From the Initial Enrollment Period to the Annual Enrollment Period, you are advised on when you should sign up for Medicare. However, it is not always clear when those Medicare benefits actually begin. If you are not careful, there can be gaps in coverage that leave you without access to the care you need.
Even if you sign up during your Initial Enrollment Period, the date your benefits kick in may vary.
The Initial Enrollment Period (IEP) starts three months before the month you turn 65 and ends three months after you the month you turn 65. This gives you seven months to sign up for Medicare without facing late penalties.
When you sign up in the first three months of your IEP, Medicare coverage starts the month you turn 65 (or the month before that if your birthday is the first of the month). When you sign up in your birth month or in the following three months of your IEP, your benefits start the month after you submit your enrollment. If you’re already receiving Social Security retirement benefits, your coverage in Medicare will be automatic and will start the first of the month you turn 65. But if you’re not yet receiving Social Security, you’ll need to complete the enrollment process to start your coverage.
There’s also a seven-month IEP for people who become eligible due to a long-term disability. Instead of centering around the month they turn 65, it’s centered around their 25th month of receiving Social Security disability benefits. Since these enrollees are already receiving Social Security benefits, their enrollment in Medicare will be automatic. But they can still use the seven-month window to decline Part B, or to pick a Medicare Advantage or Part D plan.
How long do I have to wait for benefits when I sign up during the General Enrollment Period?
When you miss the IEP (based on age or disability), you have to wait until the General Enrollment Period (January 1 – March 31) to apply for Medicare, unless you qualify for a special enrollment period. This could leave you waiting several months just for the opportunity to sign up. But when you finally do enroll during the General Enrollment Period, benefits start the first day of the next month.
Is there a delay in Medicare coverage when I have kidney disease or a disability?
Not everyone on Medicare is 65 or older. According to CMS, about 9% of Medicare beneficiaries are eligible based on a disability (meaning more than 24 months of receiving Social Security Disability benefits, or being diagnosed with ALS or kidney failure).
To qualify for Medicare before age 65, an individual must first receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits. There is a five-month waiting period from when the disability began until benefits start to be paid (as explained below, this does not apply to people with ALS), although the application process for these benefits can take more than seven months (so disability benefits could start to be paid immediately after the application is processed, if the government determines that your disability has been ongoing for at least five months, since it can take longer than five months to process the application). But that just pertains to the start of SSDI (or RRB disability) benefits. For most disabilities, Medicare coverage does not start until the 25th month of benefits.
When do Medicare benefits start if you have ALS?
Most people on Social Security Disability Insurance get Medicare coverage on their 25th month of SSDI benefits. However, because amyotrophic lateral sclerosis (ALS) is a rapidly progressive disease, Medicare benefits start the first month you receive SSDI benefits.
Also, people with ALS do not have a five-month waiting period for SSDI like other people with disabilities do.
When do Medicare benefits start if you have ESRD?
People with end-stage renal disease (ESRD) need dialysis or a kidney transplant. Their Medicare benefits start on their fourth month of dialysis if they receive the treatment at a clinic, hospital, or medical office, but could start on their first month of dialysis if they receive their treatments at home.
Alternatively, benefits can start right away when someone is admitted to a hospital for a kidney transplant and that transplant takes place within two months. If it takes longer than two months to get the transplant, Medicare coverage starts two months before the transplant is actually completed.
What makes ESRD coverage different from other types of Medicare coverage is that ESRD coverage has an end date. Benefits stop 12 months after dialysis treatments are discontinued or 36 months after a successful kidney transplant. (For other disabilities, Medicare will end if the disability itself ends, but can be permanent if the disability doesn’t end. For someone with ESRD who remains on dialysis long-term and doesn’t get a transplant, Medicare will continue to cover them.)
The problem is that people need to take lifelong immunosuppressive drugs to prevent their body from rejecting a transplant. Losing Medicare coverage could affect their ability to afford these necessary medications. This is why Medicare began to offer a new Part B benefit referred to as the Part B-ID benefit – the ID referring to immunosuppressive drugs — starting in 2023.
Under the Part B-ID benefit, people with kidney transplants who do not have other health coverage can sign up to cover those drug treatments. Part B-ID does not include other Part B benefits and as a result, the monthly premiums are lower than the premiums for full Part B coverage. Similar to regular Part B, benefits for Part B-ID begin the month after you sign up.
Are there special enrollment periods that could help me get coverage sooner?
Not everyone signs up for Medicare during the IEP based on age. If you are still working and have a health plan through your employer (or your spouse does), you can wait to sign up for Medicare. When you (or your spouse) leave your job or the health plan – whichever happens first – you have eight months to sign up for Medicare. Your benefits start the month after you sign up.
That said, it is important to understand that small employers – those with fewer than 20 employees – may require you to sign up for Medicare when you turn 65 in order to keep your health plan. You should reach out to your employer to find out how their plan works with Medicare.
While you have an opportunity to change Medicare plans every year during the Annual Enrollment Period (October 15 – December 7), there are not many other opportunities to sign up for Medicare.
If the COVID pandemic taught us anything, it’s that not everything is within our control. CMS understands that. Starting on Jan. 1, 2023, they enacted a new set of Special Enrollment Periods to give you more options to sign up for Medicare for the first time.
It takes a number of situations into consideration that could cause you to miss your IEP. They include emergencies and natural disasters (including pandemics), loss of Medicaid coverage, misleading information from your employer or health plan, and release from prison. It also allows Medicare to look into circumstances on a case-by-case basis.
Tanya Feke, M.D. is a licensed, board-certified family physician living in New Hampshire. As a practicing primary care physician in Connecticut and an urgent care physician in New Hampshire, she saw first-hand how Medicare impacted her patients. In recent years, her career path has shifted to consultant work with a focus on utilization management and medical necessity compliance.
Dr. Feke is an expert in the field, having Medicare experience on the frontlines with patients, hospital systems, and insurers. To educate the public about ongoing issues with the program, she authored “Medicare Essentials: A Physician Insider Reveals the Fine Print.” Her analysis of Medicare issues is frequently referenced by the media, and she is a contributor to multiple online publications.
