It can be confusing to know when to apply for Medicare. Below are some FAQs and answers about when you should apply to the Medicare coverage you need.
How do you know if you have to apply for Medicare?
Depending on your situation, you may have different choices about the type of Medicare coverage you get. So you might not need to sign up for the Original Medicare Part A and Part B.
Five consecutive years as an American citizen, or a legal permanent resident makes you eligible for Medicare. You can be automatically enrolled in Medicare when you turn 65 if you’re receiving certain disability benefits. These benefits include Social Security or Railroad Retirement Board (RRB) benefits.
If you’re under 65, you can also qualify for automatic enrollment. You qualify if you have been receiving disability benefits from Social Security or the RRB for at least two years. Or you have amyotrophic lateral sclerosis (ALS or also named Lou Gehrig’s disease).
Review the above to see if you qualify for automatic enrollment in Medicare. If you don’t, you must apply when you are eligible.
What to know about your Initial Enrollment Period (IEP)
A great time to change or add to your Medicare coverage will be during the Initial Enrollment Period (IEP). So you may want to study which type of Medicare coverage you’d want before you qualify for Medicare.
What is the Initial Enrollment Period (IEP)? The IEP is the time window you have when you first become eligible for Original Medicare, Part A and Part B.
During the IEP, you can change or add to your Medicare plan options. Below are the different scenarios that you have that determines the length of your IEP:
- If you’ve been obtaining RRB or Social Security disability benefits for 24 consecutive months, your IEP is a 7-month period. This will start on your 22nd month of receiving disability benefits and lasts until the end of your 28th month.
- If you’re close to turning age 65, your IEP is also a 7-month period. This will start 3 months before the month you turn 65, the month of your birthday, and ends 3 months after the month you turn 65. So, if your birthday is in November, your IEP starts August 1st and lasts until the end of February.
- If you’ve started obtaining disability benefits from the RRB or Social Security because you have end-stage renal disease or ERSD. Or you qualify for those benefits (likely through a spouse or family member). Then your IEP starts the moment you are eligible for Medicare and lasts for 3 months.
- If you have ALS (or Lou Gehrig’s Disease) and you’re obtaining RRB or Social Security Disability benefits. Then your Medicare coverage begins the same month that your disability benefits start.
You can dodge late-enrollment penalties by enrolling for Medicare Prescription Drug coverage as soon as you qualify for Medicare. This can be whether it is through a Medicare Advantage Prescription Drug Plan or a stand-alone Medicare Part D Prescription Drug Plan. If you want to add a Medicare Supplement (Medigap) plan while you stay with Original Medicare. Then the Medigap plan must accept you if you enroll for the plan during the six-month period that starts right when you turn 65. You must also be enrolled in Medicare Part B. If you decide to buy a Medigap plan after the 6-month period, then the plan does not have to accept you.
What to know about the General Enrollment Period
If you were not automatically enrolled in Medicare Part A or Medicare Part B, you can sign up in the General Enrollment Period (GEP). You can sign up from January 1st to March 31st every year.
How to avoid late-enrollment fees
If you do not sign up during your IEP and sign up during your GEP instead, then you could pay a penalty for late enrollment. This can be the case if you are not qualified for premium-free Part A Medicare. If you have worked for at least 10 years (or 40 quarters) while paying Medicare taxes, then typically Part A coverage is premium-free.
You may have to pay a late-enrollment penalty for Medicare Part B, if you sign up during the GEP rather than your IEP. For every twelve-month period where you qualified for Part B bud didn’t sign up for it, your penalty is generally 10% of your Part B premium.
You may not have to pay a late-enrollment penalty if you qualify for a Special Enrollment Period. This qualification is for Original Medicare (Part A or Part B); read on for more information.
Annual Election Period – Drop, switch or add Medicare plans
If you want to drop, switch, or add Medicare Prescription Drug Plans and Medicare Advantage (Medicare Part C) plans. Then you must do that during The Annual Election Period (AEP). This time period is from October 15 to December 7 every year.
If you do not sign up for Medicare prescription drug coverage during your IEP and instead sign up during your AEP. Then you have to pay a late-enrollment penalty for Medicare Part D.
What to know about the Medicare Supplement Open Enrollment Period
If you have Original Medicare (Part A and Part B) you can add a Medicare Supplement (Medigap) plan during your Open Enrollment Period. This is a 6-month period that starts the month you turn 65 in which you must also be enrolled in Medicare Part B. If you’d like a Medicare Supplement (Medigap) plan, it would be best to not miss this window as your acceptance is not guaranteed after this window.
Do you qualify for Special Enrollment or Election Periods (SEPs)?
You may qualify to sign up for Medicare during a Special Election Period (SEP) if you meet specific conditions.
Below are some examples of these conditions so you can qualify for enrollment during a SEP. This is only for Original Medicare, Part A and Part B. These situations include, but are not limited to:
- If your coverage by way of a union’s group or employer’s health plan ends. Then you have an 8-month period to sign up for Medicare. This will start the month after your employment -based health plan insurance ends, or the employment ends. This is dependent on whatever happens first.
- If you’re covered by way of a union’s group or employer’s health plan (if you are disabled then a family member’s or your spouse’s). Then, as long as you (or family member / spouse if disabled) is working, then you can sign up for Original Medicare (Part A and Part B) at any time.
If you want to sign up to other Medicare plans, such as Medicare Prescription Drug Plans or Medicare Advantage Plans. Then there will be other SEPs (Special Election Periods). Here are some examples, of these conditions for Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Drug) Plans, not limited to:
- If you are relocating out, relocating to, or living in a facility such as a skilled nursing facility or long-term care hospital.
- If you are losing your coverage. For instance, if Medicare cancels your plan’s contract.
- If you are relocating to a new location that is not in your plan’s service area.
The right age to apply to Medicare
You must sign up during your IEP (Initial Enrollment Period), if you don’t qualify for automatic enrollment. Typically, you can enroll in Medicare before the age of 65 if you have a qualifying disability. Or you can enroll 3 months before the month you turn 65. Contact the Social Security Administration if you have any questions about Medicare eligibility or enrollment:
- Over the phone, at 1–800–772–1213 (TTY users can call 1–800–325–0778) from 7AM to 7PM Monday — Friday
- By going to the Social Security website — https://www.ssa.gov/benefits/medicare/
- Or by visiting in person a local Social Security office.
Can I postpone Medicare enrollment and avoid penalty?
If after you turned 65 and your union’s or employer’s health insurance still covers you and you continue to work. Then you’re normally allowed to postpone your Medicare enrollment without facing a penalty. If you want to delay your Medicare enrollment for this reason, make sure you sign up for Medicare the moment the employer-based insurance ends.