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When to Apply for Medicare
- Who needs to apply for Medicare?
- Initial Enrollment Period (IEP)
- General Enrollment Period
Knowing when to apply for Medicare can be a confusing topic for many beneficiaries. Here are some frequently asked questions and answers about when and if to apply for the different types of Medicare.
Who needs to apply for Medicare?
You may not need to sign up for Original Medicare, Part A, and Part B, but you may have options about the type of Medicare coverage you receive.
To be eligible for Medicare, you must be either a U.S. citizen or a legal permanent resident of at least five continuous years. Generally, if you’re receiving Social Security or Railroad Retirement Board (RRB) benefits, you’ll be automatically enrolled in Medicare when you turn 65. If you’re under 65 and have been receiving disability benefits from Social Security or the RRB for two years, or if you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), you also qualify for automatic enrollment.
If you don’t qualify for automatic enrollment in Medicare, you need to apply when you become eligible.
Initial Enrollment Period (IEP)
Before you qualify for Medicare, you might want to research the type of Medicare coverage you’d like to have. That’s because a good time to do add to, or change, your Medicare coverage may be during the Initial Enrollment Period (IEP), described below.
The IEP for Original Medicare, Part A and Part B, is the time window during which you first become eligible for this coverage. It’s also a time when you can add or change Medicare plan options.
If you qualify for Medicare because:
- You’re turning 65, your IEP is a seven-month period. It starts three months before the month of your birthday, includes the month you turn 65, and ends three months after your birthday month. If your birthday is in March, your IEP starts December 1st and goes until the end of June.
- You’ve been collecting disability benefits from Social Security or the RRB for 24 straight months, your IEP is also a seven-month period. It starts three months before your 25th month of disability benefits, and continues until the end of your 28th month of receiving disability benefits.
- You’ve started collecting disability benefits from Social Security or the RRB because you have ALS (Lou Gehrig’s disease), your Medicare coverage starts the same month that your disability benefits begin.
- You have end-stage renal disease (ESRD) and you’re collecting disability benefits from Social Security or the RRB, or you qualify for those benefits (possibly through a family member or spouse) — your IEP starts as soon as you’re eligible for Medicare, and lasts for three months.
If you sign up for Medicare prescription drug coverage (whether through a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan), you can avoid late-enrollment penalties by enrolling in this coverage as soon as you’re eligible for Medicare. If you decide to stay with Original Medicare and add a Medicare Supplement (Medigap) plan, the Medigap plan must accept you if you sign up for Medigap during the 6-month period that begins as soon as you are 65 or older and enrolled in Part B. If you don’t buy a Medigap plan at this time, but decide to get one later, the plan may not have to accept you.
General Enrollment Period
Original Medicare’s General Enrollment Period (GEP) is from January 1st to March 31st every year. You can sign up for Medicare Part A or Medicare Part B during this time if you weren’t automatically enrolled.
Late-enrollment fees
If you don’t qualify for premium-free Medicare Part A, you could pay a penalty for late enrollment if you sign up during the GEP instead of during your IEP. Generally, Part A coverage is premium-free if you have worked for at least 10 years (40 quarters) while paying Medicare taxes.
If you sign up for Medicare Part B during the GEP instead of during your IEP, you could have to pay a late-enrollment penalty. The penalty is usually 10% of your Part B premium for each 12-month period during which you qualified for Part B but didn’t sign up for it.
If you qualify for a Special Enrollment Period (SEP) for Medicare Part A or Part B, you might not have to pay a late-enrollment penalty; see Special Enrollment Periods below.
Annual Election Period
The Annual Election Period (AEP) is a time period when you can add, drop, or switch Medicare Advantage (Medicare Part C) plans and Medicare Prescription Drug Plans. It goes from October 15 to December 7 every year.
If you decide you want Medicare prescription drug coverage, and you sign up during the AEP instead of during your IEP, you may have to pay a Medicare Part D late-enrollment penalty.
Medicare Supplement Open Enrollment Period
If you want to add a Medicare Supplement (Medigap) plan to your Original Medicare (Part A and Part B) coverage, your six-month Open Enrollment Period starts the month that you turn 65 and are enrolled in Medicare Part B. If you miss this window, your acceptance into a Medigap plan may not be guaranteed.
Special Enrollment or Election Periods (SEPs)
Some special circumstances might qualify you to sign up for Medicare during a Special Election Period (SEP).
For Original Medicare, Part A and Part B, some examples of these situations include, but aren’t limited to:
- You’re covered through an employer’s or union’s group health plan (yours, your spouse’s, or a family member’s if you are disabled). You can sign up for Original Medicare (Part A and Part B) anytime, as long as you (or your spouse, or family member if you’re disabled) is working.
- Your coverage through an employer’s or union’s group health plan ends. You have eight months to sign up for Medicare, starting the month after the employment ends, or the employment-based health plan insurance ends, whichever happens first.
Other Medicare plans, such as Medicare Advantage plans and Medicare Prescription Drug Plans, have other specific Special Election Periods. Some examples of these situations for Medicare Advantage and Medicare Prescription Drug Plans include, but aren’t limited to:
- Moving to a new location that’s not in your plan’s service area
- Moving to, living in, or moving out of a facility such as a long-term care hospital or skilled nursing facility
- Losing your coverage — for example, Medicare cancelling your plan’s contract
At what age should I apply for Medicare?
If you don’t qualify for automatic enrollment, you need to sign up during your Initial Enrollment Period (IEP). Generally, you can enroll three months before you turn 65. If you have a qualifying disability, you can enroll in Medicare before age 65, as described above. If you have questions about Medicare eligibility or enrollment, contact the Social Security Administration:
- On the Social Security website.
- Over the phone, at 1-800-772-1213 (TTY users can call 1-800-325-0778) from 7 AM to 7 PM Monday-Friday.
- In-person by visiting a local Social Security office.
Can I postpone Medicare enrollment without penalty?
If you continue to work and are covered under an employer’s or union’s health insurance plan (or your spouse’s plan) after you’ve turned 65, you’re generally allowed to delay Medicare enrollment to a time when it’s needed without facing a penalty. If you choose to postpone Medicare enrollment for this reason, however, you must enroll in Medicare as soon as the employer-based insurance coverage ends.
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Medicare Parts
Medicare Part A
Part A of Medicare covers hospitalisation. Inpatient treatment, limited time in a licenced nursing facility, limited home health care services, and hospital care are all covered under Part A.
Medicare Part B
Non-hospital medical costs such as doctor's appointments, blood tests, x-rays, diabetes testing and supplies, and outpatient hospital treatment are covered by Part B benefits. For this component of the original health insurance, you pay a monthly fee.
Medicare Part C
In a health insurance plan, Medicare Advantage or Medicare Part C normally covers all forms of health insurance coverage. Private insurance businesses that have been contracted by the CMS to provide a medicare plan as an alternative to the original health insurance plan provide it.
Medicare Part D
Medicare Part D is a prescription medication coverage option. Part D health insurance is available as a stand-alone plan from private insurance firms, with monthly rates varying from one to the next. Depending on the plan you're registered in, you'll split the cost of your prescription medicines.
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You get the same coverage as Original Medicare plus additional benefits from the Medicare Advantage insurance provider when you enroll in a Medicare Advantage plan.
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- Your Social Security benefit will be reduced by $144 each month.
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When can I enroll in a new Medicare plan?
- Initial Enrollment Period – Most persons can enrol in Medicare Part A, Part B, Part C, and/or Part D for the first time within a seven-month period: three months before, three months during, and three months after they reach 65.
- Special Enrollment Period (SEP) – Certain life circumstances, including as moving or losing current coverage, may qualify you for coverage. You usually have two months to enrol, depending on your circumstances.
- Medicare Part C & D Annual Enrollment Period (AEP) – Every year, from October 15 to December 7, Existing Medicare beneficiaries can take advantage of this time to review and adjust their Medicare Advantage (Part C) and Medicare prescription medication plans (Part D). You cannot utilise AEP to enrol for the first time in Part A and/or Part B. The following year’s coverage begins on January 1st.
- Medicare General Enrollment Period – Every year, from January 1 to March 31, While the majority of individuals will receive Part B coverage when they join in Medicare, this period is allocated for those who did not enrol in Part B when they initially became eligible. Coverage begins on July 1st of the following year.
- Medicare Advantage Open Enrollment Period (OEP) – Every year, from January 1 to March 31, You can change to a different Medicare Advantage plan with or without medication coverage during this period, or move to Original Medicare and join a separate Medicare Prescription Drug plan. You cannot, however, go from Original Medicare to a Medicare Advantage plan, join a prescription drug plan while on Original Medicare, or change from one prescription drug plan to another prescription drug plan while on Original Medicare.
