Enrolling at the Right Time

Special enrollment period

In most cases, you will be able to delay signing up for Part B beyond age 65 for as long as you have group health insurance from an employer for whom you or your spouse is still working.

When you (or your employed spouse) eventually stops working or your health coverage ends (whichever is earlier), you'll be entitled to a special enrollment period to sign up for Part B without penalty. This period lasts eight months from that date, but you can enroll earlier to ensure no break in coverage. Medicare benefits begin the first day of the month after you enroll.

Warning: If you have health coverage from an employer that has fewer than 20 workers, check with your plan to see if you're required to enroll in part B at 65.

Warning: To avoid a late penalty, you must enroll in Part B when employment ends — even if you continue to be covered under COBRA extended insurance or retiree health benefits.

Warning: Most people enroll in Part A during their initial enrollment period even if they delay Part B. But if you're still working and your employer coverage is a high-deductible plan with a health savings account, be careful. Under IRS rules, you cannot contribute to an HSA once you enroll in Medicare (A or B). The same is true if you are receiving Social Security retirement or disability benefits, because then you will be automatically enrolled in Part A as soon as you become eligible for Medicare. In these situations, you can continue to draw on funds already in your account, but you can't add to them. For details, see related article "Can I have Medicare as Well as a Health Savings Account?"

Other enrollment situations

• If you qualify for Medicare through disability: Social Security will automatically sign you up for Parts A and B and mail your Medicare card to you shortly before your benefits become effective. You can decline Part B if you choose — for example, if you are covered by health insurance provided by your own or your spouse's current employment — by following the instructions on the letter Social Security sends you.

• If you're not a U.S. citizen: At or beyond age 65, you can apply for Medicare during a seven-month individual enrollment period that ends three months after the month in which you have both established legal residency and lived in the United States for five years. If you have been married longer than one year to a U.S. citizen or legal resident who has worked and paid Medicare taxes for long enough, you may qualify for Medicare on your spouse's work record. See related article "Medicare Entitlement for Foreign Spouses."
  
  

• If you are living outside the United States when you turn 65, you're in a Catch-22 situation. You can either:
  
  Enroll in Part B during your initial enrollment period (IEP) and pay         monthly premiums — even though Medicare does not cover medical services overseas; or
  
  Delay Part B until your return to this country — but then you risk a permanent late penalty and may have to wait for coverage. Except in very limited situations, medical coverage abroad does not entitle you to a special enrollment period when you return. However, if you are working abroad — and covered either by a group health plan provided by your employer or by the national health program of the country you're living in — you will be entitled to the usual eight-month special enrollment period to sign up for Part B without penalty when you cease this employment or the health coverage ends, whichever happens first.  Note that this right does not apply to people who are living overseas but not working.
  
  

• If you are in prison when you turn 65, it's the same Catch-22 situation. You are expected to enroll in Part B and pay premiums while incarcerated, even if you have no income, or face the same consequences as above on your release.
  
  
• If you are in a same-sex marriage or partnership: You're entitled to a special enrollment period if your coverage is from your own employer. But if you're covered under your partner's employer health insurance, you must enroll during your initial enrollment period at age 65 to avoid a late penalty.
  

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