You are eligible for Medicare at age 65, but you’re enrolled automatically in Medicare only if you’re already receiving Social Security or Railroad Retirement Board benefits at least four months before your 65th birthday. Otherwise, you need to take steps to sign up yourself.
Unless you qualify for Medicare before age 65 because of a disability, the first time you’re eligible to sign up is during your initial enrollment period (IEP), which begins three months before the month you turn 65 and lasts for three months afterward.
So if you’re a few months past your 65th birthday, you still may be in your initial enrollment period. Where you are in your initial enrollment period determines when your Medicare coverage starts:
• If you enroll during those first three full months before your birthday, your Medicare begins on the first day of the month you turn 65 or the first day of the previous month if your birthday is on the first of the month.
• If you sign up during the month you turn 65, coverage begins on the first day of the following month.
• But if you wait until the fifth, sixth or seventh month of your initial enrollment period, coverage will be delayed two or three months.
However, those rules change Jan. 1. Starting in 2023, if you enroll after your birthday month, coverage will take effect at the beginning of the following month.
If you qualify for premium-free Part A, you can sign up for that coverage during your initial enrollment period or any time after without a penalty. Your Part A hospitalization coverage will be retroactive up to six months but no earlier than the month you turned 65.
Part B, which covers doctor and outpatient services, is not so flexible. If you missed your initial enrollment period, you may be able to sign up later without penalty if you qualify for a special enrollment period (SEP).
You can get out of the penalty and qualify for a special enrollment period if you or your spouse is still working and you have health insurance from that employer. This can’t be coverage from your former employer’s plan through COBRA, the federal Department of Veterans Affairs, military retiree health coverage from TRICARE, a labor union retiree plan or any other retiree health plan. You or your spouse must be actively working for the company providing the insurance.
If so, you can delay signing up for Medicare while you have that coverage. And your special enrollment period lasts from the time you turn 65 up to eight months after the employment or coverage ends, whichever happens first.
Size matters. It is complicated, and the definition of small business can vary across the federal government. For Medicare, a small business has fewer than 20 employees.
If your present health insurance comes from a company with 20 or more employees, that coverage will always pay your medical bills before Medicare. Your group health plan is primary coverage, and Medicare is secondary coverage.
Policies differ. When a company has fewer than 20 employees, the employer gets to decide whether its insurance will be the primary coverage.
Most often, a business of that size will let Medicare settle your medical bills first, and its group plan will pay for expenses and services it covers that Medicare does not. That makes Medicare the primary coverage and your company’s coverage secondary.
Don’t be surprised. You won’t have to pay a late enrollment penalty if you or your spouse delays signing up while you actively work for any size company.
But you may have coverage gaps if your insurance from those businesses with fewer than 20 workers becomes secondary and Medicare becomes primary when you turn 65. In this case if you missed signing up during your initial enrollment period, you may have to pay for any medical expenses you incur out of your own pocket.
The good news: Since you are still working and have health insurance, you can minimize your potential costs if you find yourself without Medicare and working for a company whose health insurance is second in line. You’re in your special enrollment period now and can sign up for Medicare parts A and B immediately.
As long as you sign up while you’re still working or the first month after you leave the plan, Part B coverage will begin on the first day of the month after you enroll or the first day of any of the following three months of your choice. If you sign up during the remaining seven months after you or your spouse stops working, then your coverage begins on the first day of the following month.
Premium-free Part A coverage begins six months retroactively, but no earlier than the month you turn 65.
If you miss your initial enrollment period and you don’t qualify for a special enrollment period, Medicare has a general enrollment period (GEP) Jan. 1 to March 31 each year.
Part A. If you have to pay for Part A because you or your spouse has not paid enough quarters of Medicare taxes, this is the time you’ll be eligible to sign up when you missed your initial enrollment period. But you may have to pay a late enrollment penalty.
Part B. If you’ve passed or didn’t qualify for a Part B special enrollment period, this is also when you can sign up for Part B. But you may have to pay a separate late enrollment penalty.
In 2023, Medicare will change when your coverage begins for Part A that you pay for and Part B to the month after you sign up. In the past, those who signed up during general enrollment had to wait until July 1 for their insurance to kick in.
You may have extra time. If you were unable to enroll in Medicare since Jan. 1, 2022, because of the Social Security Administration’s phone problems, you can sign up for a special “equitable relief” program through Dec. 30, 2022, a Friday, even though the 2022 general enrollment period has been over for months.
You may not escape all penalties, especially if you should have signed up in 2021 or earlier. But the time between your failed attempt to enroll in 2022 and signing up with equitable relief won’t count in the penalty calculation.
Part D. The enrollment and penalty rules are different for Part D prescription drug coverage. If you have other prescription coverage considered at least as good as Part D, you won’t face a penalty.
If you missed your initial enrollment period and have what Medicare calls “creditable coverage,” you can usually delay signing up without risking a Part D late enrollment penalty if you buy a plan within two months of your creditable coverage ending.
You also have more flexibility to sign up or change Part D plans more often if you qualify for Extra Help, the federal program that helps people with low incomes and assets pay Part D premiums and out-of-pocket costs. If you are eligible for Extra Help, you can switch Part D plans as often as once a calendar quarter during the first three quarters of the year, and you are not subject to a late enrollment penalty.
Medigap. The open enrollment period for private Medicare supplement policies is not dependent on age. If you’re 65 or older, it starts the first month you have Part B and lasts for six months. During that time insurers can’t deny you coverage or charge you more for a preexisting condition.
Medicare Advantage. To enroll in Part C, better known as an all-in-one Medicare Advantage plan, you must first be signed up for parts A and B. After that, if you’ve missed your initial enrollment period, you can sign up during these times:
• Oct. 15 to Dec. 7 with new coverage starting Jan. 1. That’s Medicare’s annual open enrollment period.
• Jan. 1 to March 31 with new coverage starting the month after you sign up for Medicare if you sign up for parts A and B during the same general enrollment period.
• All year if you decide to enroll in a five-star Medicare Advantage plan and one is available in your area.
Updated August 8, 2022
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