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.
For more details, see “Medicare When Working Beyond 65.”
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. If that is a requirement, Medicare automatically becomes your primary coverage and your employer’s insurance becomes secondary, paying only for services that it covers but Medicare doesn’t. In this case, if you don’t sign up for Part B, your employer plan won’t pay for anything that Medicare covers, and you will essentially be left with no health care coverage at all.
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 in any month that you are enrolled in Medicare (A or B). The same is true if you are receiving any Social Security benefits (retirement, disability or spousal), 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. However, if you don’t apply for Social Security benefits, and don’t enroll in any part of Medicare, you can continue contributing to your HSA at work. For details, see related article "Can I Have Medicare as Well as a Health Savings Account?"
Other enrollment situations
The timing of Medicare enrollment always depends on your situation. Here are some special circumstances:
- 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 permanent legal residency (received a green card) and lived in the United States continuously for five years. But if you have been married longer than one year to a U.S. citizen or legal resident who is at least age 62 and has worked and paid Medicare taxes for long enough, you may qualify for Medicare on your spouse's work record without having lived in the U.S. for five years. See related article "Medicare Entitlement for Foreign Spouses."
- If you are living outside the United States when you turn 65 and not working, 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.
- If you are living outside the United States beyond age 65 but you or your spouse is working, the rules are different:
If you live abroad and are covered either by a group health plan provided by your or your spouse's current employer or by the national health program of the country you're living in (even if you're self-employed) — 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 when you do sign up for Part B, Social Security will require proof that while abroad you or your spouse had been working and that you had health insurance from an employer or from the country’s public health system.
- If you are living outside the United States at or beyond age 65 but you have not earned enough work credits to qualify for premium-free Part A: In these circumstances, you cannot apply for Medicare outside of the United States. When you return to live in the U.S. permanently, you’ll be entitled to an initial enrollment period to buy into Part A and to enroll in Part B—without incurring late penalties for either of them—regardless of how long you lived abroad or how long ago you turned 65. This enrollment period begins during the month of your return as a U.S. resident and ends three months later. For example, if you return in August, your initial enrollment period expires November 30. But if you don’t sign up within this time frame, you must wait until the next general enrollment period (January 1 to March 31, your coverage won’t begin until July 1 of the same year. and you’ll likely get hit with permanent late penalties.
- If you are in prison when you turn 65, it's another Catch-22 situation. You are expected to enroll in Part B and pay premiums while incarcerated, even if you have no income, or face late penalties and possibly delayed coverage on your release.
- If you are in a same-sex marriage: You have the same rights as any other married couple: If you’re covered under your spouse’s employer coverage you can delay Medicare enrollment until the employment ends and you will be entitled to a special enrollment period of up to eight months to sign up without risking late penalties.
- If you are in a domestic partnership with a person of the opposite sex: You could qualify for a special enrollment period based on coverage from your partner’s employer health plan only if he or she is the opposite sex from you; you live together in one of the few states that accept common-law marriages and your own domestic partnership meets the legal definition of common-law marriage where you live. You could also qualify if you have Medicare on the basis of disability, are covered as a “family member” under your partner’s employer health plan and the employer has 100 or more employees —regardless of whether you are in a same-sex or opposite-sex partnerships.
Next page: Signing up for drug coverage. »