When to Enroll in Medicare
When the time comes for you to enroll in Medicare you have several options. Medicare enrollment is automatic, for some people, while for others, it may depend on when and how they become eligible.
Of all of the things you will learn during this period, these two facts are among the most important:
- Your Medicare open enrollment will begin on your 65th birthday. During this time period, you cannot be turned down for coverage because of a medical condition.
- You only get one open enrollment period and it’s for a limited time only.
How to enroll in Medicare
You have several options to enroll in Medicare Part A and/or Medicare Part B :
- Online at www.SocialSecurity.gov.
- Contact Social Security at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM.
- In-person at your local Social Security office.
If you worked at a railroad, enroll in Medicare by contacting the Railroad Retirement Board (RRB) at 1-877-772-5772 (TTY users 1-312-751-4701). You can call Monday through Friday, 9AM to 3:30 PM, to speak to an RRB representative.
When to enroll in Medicare
Situations where Medicare enrollment may occur automatically:
If you are receiving retirement benefits:
You will automatically be enrolled in Medicare Part A and Medicare Part B if you’re you’re already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, or if you sign up for Medicare Part B at the time you sign up for retirement benefits.
If you live outside of the 50 United States or D.C., you will automatically be enrolled in Medicare Part A, but will need to manually enroll in Medicare Part B.
If you are receiving disability benefits:
If you are receiving certain disability benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled inPart A and Part B,(Original Medicare) after 24 months of disability benefits if you are under 65. The exception to this is if you have end-stage renal disease (ESRD). If you:
- had a kidney transplant and have ESRD or need regular kidney dialysis, you can apply for Medicare.
- have ALS or Lou Gehrig’s disease (amyotrophic lateral sclerosis) you will automatically be enrolled in Original Medicare in the same month that your disability benefits start.
If you don’t want Medicare Part B:
In case you’re automatically enrolled in Medicare Part B, but do not wish to keep it , there are options to drop the coverage. If your Medicare coverage hasn’t started yet and you were sent a red, white, and blue Medicare card, you can follow the instructions that come with your card and send the card back. If you do not send the Medicare card back, you keep Part B and will need to pay Part B premiums. If you signed up for Medicare through Social Security, you will need to contact them to drop Part B coverage. If your Medicare coverage has already started and you want to drop Part B, contact Social Security for instructions on how to submit a signed request. After Social Security gets your request your coverage will end the first day of the following month.
If you have health coverage through either through your work or your spouse’s employer, you may be to delay Medicare Part B enrollment without incurring a late enrollment penalty. Your employer’s health benefits administrator will be able to help you understand how your current coverage works with Medicare and what the consequences would be if you drop Medicare Part B.
Medicare Part B late-enrollment penalty:
If you do not sign up for Medicare Part B when you are first eligible, a late enrollment penalty may be assessed which could be 10% higher for your Part B premium for every full 12-month period that you were eligible for Part B, but didn’t take it. The higher premium could be in effect for as long as you are enrolled in Medicare. There are several Medicare enrollment periods to apply for Medicare for those who are not automatically enrolled.
You can delay Medicare Part B enrollment without paying a late-enrollment penalty If you have health coverage through an employer health plan or through your spouse’s employer plan. COBRA or retiree benefits are not considered current employer health coverage.
Medicare Initial Enrollment Period
Enrolling in Medicare Part A is automatic for most people. There are some instances where you may have to manually enroll in Medicare Part A and/or Part B during your Initial Enrollment Period (IEP), the seven-month period that begins three months before you turn 65, including the month of your 65th birthday and ends three months later.
Some situations where you would enroll in Medicare during your initial enrollment include:
If you aren’t receiving retirement benefits:
when you are not yet receiving retirement benefits and are close to turning 65, you can sign up for Medicare Part A and/or Part B during your IEP. You can enroll in medicare and apply for retirement benefits later if you decide to delay your Social Security retirement benefits or Railroad Retirement Benefits beyond age 65.
If you do not qualify for retirement benefits:
In case you are not eligible for retirement benefits from Social Security or the RRB, you will not be automatically enrolled into Original Medicare. You can sign up for Part A and/or Part B during your IEP. You may not be able to get premium-free Medicare Part A, and the cost of your monthly Part A premium will depend on how long you worked and paid Medicare taxes. You will still have to pay a Medicare Part B premium.
Medicare General Enrollment Period
If you did not enroll during the IEP when you were first eligible, you can enroll during the general enrollment period for Original Medicare, which is from January 1 through March 31 of each year. As a reminder, a late enrollment penalty may be assessed for Part B if you did not sign up when you were first eligible.
Medicare Special Enrollment Period
If you are already covered by group medical insurance through an employer or union you may choose not to enroll in Part B when you are eligible. If you lose your group coverage, or decide you want to switch from your group coverage to Medicare you can sign up while you are still covered by the group plan or during a Special Enrollment Period (SEP).
Your eight-month special enrollment period begins either the month that your employment ends or when your group health coverage ends, whichever occurs first. If you enroll during a SEP, you generally do not have to pay a late enrollment penalty.
The Special Enrollment Period does not apply if you’re eligible for Medicare because you have ESRD. As a reminder, COBRA and retiree health coverage are not considered current employer coverage and would not qualify you for a special enrollment period.
Medicare Advantage plan enrollment
Medicare Advantage ,also known as Medicare Part C is a version of Original Medicare offered through private insurance companies. Medicare Advantage plans (MA, MAPD) must offer the same Medicare Part A and Part B benefits as Original Medicare. Some Medicare Advantage plans may also include prescription drug coverage (MAPD). You must have Part A and B, to enroll in a Medicare Advantage plan through a private insurer.
You can enroll in a Medicare Advantage plan during the Initial Coverage Election Period (IEP) ,the Annual Election Period (AEP) or a special election period (SEP) .
Medicare Advantage plan Initial Coverage Election Period:
Most beneficiaries are first eligible to enroll in a Medicare Advantage plan during the Initial Coverage Election Period. With the exception of enrolling in Part B later, this enrollment period takes place at the same time as your Initial Enrollment Period (IEP), starting three months before you have both Part A and Part B and ending on whichever of the following dates occurs later:
- The last day of the month before you have both Medicare Part A and Part B, or
- The last day of your Medicare Part B Initial Enrollment Period.
If you’re under 65 and eligible for Medicare due to disability, your Initial Enrollment Period will vary based on when your disability benefits started.
Medicare Advantage plan Annual Election Period:
The Medicare Advantage Dis-enrollment Period (January 1 – February 14 every year) will be replaced with a different arrangement. The Medicare Advantage Dis-enrollment Period lets you drop your Medicare Advantage plan and return to Original Medicare (Part A and Part B). It also lets you sign up for a stand-alone Medicare Part D Prescription Drug Plan.
You can also add, drop, or change your Medicare Advantage plan during the Annual Election Period, which occurs from October 15 to December 7 of every year. During this period, you may:
- Change from Original Medicare to a Medicare Advantage plan, and vice versa.
- Change one Medicare Advantage plan for a different one.
- Switch from a Medicare Advantage plan without prescription drug coverage to a Medicare Advantage plan that covers prescription drugs, and vice versa.
Medicare Advantage Open Enrollment
In 2019, a new Medicare Advantage Open Enrollment Period will run from January 1 – March 31 every year. If you’re enrolled in a Medicare Advantage plan, you’ll have a one-time opportunity to:
- Switch to a different Medicare Advantage plan
- Drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B
- Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if you return to Original Medicare). Most Medicare Advantage plans include prescription drug coverage already. Usually you can’t enroll in a stand-alone Medicare Prescription Drug plan if you already have a Medicare Advantage plan, but there are some situations where you can. Call your Medicare Advantage plan if you have questions.
Medicare prescription drug coverage
Medicare prescription drug coverage is optional and does not occur automatically. You can receive coverage for prescription drugs by either signing up for a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage, also known as a Medicare Advantage Prescription Drug plan. Medicare prescription drug plans and Medicare Advantage plans are available through private insurers. Please note that you cannot have both a stand-alone Medicare prescription drug plan and a Medicare Advantage plan that includes drug coverage.
Initial Enrollment Period for Medicare Part D:
You can enroll in a stand-alone Medicare prescription drug plan during your Initial Enrollment Period for Part D. You are eligible for drug coverage if you:
- live in a service area covered by the health plan, and
- have Medicare Part A AND/OR Medicare Part B.
Generally, your Initial Enrollment Period for Part D will occur at the same time as your Initial Enrollment Period for Medicare Part B (the seven-month period that starts three months before your eligibility for Part B, includes the month you are eligible, and ends three months later).
Once you are eligible for Medicare Part D, you must either enroll in a Medicare prescription drug plan, Medicare Advantage Prescription Drug plan, or have creditable prescription drug coverage(that is, drug coverage that is expected to pay at least as much as standard Medicare prescription drug coverage). Some people may choose to delay Medicare Part D enrollment if they already have creditable drug coverage through an employer group plan.
However, if you do not sign up for prescription drug coverage when you are first eligible for Part D, you may have to pay a late-enrollment penalty for signing up later if you go without creditable prescription drug coverage for 63 or more consecutive days.
Medicare Part D Annual Election Period:
If you did not enroll in drug coverage during IEP, you can sign up for prescription drug coverage during the Annual Election Period that runs every year from October 15 to December 7.
During AEP, you can:
- Sign up for a Medicare prescription drug plan.
- Drop a Medicare prescription drug plan.
- Join a Medicare Advantage plan that includes prescription drug coverage.
- Switch from a Medicare Advantage plan that doesn’t include drug coverage to a Medicare Advantage plan that does (and vice versa).
Medicare Supplement plans enrollment
Medigap (or Medicare Supplement Plans) are voluntary, additional coverage that helps fills the gaps in coverage for Original Medicare. The best time to enroll in a Medicare Supplement plan is during your individual Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month you turn 65 and have Medicare Part B. If you decide to delay your enrollment in Medicare Part B, for certain reasons such as having health coverage based on current employment, your Medigap Open Enrollment Period will not begin until you sign up for Part B.
During your Medigap Open Enrollment Period, you have a “guaranteed-issue right” to buy any Medigap plan sold in your state. This means that insurance companies cannot reject your application for a Medicare Supplement plan based on pre-existing health conditions or disabilities. They also cannot charge you a higher premium based on your health status. Outside of this open enrollment period, you may not be able to join any Medigap plan you want, and insurers can require you to undergo medical underwriting. You may have to pay more if you have health problems or disabilities.
Medigap plans, like Medicare Advantage plans, are offered through private insurance companies and are available for purchase through many of the carriers we work with.