Original Medicare, which includes Part A (hospital coverage) and Part B (medical coverage) has different enrollment periods. It’s important to understand when to enroll, as well as what you can do if you don’t enroll on time.
|1. Original Medicare has an Initial Enrollment Period of seven months around your 65th birthday.
|2. Original Medicare also offers a General Enrollment Period for those who don’t apply within their Initial Enrollment Period.
|3. Medicare’s General Enrollment Period is January 1 through March 31 each year, and coverage begins on July 1.
|4. General enrollment only applies to Original Medicare, which is Part A and Part B, and going this route is more costly.
Generally speaking, most people should enroll in Original Medicare when they turn 65. This is called the Initial Enrollment Period. Missing the enrollment period can have consequences including a lapse in coverage and late enrollment penalties.
There are some exceptions to using the Initial Enrollment Period, such as if you are automatically enrolled in Medicare because you are on disability. Or, if you or your spouse still has employer health coverage, you can choose to delay your enrollment. In that case, you’re allowed to enroll later (when that coverage ends) without penalty during a Special Enrollment Period.
If you miss your Initial Enrollment Period and don’t have health coverage, there is still a chance to get into Medicare later – but you’ll have to wait for the next General Enrollment Period.
The General Enrollment Period is every January 1 through March 31. If you enroll in that timeframe, your coverage will begin on July 1. General enrollment is the last resort for those who miss the initial enrollment and don’t qualify for a Special Enrollment Period. There are serious consequences: delayed coverage and a late enrollment penalty that translates into a higher premium.
“What generally happens is someone who missed their window has a need and wants to get into Medicare, and they can’t because they have to wait to go through general enrollment,” says Keith Armbrecht, founder of MedicareOnVideo.com. Here’s a worst case scenario: “If you’re in August and you really need it, you’re not going to get it for 11 months,” he says.
What’s more, when you go through general enrollment for Medicare, you’ll pay a higher premium for Part A and/or Part B than you would have if you’d gone in during the initial enrollment. And that higher cost will stay with you for life.
Not exactly. The initial Medicare enrollment period is a 7-month window starting 3 months before you turn 65. So if you turn 65 in June, your Initial Enrollment Period would be from March through September.
It’s best to get the process started two to three months before you’re hoping to go into Medicare, advises Armbrecht.
That said, you don’t have to enroll this way if you’re still working and have healthcare coverage, or if you’re covered under your spouse. People who meet this criteria can join later through a Special Enrollment Period.
However, for those who just opt not to join or miss the initial window, they can’t simply join whenever they want. They have to wait for the General Enrollment Period.
In addition to initial, special, and general enrollments, there’s the Open Enrollment Period or Annual Election Period. This is the time each year (from October 15 through December 7) in which you can make changes to your existing Medicare status, says Armbrecht. “If you want to get in, get out, or make a change, you have to make that choice during this period,” he says. Those changes will then go into effect on January 1.
Some of the the things you can do during Medicare open enrollment include:
Prescription drug plan enrollment can be a big change during this period, particularly if you didn’t have coverage. The Late Enrollment Penalty may be assessed if you didn’t have creditable coverage prior to enrolling in a drug plan.
You do not have to join Medicare when you turn 65. For example, if you’re still working, you may not want to start Medicare while you still have coverage.
And even if you’re not working, you technically aren’t mandated to enroll in Medicare – but there are consequences if you wait.
“Just know that if you go in later, there are going to be penalties and timelines that are a little more complicated,” says Armbrecht.
This expert was consulted for insight into the Medicare General Enrollment Period:
Keith Armbrecht, founder of MedicareOnVideo.com
LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional for nearly 15 years. First as a Medicare provider enrollment specialist, and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans. He’s passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.