Most people apply for Medicare around their 65th birthday month if they do not have large employer insurance past age 65. The enrollment window that surrounds your 65th birthday month is called your Initial Enrollment Period (IEP). Many individuals who are not automatically enrolled in Medicare will apply during that window. Since it is based on your birthday month, you may complete your Medicare application during a different month than someone else since your eligibility will be different than theirs.
When to Sign-Up for Medicare
Suppose you qualify for Medicare health insurance early due to disabilities. In that case, you will be automatically enrolled in Medicare Parts A (hospital insurance) and B (medical insurance). You should receive your Medicare card about two months before your Medicare is effective. Those who qualify early include those receiving Social Security Disability Insurance (SSDI) for at least 24 months, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig disease), or have End-Stage Renal Disease (ESRD) and need dialysis or kidney transplant. Additionally, you will be automatically enrolled in Medicare if you’ve been receiving Social Security benefits or Railroad Retirement Board benefits for at least four months before your 65th birthday month.
However, if you do not fall into either of those situations, then you will need to sign up for Medicare on your own. If you do not actively work for a large employer or are not covered by your spouse’s large employer, you will need to enroll during your IEP.
Initial Enrollment Period
The IEP window starts three months before your 65th birthday month and ends three months later. When you submit your application for Medicare during the three months before, your Medicare benefits will start on the 1st of your 65th birthday month. However, when you apply during the three months after, your benefits can be delayed by 2 or 3 months. Also, if your birthday falls on the 1st of the month, then your IEP window shifts one month early.
If you contribute to a health savings account (HSA), you will want to delay Medicare as long as you have creditable coverage. If you contribute to an HSA and enroll in Medicare, you will be subject to an IRS penalty.
Additionally, beneficiaries who live in Puerto Rico will need to apply for Medicare Part B coverage no matter what.
Special Enrollment Period Window
If you are covered by large employer insurance based on active employment, you can delay Medicare past 65. You will qualify for a Special Enrollment Period (SEP) when you lose coverage or employment. However, the employer must have more than 20 employees for you to qualify.
You are given an 8-month window to apply for Medicare that starts the day you lose group health plan coverage or employment, whichever comes first. If your spouse covers you on their large employer health plan, you can still delay Medicare past 65 while they continue to work.
When you qualify for this window, you must submit documentation to Social Security. You will fill out two CMS forms. One is CMS form 40B, and the other is CMS form L564. Those documents are the Part B application and the proof of employment. However, if you do not have Part A coverage, you will need to call Social Security first to verify the process.
If you fail to enroll in Medicare Part A and Part B, you will be penalized and must pay a late enrollment penalty when you sign-up in the future.
General Enrollment Period Window
The General Enrollment Period (GEP) is for anyone who missed their IEP and did not have creditable coverage to use the SEP window. The GEP window starts January 1 of every year and ends March 31. However, coverage will not be effective until July 1. Since you did not enroll when you were first eligible, you will pay the late enrollment penalties for Part B and Part D.
How to Apply for Medicare
There are three ways you can apply for Medicare. If you are enrolling during your IEP, you can register online through the SSA website, call the Social Security office number by dialing 1-800-772-1213 or 1-800-325-0778 (TTY), or 1-877-772-5772 for the Railroad Retirement Board, or you can visit a local SSA office in-person.
How to Pay for Medicare
Medicare beneficiaries who do not receive Social Security benefits will receive a bill in the mail for their Part B premium payment. Typically, it is a quarterly bill. However, once you start receiving Social Security benefits, the premium will automatically be deducted from your Social Security check each month.
Also, you can be subject to Income Related Monthly Adjustment Amount (IRMAA) if you are in a higher income bracket. You would pay more for Medicare Part B and Medicare Part D premiums. Social Security evaluates your income each year, so your premium costs could change depending on your income.
Applying for Additional Coverage
Once you have applied for Medicare and have been approved, you can start exploring your supplemental plan options. You can enroll in a Medicare Supplement insurance policy and pair it with a Part D prescription drug plan, or you can enroll in a Medicare Advantage plan. One individual’s plan may be different from the plan you choose. Your plan choice should be based on your medical needs and budget.
If you’d like help exploring these plans, you can contact a licensed agent for more information. However, you will want to check your resources for the exact rules in your state, as the cost for plans will vary across the country.
Applying for Medicare and the additional coverage options are essential steps that you don’t want to mess up. You could be stuck with a penalty if you fail to enroll during the correct window.