What you need to know about enrolling in Medicare the first time in retirement 

When should you enroll in Medicare? Medicare in retirement is available as soon as the month you turn age 65, but that doesn’t mean you should enroll for coverage to have health insurance through this government sponsored plan at this time. The timing for when to begin taking Medicare and which parts to enroll in when you do depend on a number of factors.  The problem is that you will need to enroll in Medicare during certain periods or else you could be subject to significant penalties or worse yet, be left with-out coverage which would leave you open to an unlimited amount health care exposure. So you will want to know when you should enroll for Medicare coverage.

There are generally four initial enrollment periods into Medicare. These are:

  1. Medicare Automatic Enrollment
  2. Medicare Initial Enrollment Period
  3.  Medicare Special Enrollment Period
  4. Medicare General Enrollment Period

Understanding what you can, need and should do during each of these enrollment periods will help you have the health insurance coverage you need and prevent costly late enrollment penalties.

Medicare Automatic Enrollment

If you have been receiving Social Security retirement benefits for four months prior to turning age 65, you will automatically be enrolled in Part A and Part B or Medicare.

Retirees who are receiving Social Security retirement benefits when they turn age 65 MUST accept Medicare Part A. However, they can opt out of the optional Medicare Part B if they chose.

Medicare Initial Open Enrollment

Visual representation of the Medicare initial enrollment period
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The initial Medicare enrollment period is officially a 7-month period that begins 3 months before you turn age 65 and 3 months after you turn age 65.  It allows individual to both enroll in Medicare chose their initial path of either Original Medicare Part A and B, Part D drug coverage and a supplement plan OR Medicare Part C (Medicare Advantage.)

For Medicare Parts A and B, individuals who sign up for Medicare up to three months before they turn age 65 will have health insurance coverage on the first day of the month they actually turn age 65. Those who wait until their birth month to sign up for Medicare will not receive coverage until the following month. Those who wait one month after their birth month to sign up for Medicare will have to wait two more months for coverage (this equates to three months after the month they turn age 65) and finally, those who wait two or three months after the month they turn age 65  to enroll in Medicare must wait an additional (3) months onger for coverage to begin (See blue areas of attached chart.)

For Medicare Part D (prescription drug coverage), those who enroll sometime in the three months prior to the month they turn age 65 will have coverage on the first day of the month in which they turn age 65. If they enroll after this, they will have coverage the following month (see orange colored boxes in attached picture.)

For those who are going to enroll in a Medicare supplement plan (aka – Medigap) they officially can buy a plan when they turn age 65 and enrolled in Medicare Part B. There may be instances that a person can buy a Medigap plan before they turn age 65 but most companies will make them wait until the month they do actually turn 65. After that, the initial enrollment period lasts for 6 more months during which time an insurance company MUST accept the applicant regardless of any pre-existing health issues. Those who chose to delay their enrollment into Medicare Part B can delay the effective date of their Medigap supplement policy as well even if they apply on time.



Medicare Special Enrollment Periods

Medicare Special Enrollment Periods

Medicare special enrollment periods apply to people who have had group health insurance coverage, either through their own or their spouses employer, and lose that coverage after turning age 65 allowing them to enroll in Medicare.

The special enrollment period lasts as long as the individual continues to be covered by the qualifying group insurance plan and ends eight months after termination. At any time during this period, an individual can enroll in Medicare Part A and B without penalty. However, for Medicare Part D (prescription drug coverage) the individual only has two months to enroll. It is important to note that group coverage in regards to the special enrollment period does not include coverage under COBRA or post-employment health coverage.

The special enrollment period for a Medicare supplement plan starts six months after the actual Medicare Part B enrollment and ends six months after that period.

Other special enrollment periods occur when an individual experiences a “life changing event.” This could be a time when you change where you live, lose existing coverage, have the opportunity for new coverage, your current plan changes mid-year or a number of other circumstances. Visit Medicare for a complete list of special circumstances here…[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]Medicare General Enrollment

Medicare General Enrollment Period

If you happen to screw up and not enroll into Medicare during your initial or special enrollment periods, you will only be able to enroll into Medicare during certain times of the year. Medicare general enrollment periods are for people who missed enrolling into the various parts of when they were first eligible and want to enrol now. You should know that when enrolling outside of your initial or special enrollment periods, you may be subject to several penalties.

Medicare General Enrollment Part D

Many times individuals do not take Medicare Prescription Drug Coverage when they are first eligible and have to wait until General Enrollment. The good news is that they will be automatically accepted into the plan; the downside is they will be subject to a life-long penalty that is 12% per year. The general enrollment period for Medicare Part D is October 15 – Dec. 7 for those who are enrolled in Medicare Parts A and B. This period also coincides with Medicares Open Enrollment.

In addition, if an individual signs up for Medicare Part B during the general enrollment (below) they also can sign up for drug coverage between April 1st to June 30th.

Medicare General Enrollment Parts A & B

The general enrollment for Medicare Parts A & B is from January 1st to March 30th. Coverage purchased during this period DOES NOT TAKE EFFECT until July 1st leaving a potentially large gap in health insurance coverage.

General Enrollment for Medicare Supplement Policy

There is not a general enrollment period to purchase a Medicare supplement policy. They can be purchased anytime. The problem with Medicare supplement insurance if it is not being purchased when a beneficiary is first eligible is that the insurance company may not accept you if you have a pre-existing condition. This means that if you wanted to limit your out of pocket expenses, you may need to accept a Medicare Part C Plan (Medicare Advantage) which may limit the choices you would have choosing health care providers. An individual who first enrolls into Medicare Part B during the general enrollment period can chose a Medicare Advantage Plan between April 1 and June 30th.

How to enroll in Medicare if you are not receiving Social Security

When you’re ready to sign-up, you have three options for actually enrolling in Medicare.

  1. Enroll online at www.socialsecurity.gov/medicareonly. Before you start the process, look over the online publication “How to apply online for Medicare only”. Social Security promotes using their website as the easiest and quickest way to enroll. If you have questions or your situation is at all unusual, Social Security will contact you.
  2. Call Social Security at (800) 772-1213 between 7:00 AM and 7:00 PM Monday through Friday. Please be aware, depending on when you call, you may wait for extended periods of time before speaking to a person. Then, the agent will schedule a telephone appointment with your Social Security office, which may be several days or weeks in the future. Record the names of the persons you speak with and the time/date of your conversations.
  3. Visit your local Social Security office. To locate an office near you, visit the Social Security office locator website and enter your zip code.  Please note that you may find yourself waiting awhile at a Social Security office.  If you want to reduce this waiting time, you can call (800) 772-1213 to set-up an appointment. Some offices may not schedule appointments.

Information you will need to enroll in Medicare

Getting ready to enroll in Medicare? You can do that online. But, first, if you don’t have one, you must establish a My Social Security account. In some cases, you may need to prove your identity, age, and citizenship. According to the Social Security website, here are the documents (originals, not photocopies) you may need:

  • Your birth certificate or other proof of birth
  • Proof of United States citizenship or legal residency, such as a passport
  • Driver’s license

It would be a good idea to establish this account before you’re ready to enroll. If there are issues confirming your identity, it may take time or a visit to your local Social Security office.

Then, when it’s time to enroll, once the account is established, you may need additional information to answer the questions.

  • Your Social Security card, if you are already receiving benefits
  • Health insurance information about the type and dates of coverage
  • Information about your employment, such as a W-2 form, if you are still working
  • US military discharge papers if you served before 1968

If you sign up for Medicare online or by phone, you may need to submit additional information. Social Security will let you know if you need to do this and what that information might be.

Conclusion when enrolling into Medicare

Hopefully you have gained some insight and this article hasn’t confused you any more than you may already had been. The fact is that Medicare is confusing.

We want to invite you to learn more about our Medicare “RoadMaps” that can help you save time in picking the correct Medicare path for you to take.