Your Money
YOUR GUIDE TO MEDICARE DEADLINES
Millions of Americans pay penalties to Medicare or can’t get the coverage they want because they didn’t sign up in time. Here’s a list of important deadlines … and what they’ll cost you if you miss them.
THE BASICS OF MEDICARE COVERAGE
PART A
● Inpatient care at hospitals and skilled nursing facilities
● Free for most Medicare enrollees.
PART B
● Office visits and preventive services
● Available through either original Medicare or Medicare Advantage (Part C). Requires a monthly premium.
PART C (MEDICARE ADVANTAGE)
● Private insurance comprising Parts A, B and usually D
● Some Medicare Advantage plans require both the Part B premium and an additional premium.
PART D
● Prescription drug coverage
● Paid for separately if you’re in original Medicare. Included in the price of most Medicare Advantage plans.
MEDICARE SUPPLEMENT INSURANCE (MEDIGAP)
● Coverage for original Medicare enrollees of certain out-of-pocket expenses not paid for by Parts A and B, such as coinsurance and deductibles
● Premiums and coverages vary by plan.
THE DEADLINES
THE PENALTIES
PART A
Sign up late and you may pay an extra 10 percent of your premium each month for double the number of years you were eligible for Part A but didn’t enroll.
Mimi, who is short the 40 credits of Medicare-covered employment needed to obtain Part A for free, didn’t buy coverage until 12 months after her initial enrollment period. That resulted in her having to pay a 10 percent surcharge on Part A premiums for 24 months.
2025–2026 TOTAL PENALTY: $715
KEEP IN MIND
▶︎ Part A is usually free. Ninety-nine percent of Medicare beneficiaries don’t pay a Part A premium because they or a spouse worked and paid Medicare taxes for 10 or more years.
PART B
Sign up late and you’ll pay an extra 10 percent of the standard monthly premium for every 12 months you were eligible but didn’t enroll. You pay the penalty for as long as you have coverage.
Marvin was eligible for Part B in 2022 but delayed enrollment for two years, so he’s paying a penalty of 20 percent of the standard monthly premium for life. 2026 total penalty: $487
2026 TOTAL PENALTY: $487
COMMON MISCONCEPTIONS LEADING TO PART B LATE ENROLLMENT PENALTIES
▶︎ “Medicare enrollment is automatic.”
That’s only if you already receive Social Security. If not, you must apply through the Social Security Administration.
▶︎ “My retiree, small business, COBRA or Marketplace plan provides all the coverage I need.”
Plans through COBRA and businesses with fewer than 20 employees don’t qualify as primary insurance once you turn 65. Marketplace plans are off-limits if you’re Medicare eligible. Federal employee retirement benefits don’t shield you from Part B penalties. You can avoid penalties only with a plan from your current employer (or your spouse’s) of 20 or more people.
PART D
If you sign up late, you’ll pay every month an extra 1 percent for each month you didn’t join a drug plan when first enrolled in Medicare, or for each month after you go at least 63 days without coverage but don’t apply for a Part D plan. You pay the monthly penalty for as long as you have Part D coverage.
Mario enrolled in Part B in 2022 but delayed getting Part D for two years.
2026 TOTAL PENALTY: $113
KEEP IN MIND
▶︎ Medicare uses a plan premium averaging calculation to determine the penalty no matter your plan’s cost.
▶︎ If you have non-Medicare drug insurance that pays as much as Medicare coverage or more—what’s known as “creditable” coverage—you won’t be penalized, when you sign up for Part D, for the months in which you had that coverage. If your non-Medicare plan, such as a VA or retiree plan, is creditable, you should get an annual notice to that effect.
▶︎ If you lose creditable coverage, you must apply for Part D within 63 days to avoid the penalty or wait until the annual open enrollment period.
MEDIGAP
If you are not in one of the guaranteed issue periods, companies can charge you considerably higher premiums or simply deny you coverage altogether. That leaves you on the hook for certain costs not covered under original Medicare.
Mona, who had a Medicare Advantage policy for three years, switched to original Medicare. Her Medigap application was denied because of her high blood pressure. She now has to pay the coinsurance and deductibles that Medigap might have covered.
KEEP IN MIND
▶︎ In the first six months you’re at least 65 and enrolled in Part B, you have a “guaranteed issue” right for Medigap. Insurers must sell you a plan at the best rate available, despite any health problems.
▶︎ If you start out Medicare with an MA plan, you have a guaranteed-issue Medigap right if you switch to original Medicare within a year.
▶︎ Connecticut, Massachusetts and New York residents have guaranteed issue rights at any age over 65. Other states offer such rights under certain circumstances.