Medicare Enrollment: Your Guide to Signing Up for Coverage

Medicare allows senior citizens and other qualifying Americans to obtain health insurance coverage through a program that they have paid into throughout their working lives. It’s often a source of instrumental help to those who might not be able to get health insurance otherwise.

The numerous public and private policy options that make up the Medicare system have various rules about when you can enroll in coverage. If you are wondering when to sign up, Senior Healthcare Solutions has the answers.

Medicare Enrollment Rules Vary by Plan

There are numerous Medicare plans available on the market today.

• Original Medicare: All Medicare enrollees participate in this program. It contains two types of coverage—Part A and Part B. Part A pays hospital costs, while Part B pays outpatient costs. This is the government’s standard Medicare coverage.
• Medicare Advantage Plans: These plans are sold by private insurers. They cover nearly all of the same care as Original Medicare, but can include other coverage (dental, vision, prescription, etc.). They can also include certain different cost sharing rules. You remain part of the Original Medicare program even if you enroll in a Medicare Advantage plan.

Depending on which plan you select, your enrollment timeline might vary.

Who can Enroll in Medicare?

You have to meet several qualifications to be eligible for Original Medicare*. Participants must:

• Be aged 65 or older; or
• Be a younger person with a qualifying disability; or,
• Have End-stage Renal Disease (ESRD) (kidney failure, dialysis recipients or transplant recipients)

*Medicare Advantage patients have additional rules to qualify for a plan.

Will I automatically be enrolled in Medicare when I turn 65?

Some people are automatically enrolled in Medicare Parts A & B if they are already receiving Social Security benefits (retirement or disability) before their 65^th birthday*. If you don’t meet these qualifications, you will have to initiate your enrollment yourself.

*If you already receive Social Security Disability benefits (and have for at least 24 months), you will be automatically enrolled in Medicare once you enter your 25^th month of receiving benefits.

What is the Medicare Initial Enrollment Period?

If you don’t qualify for automatic enrollment, then your best time to sign up is during your Initial Enrollment Period (IEP). This is a period of time around your 65^th birthday. It encompasses 7 months:

• Three months before your birthday.
• The month of your birthday
• Three months after your birthday.

So, if your birthday is August 8, you can begin enrolling in coverage as early as May 1. You will be able to enroll until November 30. The date on which you enroll determines the day your Part B coverage starts.

Are you penalized if you don't sign up for Medicare at 65?

If you don’t enroll in Original Medicare during your IEP, then you might face a penalty, usually increased Part A & Part B premiums (though many people don’t have to pay Part A premiums, regardless).

However, certain people who are still working and still have health insurance when they turn 65 can delay their Part B enrollment. Some people choose to go ahead and enroll in Part A at 65, and wait until they stop working to enroll in Part B.

What is a Medicare Special Enrollment period?

There are certain people who qualify for a special enrollment period (SEP), including:

• Individuals (and their spouses) who are working and receive health insurance through that job.
• Some individuals with Health Savings Accounts (HSAs) and High-Deductible Plans (HDHPs).

SEPs last 8 months. They start either on the date your employment ends, or the date your health insurance from that employment ends, whichever is first.

Please note: Having a retiree health plan, a COBRA plan, or having end-stage renal disease does not qualify you for an SEP. Kidney patients will follow their own enrollment rules.

When is the General Medicare Enrollment period?

If you do miss your IEP or SEP, you still have a chance to enroll in Medicare. This is the Medicare General Enrollment Period, and it lasts from January 1 to March 31 each year. Coverage will take effect in July.

Is there a different enrollment period for Medicare Advantage plans?

You can enroll in a Medicare Advantage plan during your 7-month IEP, but you must get Original Part A & Part B coverage first. Additionally, there are two further enrollment periods:

• October 15 – December 7

During this enrollment period, you can:

• Join a new Medicare Advantage plan from an Original plan.
• Switch from Medicare Advantage back to Original Medicare.
• Change from one Medicare Advantage plan to another.

Changes to your policy will take effect on January 1.

• January 1 – March 31

Also called the Medicare Advantage Open Enrollment period, during this time, you can:

• Switch from one Medicare Advantage plan to another.
• Change from a Medicare Advantage plan back to Original Medicare.

However, you cannot switch from Original Medicare to a Medicare Advantage plan during this time.

Some Medicare advantage patients qualify for additional special enrollment periods, such as if they move to an area that doesn’t offer their current Medicare Advantage plan.

Who do You Call with Medicare Questions?

We get it, enrolling in Medicare can seem confusing. If you have questions, call Senior Healthcare Solutions at 631-539-6351. We can help you get covered today!

You can also contact the Medicare system directly at:

• www.Medicare.gov/forms-help-resources
• National Phone Number: 1-800-MEDICARE (1-800-633-4227)
• TTY Phone: 1-877-486-2048
• Medicare Contact Center Operations
  PO Box 1270 
  Lawrence, KS 66044