When you’re approaching the age of eligibility for enrollment in one of the many Medicare coverage plans, it’s important to thoroughly research the benefits and costs of each plan, but it’s probably even more important to make sure you enroll at the right time. Missing an enrollment date could cost you higher premiums down the line – or it could cost you coverage entirely.
If you’re eligible for premium-free part A
If you’re already receiving Social Security or Railroad Retirement Board benefits and you’re a U.S. resident, you won’t have to worry about your enrollment date, since the government automatically enrolls you in both Part A and Part B at age 65. (Three months prior to your 65th birthday, your Medicare card will arrive in the mail.)
Your only concern of timing would be if you declined Medicare Part B during the initial enrollment window. (Part B has a premium, and some eligible individuals choose not to purchase it.) If you do decline Part B, you will pay higher Part B premiums if you enroll later on. For each year that you don’t enroll, your premium will be 10 percent higher, unless the reason you declined Part B was because you’re insured by an employer-sponsored health insurance.
If you are covered by a group health plan (because you or your spouse is still working) and don’t need Part B, you’ll have another opportunity to enroll in Part B in the future. When your group coverage ends, you’ll have an eight-month window during which you can enroll in Part B.
If you aren’t eligible for premium-free Part A
If you are 65, but you’re not receiving Social Security or railroad retirement benefits, you won’t be automatically enrolled in Original Medicare. Instead, you’ll be able to enroll during one of three enrollment periods.
- Initial enrollment period – a seven-month window of time that begins three months prior to the month of your 65th birthday (if your birthday is the first of the month, your special enrollment period is still seven months long, but it’s shifted back to begin and end one month earlier than the normal schedule). The date your coverage starts depends upon how early in the IEP you enroll. If you wait until the last four months of the IEP, the start date of your coverage will be later.
- General enrollment period – January 1 to March 31 of each year. Your coverage will begin on July 1 of the year you enroll.
- Special enrollment period – You can wait to enroll in Part B and not incur a premium hike if you had coverage through your job or your spouse’s job at the time you became eligible for Medicare. While you’re still covered, you can enroll in Medicare at any time – and for another eight months after you lose your group coverage or you (or your spouse) stop working.
- For more information about signing up in Parts A and B, call Social Security at 1-800-772-1213. (TTY users, call 1-800-325-0778.)
If you have end-stage renal disease (ERSD)
Individuals who have been diagnosed with end-stage renal disease (ERSD) – and who have had a kidney transplant or are undergoing dialysis – are eligible for Medicare. Your enrollment date in Medicare will depend on the date you begin receiving dialysis or the date you receive a transplant. You may also receive a combination of coordinated coverage from your employer – or COBRA – and Medicare.
Medicare has outlined a number of scenarios to guide you through various coverage options.
If you’ve been diagnosed with ALS
If you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), you’ll be automatically enrolled in Medicare in the month you begin receiving Social Security Disability Insurance or a railroad disability annuity payment. Enrollees with ALS receive their Medicare Part A card through the mail the month their disability benefits begin.
When do I enroll in Medicare advantage
If you want to enroll in a Medicare Advantage plan, you can do so when you’re first eligible for Medicare or – if you have Social Security Disability Insurance, you can enroll in the 25th month of your disability or during the three months before or after that month.
You can also change to or from Medicare Advantage during Medicare’s Open Enrollment period, from October 15 to December 7 each year. Starting in 2019, there’s also a Medicare Advantage open enrollment period (January 1 to March 31) each year, during which you can drop Medicare Advantage and switch back to Original Medicare (and a Part D plan if you want one) OR switch to a different Medicare Advantage plan (the ability to do this in the first part of the year is new as of 2019; for the last several years, Medicare Advantage enrollees have been allowed to switch to Original Medicare at the start of the year, but not to a different Medicare Advantage plan).
You may choose to:
- Change from Original Medicare to a Medicare Advantage plan – You can switch between October 15 and December 7.
- Change from a Medicare Advantage plan to Original Medicare – You can switch between October 15 and December 7 and also from January 1 to March 31. You also have the option of joining a Medicare Prescription Drug Plan to supplement your Original Medicare coverage, but be aware that Medigap plans (Medicare supplemental insurance) are not guaranteed issue during this period.
- Switch from one Medicare Advantage plan to another – You can switch plans between October 15 and December 7, or between January 1 and March 31.
When do I enroll in Medicare part D?
With Medicare’s prescription drug coverage, your first opportunity to enroll is when you’re first eligible for Medicare (during the seven-month period beginning three months before the month you turn 65). If you enrolled in Medicare due to a disability, you can enroll in a prescription drug plan during a seven-month window beginning three months prior to your 25th month of disability, and ending three months after your 25th month of disability.
It’s important to note that if you don’t enroll during the seven-month period when you’re first eligible, you may pay a late-enrollment penalty that will raise your Part D premium when you do decide to purchase coverage.
During the Open Enrollment Period mentioned above, you can also enroll in a Medicare Part D plan, switch to another Part D plan or leave Part D entirely. During the Medicare Advantage open enrollment period, you can switch from Medicare Advantage to Original Medicare, and also purchase a Medicare Part D plan at that point. Again, pay close attention to the dates as they affect your options.
- Between October 15 and December 7 – You can join a Part D plan, switch between Part D plans or drop your Part D coverage.
- Between January 1 and March 31 – You can leave a Medicare Advantage plan and switch back to Original Medicare. If you do, you’ll have an opportunity during this time to enroll in a prescription drug plan as well. But you cannot switch from one Part D plan to another during this period.
Still confused? Read this comprehensive guide to Medicare.
Enrolling in Medicare supplement insurance (Medigap)
It’s essential that you’re conscious of your specified Medigap enrollment period, since it’s the best time to enroll.
The enrollment period begins on the first day of the month in which you turn 65 and are enrolled in Medicare Part A and B. Your open enrollment period continues for six months.
The timing for Medigap enrollment is pivotal. If you enroll within the period, you can’t be denied Medigap coverage or be charged more for the coverage because of a past medical condition. If you miss the enrollment period, your carrier has the option of denying the application or increasing the premiums based on the company’s underwriting requirements (states can set their own rules for Medigap plans: Connecticut, Massachusetts, and New York require Medigap plans to be guaranteed issue year-round, and Maine requires Medigap insurers to offer at least Plan A on a guaranteed-issue basis for at least one month each year).