Will I Be Automatically Enrolled in Medicare at Age 65?

Stop contributing to your health savings account

And if you’re not paying a premium for Part A — it’s free if you or your spouse have worked 40 quarters, the equivalent of 10 years, and paid Medicare taxes — the government generally doesn’t allow you to drop it. Only if you are paying a premium can you delay it.

Some people are covered through a working spouse’s high-deductible health plan and set aside pre-tax contributions in a health savings account (HSA) family plan. If that’s you, make sure your spouse starts contributing to the HSA instead as a single enrollee as you prepare to be on Medicare.

You can’t be enrolled in Medicare and put away money in a health savings account. If you do, you’ll face tax penalties and fines. 

To avoid penalties, the government recommends that you stop deductions to your health savings account at least six months before your Medicare coverage begins.

What you’ll need to do next

Now that you have Part A and Part B, you’ll have to decide between original Medicare and Medicare Advantage. You must make your selection within a set amount of time, or you could lose opportunities and face penalties.

Having your Medicare number means you can enroll before you’re 65, so coverage can start as soon as your birthday month.

Your welcome packet comes at the beginning of your seven-month initial enrollment period, which spans the three months before your 65th birthday month, the month of your birthday and the three months after.

If you choose original Medicare, you’ll want to enroll in a Part D prescription plan unless you have similar or better coverage elsewhere, such as from an employer or union retiree plan, the military’s Tricare for Life or Department of Veterans Affairs (VA).

Those plans will have to tell you whether they’re offering what Medicare calls creditable coverage, at least as good as a Part D plan. If you go 63 days or more — think of it as two months — without creditable drug coverage, when you do decide to enroll, for the rest of your life you’ll pay an extra 1 percent each month times the number of months you went without Part D.

The penalty, written into law, serves as an incentive to enroll when you first become eligible and likely have fewer prescription needs.

If you take few or no prescription medicines now, you can find a less expensive, even premium-free, plan with a basic drug list, called a formulary, through Medicare’s Plan Finder. When you add more medications in the future, you can switch to plans to suit your new needs each year during Medicare open enrollment Oct. 15 to Dec. 7.

Another insurance to consider with original Medicare is a Medigap plan. Without Medigap, original Medicare has no ceiling on your out-of-pocket costs.

When you choose your favorite among the options for a Medigap plan, you’ll know what you have to pay even if you have an expensive hospitalization. In most states, you have a once-in-a-lifetime six-month window to choose a plan at its lowest cost and without a health questionnaire once Part B becomes effective.

With your Medicare number, you can shop in a separate Medigap Plan Finder and have the policy start the minute your Medicare coverage begins. After you make your choice, you’ll have to call the plan to enroll.

The best part: You’ll get the lowest premiums now when you’re younger, and no plan can reject you, no matter your preexisting conditions, if you enroll during your Medigap open enrollment period.

It’s important to note that this one-time open enrollment period is a barrier to switching from a Medicare Advantage plan to original Medicare if you’re unhappy with Medicare Advantage after a 12-month trial period. In most states, Medigap plans can look at your age, health history and lifestyle to determine your premium or even deny coverage, a process called medical underwriting; a few states have less stringent rules.

If you choose Medicare Advantage, you can enroll now that you have your Medicare number for coverage effective when Medicare starts. You can compare the plans available in your area in the Medicare Plan Finder.

You’ll need to sign up during your initial enrollment period if you want it to start right away. After you’re 65, the coverage would become effective the first of the next month.

If you miss your initial enrollment period entirely, you’ll have to wait until open enrollment Oct. 15 to Dec. 7 to switch. You can’t sign up for Medicare Advantage any time of the year.

Be prepared for an automatic deduction

Beginning in your birthday month, your Social Security check will shrink by the amount of your Part B premium.

Everyone who has original Medicare or Medicare Advantage must pay it, and the amount changes every year. For most people, it’s deducted automatically from their Social Security payment.

If your benefits aren’t enough to cover the Part B premium, you’ll receive a bill to pay the premium every three months. You can sign up for Medicare Easy Pay online; financial assistance is also available to help with premiums and other Medicare costs.

How to delay Part B coverage

If you’re getting Social Security and want to hold off on Part B, you’ll need to return your Medicare card to the Social Security Administration. Within a few weeks, you’ll receive a different card noting your enrollment in Part A only.

Before returning it:

• Don’t remove your Medicare card from the form you received in the mail.
• Write down your Medicare number in case you need to go to a hospital before your new card arrives.
• Check the box beside “I DON’T want Medicare Part B (Medical Insurance)” on the back of the form.
• Sign your name.
• Return the entire form, including your card, in the envelope that came with it before your coverage begins.

Puerto Rico residents aren’t auto-enrolled in Part B

If you live in Puerto Rico and have been collecting Social Security at least four months before your birthday month, you’ll be enrolled automatically only in Medicare Part A.

This is an exception written into federal law and applies only to Puerto Rico.

You’ll have to sign up for Part B during your initial enrollment period. If you miss the window, you could face gaps in coverage and potentially pay a late enrollment penalty.

Like in the states, if you have employer insurance through your spouse, you can delay enrolling in Part B and will qualify later for a special enrollment period when the coverage ends.

To sign up for Part B during your initial enrollment period, you can sign up online through your my Social Security account, fill out Form CMS-40B online or reach out to your local Social Security office by calling 800-772-1213 to request the form and a preaddressed return envelope. You can also enroll at a local Social Security office, but you’ll have to make an appointment.

This story, originally published Oct. 10, 2018, has been updated with information about what to do next, automatic Part B premium deductions from your Social Security checks and other details.