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When and How to Apply for Medicare

So, you've done all this work to determine you are eligible for Medicare. Now what?

Most Americans can apply for Medicare Parts A & B (Original Medicare) during an Initial Enrollment Period (IEP) that spans the three months prior to their 65th birthday, their birthday month, and the three months afterwards. So if your birthday is in April, you have from January 1 to July 31 to enroll. 

Whether you actually have to apply for Medicare Parts A & B (Original Medicare) or will be auto-enrolled depends on if, and when, you started to receive Social Security benefits. 

And keep in mind that while enrolling in Parts A & B might be automatic depending on your situation, you’ll still want to enroll in a Medicare Part D plan (drug coverage) or enroll in a Medicare Advantage Plan (Part C) during your IEP. Otherwise, you may be on the hook for Part D penalties when you do sign up.

Enrolling in Medicare Parts A & B (Original Medicare)

If you started to receive your Social Security benefits at least three months before your 65th birthday, you do not need to apply for Original Medicare. You’ll be auto-enrolled and should receive information in the mail before your 65th birthday detailing your benefits.

If you did not start your Social Security benefits at least three months before your 65th birthday, you’ll need to enroll on your own during the Initial Enrollment Period (IEP). Your first enrollment period is crucial, as missing this window will almost certainly result in higher premiums for the rest of your life (see below). 

If you are receiving any other kind of Social Security benefits than regular retirement benefits (such as spousal benefits), you should contact your local Social Security office to see if you will be auto-enrolled in Medicare.

How to apply for Medicare Parts A & B if you’re not auto-enrolled

There are three ways to enroll in Medicare Parts A & B, and completing your application typically takes between 10 and 30 minutes.

When to enroll in Medicare if you’re not auto-enrolled

While you can enroll at any time during the Initial Enrollment Period, the date you sign up affects when your coverage begins (see below). And if you wait until after your birthday, you may face a delay in coverage.

Should I enroll in Medicare Parts A & B if I’m covered by a work plan?

In general, if you’re still getting health insurance from your or your spouse’s employer at age 65, you don’t need to drop it to enroll in Medicare Parts A & B (though you can). Instead, you’ll qualify for a Special Enrollment Period (SEP) that starts when that coverage ends.

For Original Medicare, this SEP lasts eight months, but for Medicare Advantage (Part C) and Prescription Drug Plan (Part D) coverage, you have only 63 days after your employer insurance ends.

The eight-month period applies whether or not you continue your employer coverage by signing up for COBRA, so don’t wait until your COBRA ends to apply for Part B.

And even if you do decide to stay on your employer’s health plan, you should still enroll in Medicare Part A as soon as you’re eligible. Part A is free for most people and it may cover some of your hospital costs if ever needed. 

One important caveat: If you work for a very small company (fewer than 20 employees), Medicare may not recognize your work health plan as “creditable coverage,” and you’ll risk penalties by not signing up at age 65 (more on those penalties below). Check with your employer to make sure.

Late enrollment penalties for Medicare

Say you’re 65 and in good health, and you don’t want to pay Medicare premiums ($135.50 a month in 2019 for most beneficiaries). So why sign up? Because the government imposes stiff penalties if you don’t.

Original Medicare. For Part B, your premium will be 10% higher for each 12-month period in which you were eligible but didn’t sign up.

So if you delay signing up for Part B for 28 months after your IEP ends, your premiums will be 20% higher than they would have been if you’d signed up as soon as you were eligible. And that penalty stays in effect for as long as you remain on Medicare. 

Medicare Part D. With a prescription drug plan, a late enrollment penalty may apply if your IEP ends and you don’t have Part D or any other creditable drug coverage for 63 or more days in a row.

The penalty for Part D has a complicated calculation. You’ll pay an extra 1% of the “national base beneficiary premium,” or an estimated average of current Part D monthly plan costs, multiplied by the number of months you delayed enrollment. For 2019, the national base beneficiary premium is $33.19.

You’ll pay this penalty for as long as you’re enrolled in Part D, and it could go up, since the national base beneficiary premium changes each year.

Translation: Even if you don’t think you need a Prescription Drug Plan now, you may still want to enroll in one anyway to avoid paying higher premiums if you want coverage later.

When can I sign up if I missed my Initial Enrollment Period?

If you missed your Initial Enrollment Period or your Special Enrollment Period (if you were eligible for one), you can sign up for Medicare Part A and Part B during the General Enrollment Period, which runs from January 1 to March 31.

When you sign up during the General Enrollment Period, your coverage won’t start until the following July 1, and you might face higher premiums due to a late enrollment penalty.

When can I enroll in a Medicare Supplement Policy?

Once you’re 65 and enrolled in Part B, you’re eligible to buy a Medicare Supplement policy (Medigap). Your six-month Medigap open enrollment period starts the first day of the month after you are both 65 and enrolled in Part B. During that time, you can purchase Medigap without being subject to medical underwriting.

When can I enroll in Medicare Advantage?

Most people enroll in Medicare Advantage (Part C) when they first become eligible for Medicare during their Initial Enrollment Period. This is the seven-month period around your 65th birthday. 

If you (or your spouse) are still working and have delayed signing up for Medicare Part B because you still get health coverage from a current employer, you can sign up for a Medicare Advantage plan (or Original Medicare, for that matter), when you stop working and that health coverage ends during what’s known as a Special Enrollment Period (SEP). The SEP lasts for two months after the month your work coverage ends.

There are a few other circumstances when you can sign up for Medicare Advantage during a Special Enrollment Period. They are:

  • Your current plan is discontinuing coverage in your area, or you move out of the service area.
  • You have Original Medicare and Medicare SELECT (a type of Medigap policy that limits your coverage to a specific network of hospitals and, in some cases, doctors), and you move out of the Medicare SELECT plan’s service area.
  • You dropped your Medicare Supplement (Medigap) plan for a Medicare Advantage plan for the first time, and you want to switch back within the first year of coverage.
  • Your insurance company goes bankrupt, or otherwise your coverage ends through no fault of your own.
  • Your insurance company hasn’t followed the rules, or has misled you.

From December 8 to November 30 (the following year), you also have a one-time opportunity to enroll in a Medicare Advantage plan that is rated 5-stars by the Centers for Medicare & Medicaid Services (CMS). You may only use this SEP if there is a 5-star plan in your area.

For a complete list of SEPs, check out the U.S. Government site for Medicare here.

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