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
Your Medicare Approval During Your Initial Enrollment Period
Your Initial Enrollment Period is a 7-month window surrounding your 65th birthday month. You can apply through the Social Security Administration website or over the phone when you use this window. Although many beneficiaries become eligible during this period, it can still take about 2-6 weeks to approve your Medicare application.
Since the COVID-19 pandemic began, Social Security representatives have worked from home, which means Social Security is backlogged. Since your local Social Security office processes your Medicare application, approval times can vary. Some people will receive confirmation within a week or two after applying, while others wait longer.
Your effective date will depend on what month you applied. If you applied before your birthday month, it would start on the 1st of your birthday month. However, if you applied after your birthday month, Social Security will delay your effective date by up to 3 months, depending on when you apply. Ask your representative for confirmation of your Medicare start date, so there are no surprises.
Cms Proposes Medicare Enrollment Coverage Changes
The Centers for Medicare & Medicaid Services Friday released a proposed rule that would implement provisions in the Consolidated Appropriations Act of 2021 that revise the effective dates of coverage in traditional Medicare authorize special enrollment periods for certain eligible individuals and extend Part B coverage for immunosuppressive drugs for kidney transplant patients.
Beginning Jan. 1, 2023, coverage for individuals enrolling in traditional Medicare during the last three months of their initial enrollment period or during the general enrollment period would begin one month after enrollment, CMS said. The rule also would create SEPs for individuals impacted by an emergency or disaster who can demonstrate that their employer or health plan materially misrepresented information related to timely enrolling formerly incarcerated individuals after termination of Medicaid eligibility and other exceptional conditions.
Beginning this October, individuals with end stage renal disease who do not have other health insurance could enroll in Medicare Part B coverage for immunosuppressive drugs beyond the 36-month post-transplant period.
Among other changes, the rule also would require states to specify their policy for paying Medicare Part A and B premiums on behalf of low-income individuals in their Medicaid plan and limit states liability for retroactive Part B premiums to 36 months for certain full-benefit dually eligible beneficiaries.
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Medicare Is Well Regarded As An Extremely Beneficial Insurance Program With So Many Different Parts And Plans It Can However Be Difficult To Navigate Medicare Coverage Start Dates
If youre coming up on retirement or have already retired, you may be thinking, When does my Medicare start? Dont worry, youre not alone in your wonderment or confusion. Some of the most common questions regarding Medicare coverage start dates are included below:
- When you turn 65, when does coverage start?
- When does Part A coverage start?
- When does Part B coverage start?
- When you sign up for Medicare, when does coverage start?
Medicare Supplement Open Enrollment Period
If youre looking to supplement your Original Medicare coverage to help with additional costs, the best time to buy a Medicare Supplement plan is during the six-month enrollment period that starts the first day of the month you turn 65 as long as you have signed up for Medicare Part B.
If you dont sign up for a Medicare Supplement plan during this Open Enrollment Period, you may not be able to buy a Medicare Supplement plan. Unless you have a guaranteed issue right, you may be required to answer medical questions.
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Can I Start Medicare Before My 65th Birthday
You will have a Medicare initial enrollment period. If you sign up for Medicare Part A and Part B during the first three months of your initial enrollment period, your coverage will start on the first day of the month you turn 65.
For example, say your birthday is August 31. Your initial enrollment period will begin three months prior to your birthday month, or in this case, May. If you sign up in May, June, or July, your coverage will start on August 1.
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
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Check Status Of Medicare Application
There are various ways to receive Medicare coverage.
Otherwise, you need to sign up for this coverage on your own.
Once your application is submitted, you can check on its status by:
- Logging in to your My Social Security account
- Visiting your local Social Security office
- Visiting the Check Enrollment page on your MyMedicare.gov account
To check the status of your Medicare application on the Social Security website, you will need to enter your Social Security number and the confirmation number you received when you filed your application.
Your application status will show:
- The date your application was received
- Any requests for additional documents
- The address of the Social Security office processing your application
- Whether a decision has been made about your application
Once your application is processed, you will receive a notification letter in the mail to inform you of whether your application was approved.
If you need help, or are unable to check your application status online, call the Social Security Administration at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday.
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.
The Medicare Initial Enrollment Period
Around your 65th birthday , you’ll have a 7-month window of time when you can sign up for Medicare. It’s called your Initial Enrollment Period or IEP for short. Your IEP includes your 65th birthday month, the 3 months before and the 3 months after.
Example: You turn 65 on June 7. Your IEP is March 1 September 30.
If, however, your birthday is on the 1st of the month, then your IEP is determined as though you were born the month before.
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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How Do You Enroll If You Are Not Going To Collect Ssa Benefits Yet
If you are not currently enrolled in SSA benefits prior to your Initial Enrollment Period , you will need to apply for Medicare yourself.
Most people do not pay a premium for Part A because they or their spouse) have paid enough in Medicare taxes during their employment history. Part B will always have a premium that has to be paid. You can sign up for Parts A and/or B by doing the following:
- Apply online
- Contact your local SSA office
Medicare Coverage And End Stage Renal Disease
You may get Medicare benefits at any age if you have ESRD and one of the following applies:
- You are eligible for Medicare based on your work record.
- You are already getting Social Security or Railroad Retirement Board benefits, or you are eligible for benefits.
- Your spouse or parent meets one of the above requirements.
Medicare coverage starts the fourth month you receive dialysis treatments. For example, your Medicare coverage would start on October 1 if you start getting your dialysis treatments in July.
Medicare coverage could start the first month you receive treatments if all of these apply:
- You attend a home dialysis training program provided by a Medicare-certified training facility.
- Your doctor expects you to complete the training and be able to do your own dialysis treatments.
- You maintain regular dialysis treatments throughout the usual required waiting period.
You must enroll in Original Medicare yourself. Once you have both Part A and Part B, you may make other Medicare coverage choices, such as adding Medicare Part D prescription drug coverage or choosing a Medicare Advantage plan.
If you are 65 or older, or disabled, and are already enrolled in Part A, you may enroll in Part B without penalty if you are approved for Medicare based on ESRD. You may also have an existing Part B late enrollment penalty removed.
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When Does Medicare Start
When your Medicare coverage starts depends on when you sign up. You may be automatically signed up if you are already receiving Social Security benefits.
Notice that signing up after your 65 birthday month creates a delay in when your Medicare coverage starts.
|If you sign up for Medicare Part A and/or Medicare Part B in this month:||Your coverage starts:|
|3, 2, or 1 month before you turn 65||The first day of your birthday month|
|The month you turn 65||1 month after you sign up|
|1, 2 or 3 months after you turn 65||The first day of the month after you sign up|
|During the Jan 1-March 31 General enrollment period|
To look for a Medicare Advantage, Medicare Part D, or Medicare Supplement insurance plan in your area, enter your zip code on this page.
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Medicare Initial Enrollment Period
The initial enrollment period includes the three months before and after your 65th birthday as well as your birthday month.
If you sign up for Medicare during the first three months of your IEP, your coverage starts the first day of your birthday month.
For example: Sams 65th birthday is on August 15. If he signs up for Medicare in May, June or July, his coverage will start on August 1.
For those whose birthdays fall on the first day of the month, Medicare coverage will begin on the first day of the previous month.
For example: Kims 65th birthday is on October 1. If she signs up for Medicare in June, July or August, her coverage will start on September 1.
A common enrollment mistake is missing the IEP. If that happens, you can enroll during the general enrollment period. Note that missing both enrollment periods could result in late enrollment penalties or higher monthly premiums.
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When Does Medicare Part A Start
Initial Enrollment Period: If you qualify for Medicare Premium-Free Part A, your coverage can begin the month of your 65th birthday. If your birthday falls on the 1st of the month, your coverage will begin the month before your 65th birthday.
After Initial Enrollment Period: If signing up for Medicare Premium-Free Part A after your initial enrollment period, your coverage will be applied for 6 months prior to your application date. However, coverage can only begin when you turn 65 years old. If you apply when you are 65 years old and 3 months, the coverage will only post-date until your 65th birthday.
If you do not qualify for Premium-Free Part A Medicare coverage, you will be able to purchase Premium Part A coverage. Premium Part A coverage will start in the same time frame as Medicare Part B. Medicare Part B and Premium Part A coverage are outlined below.
Employer Or Military Retiree Coverage
If you or your spouse has an Employer Group Health Plan as retiree health coverage from an employer or the military , you may not need additional insurance. Review the EGHPs costs and benefits and contact your employer benefits representative or SHIIP to learn how your coverage works with Medicare.
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When You Can Expect Your Medicare Card
Once you have confirmation that your Medicare application was approved, you should receive your Medicare card in the mail about 2-4 weeks later. Your card will state your Medicare effective dates and number.
Your Medicare number is all you need for other applications, such as Medigap, Medicare Advantage, and Part D. Since you can view your Medicare number in your SSA account, you dont necessarily need to wait to receive your card to move forward with the other applications.
Does Medicare Start On Your Birthday
Original Medicare coverage does not start on your actual birthday. At the earliest, coverage begins on the first day of the month you turn 65. So, if your birthday is July 24, your coverage will begin July 1.
However, there is one exception to this rule. If you are born on the first of the month, your Medicare coverage will begin one month earlier. So, if you are born on September 1, your Initial Enrollment Period will be the same as those born in August.
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