Timing is Everything: Enrolling in Medicare
Qualifying for Medicare happens at different times for different people. Enroll at your designated time to ensure coverage and avoid late fees.
When to Apply
Approximately a few months before your 65th birthday, you can enroll in Medicare. You will also receive your Medicare Benefits card in the mail. Individuals under 65 with certain disabilities or End-Stage Renal Disease also qualify for Medicare. Before enrolling in a Medicare Advantage plan, you must sign up for Original Medicare (Parts A and B). You can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP), a seven-month period that includes the three months before you turn 65, your birthday month, and the three months after. Suppose you don't enroll during your Initial Enrollment Period. In that case, you may have to wait to enroll during the General Enrollment Period (January 1 - March 31 of each year) unless you qualify for a Special Enrollment Period. If you enroll later, your premiums could be higher.
Medicare Due to Disability
When eligible for Medicare with a disability, you have an Initial Enrollment Period of 7 months.
Your Initial Enrollment Period will begin after receiving either disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board for 24 months. In other words, your IEP starts on the 25th month of disability benefits.
While you're automatically enrolled in Medicare Part A, if you decide to get a Medicare Advantage (Part C) plan or Part D prescription drug plan, you'll need to enroll yourself directly through a private plan provider. You'll have to enroll in Part B during your IEP to avoid a late enrollment penalty.
Special Circumstances: Medicare with ALS (Lou Gehrig's Disease) or End-Stage Renal Disease (ESRD)
Medicare eligibility rules for people with ALS (Lou Gehrig's disease) or end-stage renal disease (ESRD) are different. Individuals who qualify for Medicare with ALS or ESRD do not have to wait for their 25th month of disability to be eligible for Medicare.
If you qualify with ALS:
- You will automatically get Medicare Part A and Part B the month your disability benefits begin.
If you qualify with ESRD:
- For most people, Medicare coverage will start on the 1st day of the 4th month of dialysis treatment.
- If you have an employer group health plan, Medicare will begin on the fourth month of dialysis.
- If you participate in an at-home dialysis training program, your coverage may begin the first month of a regular course of dialysis, provided the following are true:
- You participated in training from a Medicare-approved training facility for the first three months of your regular dialysis
- Your doctor expects you to finish training and be able to do your dialysis treatments yourself
Note, according to Medicare to qualify with ESRD, all of the following must apply:
- Your kidneys no longer work
- You receive dialysis regularly or have had a kidney transplant
- One of the following must be true for you:
- You're already eligible for or are currently getting Social Security or Railroad Retirement Board (RRB) benefits
- You have worked the required amount of time under Social Security, the RRB, or as an employee of the government
- You are either the spouse or dependent child of someone who meets either of the above requirements
For more information related to ALS and Medicare, www.als.org.
For more information related to ESRD and Medicare, visit www.medicare.gov/basics/end-stage-renal-disease
General Enrollment Period
You may use the General Enrollment Period (GEP) to enroll in Medicare Part A, Part B, or both if you missed your IEP. The GEP happens every year from January 1 to March 31. If you already have Medicare Part A, and enrolled in Medicare Part B during the GEP, you may enroll in a Medicare Advantage plan or a Prescription Drug plan in the same year from April 1 to June 30.
If you pay a Part A premium and enroll in Part B for the first time during the General Enrollment Period, you can enroll in a Medicare Advantage plan from April 1 – June 30. Your coverage will begin on July 1.
Late Enrollment Penalties
It's essential to know your enrollment dates and to enroll on time. Otherwise, you may receive the following penalties unless you qualify for a SEP or another exception.
- Part A: People who pay a premium (most don't) could pay an additional 10% of the premium amount. The penalty is charged monthly for twice the years of delayed enrollment.
- For example: If you were eligible for Part A for two years but didn't sign up, you'd have to pay a higher premium for four years.
- Part B: You could pay an additional 10% of the premium amount for each total 12-month period enrollment is delayed. The penalty is charged monthly for however long you don't have Part B.
- Part D: You could pay an additional 1% (12% a year) of the average Part D premium if you don't join a Medicare drug plan when you first apply or if you go 63 days or more without creditable drug coverage.
- Medicare Supplement Insurance: You could be denied coverage or charged a higher premium based on your health history.
Working Beyond 65
If you turn 65 but continue to work, you have options:
- There is still a Medicare Initial Enrollment Period (IEP) when you turn 65. You may choose to enroll in Part A during this time. If you or your spouse worked and paid Medicare taxes for at least ten years, it's still premium free.
- The Centers for Medicare & Medicaid Services (CMS) won't notify you about your IEP unless you currently get Social Security or Railroad Retirement Board benefits, so you'll have to be proactive and enroll in Medicare yourself.
- You may qualify for a Medicare Special Enrollment Period (SEP) that allows you to delay enrolling in Part B and Part D without incurring late enrollment penalties. However, you'll need confirmation of creditable coverage from your employer.
- If you're covered by your working spouse's employer health insurance plan, and you're 65 or older, you may qualify for a Medicare Special Enrollment Period when that coverage ends. Same-sex spouses included.
Do I need to enroll each year?
Your plan will automatically renew each year provided the premium is paid, and the plan is still available in your area.
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