medicare , you have 2 options:
Once you sign up , youll get a welcome package with your Medicare card.
Contact Social Security To Sign Up For Medicare
You can either:
Know when to sign up for Part BYou can only sign up for Part B at certain times. If you dont sign up for Part B when you turn 65, you might have to wait to sign up and pay a monthly late enrollment penalty. Find out when you can sign up. How much is the Part B late enrollment penalty?
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What Happens If A Provider Opts Out Of Medicare
If your provider opts out of Medicare, Medicare will paynothing. TFL would cover up to 20 percent of allowed TRICARE amounts forservices, and youd be responsible for the remaining bill. This rule applies toany care received from a U.S. Department of Veterans Affairs for injuriesor illnesses not related to your military service. You can read more about theVA and associated care and costs at www.va.gov/healthbenefits/apply/veterans.asp.
Medicare Eligibility At 65 And Older
You can apply for Medicare the year you turn 65, but you generally must meet three eligibility requirements to qualify for full Medicare benefits at this age.
The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.
In addition, you must meet one of the following other requirements:
- You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means you have worked for at least 10 years. You must be eligible for these Social Security benefits even if you are not yet receiving them.
- You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.
If you pay Medicare payroll taxes for 10 full years, you wont have to pay premiums for Medicare Part A, which covers hospital care.
You dont need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, and Medicare Part D, which covers prescription drugs. Everyone pays premiums for both regardless of work history.
If you are still working at 65, you dont have to sign up for Medicare but there are benefits to signing up while still employed. Similarly, if you have never worked, you can still get Medicare. It may be more expensive depending on your spouses work history.
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