Sign up for Medicare when you turn 65 or if you qualify based on your disability.
Your 65th birthday marks the date when, after decades of working and paying into the Medicare system through taxes, the system finally starts paying you back with a government health insurance plan.
“Enrolling in Medicare is vitally important for all Americans, and it’s just as important to do it in the right way, at the right time,” says Bryan W. Adams, cofounder and CEO of Integrity Marketing Group. Given that health care expenses tend to rise as you age, “taking full advantage of the Medicare coverage and benefits you’ve earned can play a crucial role in protecting your health and savings.”
It pays to be on time with Medicare enrollment. If you sign up for your plan too late or miss your enrollment period, you may get a penalty in the form of a higher monthly premium. Every 12 month-period you could have had Part B but didn’t, your monthly premium could increase by 10%, unless you qualify for a Special Enrollment Period (SEP) by having creditable coverage, such as group health plan coverage through your current employer. You’ll have to keep paying this higher premium for as long as you have Medicare.
Here are some frequently asked questions (FAQs) about Medicare enrollment, and when to sign up.
Depending on your personal situation, when you should sign up for Medicare can vary. For most people, it will be during the initial enrollment period as you approach turning 65.
If you start getting Social Security or United States Railroad Retirement Benefits (RRB) at least four months before turning 65, you’ll have automatic enrollment in Medicare Part A and Part B (Original Medicare) when you turn 65. You should get your Medicare card in the mail three months before your 65th birthday. Your medical insurance coverage will begin the first day of the month you turn 65 unless your birthday is the first day of the month, in which case coverage starts the month before age 65. Your Medicare premiums will be deducted automatically from your Social Security retirement payments.
If you aren’t receiving Social Security or RRB at least four months before your 65th birthday, you’ll need to take care of Medicare enrollment yourself. Generally, you should do this during your Initial Enrollment Period (IEP) to avoid paying a penalty premium.
Your IEP begins three months before the month you turn 65 and lasts for three months after your birthday month, giving you seven months total to enroll. For example, if your birthday is in September, your Initial Enrollment Period will last from June 1 through December 31. Your Part A (hospital insurance) coverage can apply retroactively for up to six months before enrollment but not beyond the date you are first eligible for Medicare Part A insurance.
“I would recommend enrolling as soon as possible, so you can start receiving benefits as soon as you’re eligible,” Adams says.
If you don’t sign up during your Initial Enrollment Period, you can during the annual enrollment period, which lasts from January 1 through March 31 of each year. Just be aware that when you enroll during general enrollment, your coverage doesn’t begin until July 1 of the year you enroll. You may also face higher premiums for Medicare Part B, which is a form of late enrollment penalties.
“Medicare Part B coverage is fully optional,” Adams says. Because you must pay a premium for Medicare Part B, you can turn down that part of your coverage. Doing so could prove costly down the road.
“By not having Part B, you cannot enroll in a Medicare supplement [Medigap] or Medicare Advantage Plan,” says John Norce, president of Medicare assistance firm Medicare Portal. “Thus, you’re exposed to all claims that normally would be covered under Part B until your enrollment is active.”
Part B insurance also cannot be backdated or retroactively enrolled “unless there is some crazy mitigating circumstance where the government made a mistake or you received bad information from the government,” Norce says.
Some people who may be eligible can delay Medicare coverage after turning 65 and sign up later via a special enrollment period. If you have group health plan coverage through your current employer or your spouse’s employer, you may be able to delay enrollment without having to pay late enrollment penalties when you do sign up.
People with certain disabilities or conditions may be eligible to sign up for Medicare before turning 65. You’ll be automatically enrolled in Original Medicare (Parts A and B) after you’ve received Social Security or RRB disability benefits for 24 months. You should receive your Medicare card in the mail three months before the 25th month of your disability benefits.
Certain conditions can change Medicare eligibility and enrollment. If you have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), you’re enrolled automatically in Medicare Part A and Part B starting the month you begin receiving disability benefits. Individuals with end-stage renal disease (ESRD) who qualify for Part A can sign up before turning 65 as well. If you qualify for Part A due to ESRD, you can also get Part B. You’ll need both Parts A and B to cover some dialysis and kidney transplant services. You won’t be subject to the late enrollment period if you’re approved for Medicare based on ESRD.
Once you know when to enroll, you’ll have to decide if you need both part hospital insurance and part medical insurance, as well as a prescription drug plan, or if you want to go with Medicare Advantage. Some people may also decide to get Medicare supplement insurance (also called Medigap). Whatever choice you make, you can always modify it during the Medicare open enrollment period each year.
Whether you’re enrolled in Medicare Part A and Part B automatically or sign up yourself, you may decide to get a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D). You can sign up for Parts C and D during your IEP, or the Medicare open enrollment period from October 15 to December 7 each year. If you join a Medicare Advantage Plan that has drug coverage, you won’t need to sign up for Part D prescription drug coverage too.
If you aren’t automatically enrolled in Medicare Part A, you can sign up online at SSA.gov or your local Social Security office, if it’s open*. The online application process takes 10 minutes and usually doesn’t require any documentation or signatures. You’ll need to submit:
*All Social Security Administration offices are closed for walk-ins due to COVID-19, but the Medicare hotline is still available to answer questions at (800) -633-4227.
To enroll in Part B through a SEP, you can apply online or mail a completed Application for Enrollment in Medicare – Part B form (CMS 40B) along with a Request for Employment Information form (CMS L564) and any required proof of employment to your local Social Security office. You can also fax these forms to (833) 914-2016. These forms are available on the U.S. Centers for Medicare & Medicaid Services website, CMS.gov.
Once you sign up, you’ll have to choose what parts of Medicare coverage you want. “The cost and benefits of the coverage options available to you can vary significantly, so you’ll want to do a little homework ahead of time,” Adams says. “Making a list that includes your doctors and hospitals, prescription drugs, and lifestyle and budget can help narrow down your options and find coverage that fits your needs.”
LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.
Moore holds a bachelor’s degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.
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.