Am I eligible?
Before enrolling in Medicare, let’s first make sure you are eligible. Medicare eligibility begins at age 65 for most people and individuals must also be a US citizen or permanent resident who has lived in the U.S. continuously for at least five years. Additionally, those who have been receiving Social Security disability benefits for at least 24 months are also eligible as well as individuals with end-stage renal disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).
How Do I Enroll?
For starters, Medicare is not required however, if you do not have other qualifying health coverage, you may face penalties for delaying your Medicare enrollment. If you are already receiving Social Security income benefits, you will be automatically enrolled into Medicare Part A once you turn 65 and will have to decline Part B if you choose not to enroll. For everyone else, you must take action to enroll in Medicare which is done through the Social Security Administration. This can be done online at ssa.gov, in-person at a local SSA office, over the phone, by mail or fax.
Medical Enrollment Periods
Initial Enrollment Period:
Your initial enrollment period (IEP) begins three months before the month you turn 65 and ends 3 months after your birth month UNLESS your birthday is on the first of the month in which case your enrollment period will begin and end one month earlier. During this IEP you can enroll in Medicare Parts A, B, C and/or D.
Annual Enrollment Period:
The Annual Election Period (AEP) is the time of year where current Medicare beneficiaries can add, drop or change their Part C and Part D coverage. It begins on October 15 and ends on December 7 each year. If there are changes you need to make for the following year, this is the time to do it. Changes made during AEP will become effective on January 1 the following year.
Medicare Supplement Open Enrollment Period:
Once enrolled in Parts A & B, there is a six-month window to enroll in a Medigap plan. This period begins with your Part B effective date and is a one-time election period. It is important to understand your rights for Medicare Supplement enrollment as you may face denied applications or higher premiums once outside of this window.
Special Enrollment Periods:
If you have other coverage, such as employer coverage, you may not face these penalties. For instance, many people work past the age of 65 and choose to continue receiving health coverage through their employer. For most people, this is fine but it is important to understand how coordination of benefits will work once you reach Medicare eligibility. You can sign up for Medicare anytime while you are covered by this employer plan and for eight months from the month you or your spouse quits work or the month your group coverage ends; whichever comes first.
What if I Didn't Sign Up During My Initial Enrollment Period?
All hope is not lost here but you may face penalties and a lapse in coverage so it is important to understand if your situation allows you to delay Medicare. For those who missed their IEP and do not have other coverage or another qualifying Special Enrollment Period (SEP), the time to apply is during Medicare’s General Enrollment Period (GEP). This takes place every year from January 1 and March 31 with coverage becoming effective on July 1 of the same year. Parts C & D can be added between April 1 and June 30 for a July 1 effective date. In addition to a potential lapse in coverage, there are possible penalties for Parts A, B and D.
If you don’t qualify for premium-free Part A coverage due to your work history and you miss your enrollment period, you will pay an extra 10% of your premium for twice the number of years you didn’t have coverage.
If you miss your enrollment period for Part B, you will pay an extra 10% of your premium for every 12-month period you should have had Part B. This penalty does not go away as long as you are enrolled in Medicare Part B.
If you miss your enrollment period for Part D, you will pay an extra 1% of your premium for each month you should have had Part D. This penalty also does not go away as long as you have Medicare Part D.
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