Complete Guide to Medicare: Understanding When You Can Enroll in Medicare
Last Updated : 06/10/20198 min read
This article outlines when you can enroll in Medicare Part A, Medicare Part B, Medicare Supplement insurance a stand-alone Medicare Prescription Drug Plan (Part D), or a Medicare Advantage plan.
Assuming you meet residency requirements, you generally first qualify for Medicare when one of the following is true:
- You have turned 65.
- You have been receiving Social Security disability benefits for 24 consecutive months.
- You have been diagnosed with end-stage renal disease (ESRD).
- You have been diagnosed with Amyotrophic Lateral Sclerosis (also known as ALS or Lou Gehrig’s disease).
When you first qualify for Medicare you enroll during the Initial Enrollment Period. The Initial Enrollment Period is a seven-month period that starts three months before you are first eligible for Medicare. For example, Mary Doe Jones turned 65 on April 27, 2019. She is first eligible for Medicare starting in April 2019 because she is turning 65. Her initial enrollment period for Medicare starts January 1, 2019 and lasts until July 31, 2019.
When can I sign up for Medicare Part A and Part B?
If you’re already getting Social Security or Railroad Retirement Board benefits, usually you will be contacted a few months before you become eligible for Medicare and given the information you need. Most people will be enrolled in Medicare Part A and Part B automatically during their individual Initial Enrollment Periods. However, because you must pay a premium for Part B coverage, you have the option of turning it down. If you “opt out” of Part B and then decide to enroll later, you might end up paying a late-enrollment penalty.
If you don’t qualify for automatic enrollment, you can sign up for Original Medicare, Part A and Part B during your initial enrollment period by contacting the Social Security Administration. You can call Social Security at 1-800-772-1213 or TTY 1-800-325-0778 between 7 a.m. and 7 p.m. Monday through Friday in every time zone.
If you aren’t eligible for full Social Security or Railroad Retirement Board (RRB) benefits at age 65, you may be able to get your full Medicare benefits at age 65, but you must contact Social Security or the RRB to sign up. People who are not automatically enrolled in Medicare Part A and/or Part B can usually enroll during the Initial Enrollment Period. Most people will not have to pay an additional premium amount for Medicare Part A. If you or your spouse worked 10 years and paid Medicare taxes, you won’t have to pay the Part A premium. People who did not work a minimum of 10 years may still obtain Medicare Part A coverage but may have to pay a premium amount. That amount is determined by Social Security.
If you turn down or delay your enrollment in Part B, you may have to pay a 10 percent Part B premium penalty for each 12-month period for which you qualified but delayed enrollment. This penalty is added to your monthly Part B premium, and would begin once you enroll in Part B. In 2019 the “standard” Medicare Part B premium amount is $ 135.50 (the amount you pay may be different depending on your income).
For example, Mary Doe Jones first qualified to enroll in Medicare Part B on 2/1/2017. She delayed her enrollment. She enrolled in Medicare Part B in March 2019, during the annual General Enrollment Period (January 1 – March 31). The penalty will be assessed based on the Medicare Part B premium amount when she enrolled.
- Ten percent of the standard Medicare Part B premium in 2019 is $13.55.
- Mary could have had Medicare Part B for two full 12-month periods before she enrolled. Therefore, the penalty that she may have to pay in addition to the Medicare Part B premium amount is two times $13.55, which is $27.10.
- So, $27.10 gets added to her standard premium payment ($135.50 in 2019) for a total premium amount of $162.60.
- She will have to pay this penalty for as long as she has Medicare Part B.
When can I sign up for prescription drug coverage?
You can sign up for stand-alone Medicare Part D Prescription Drug coverage during your Initial Enrollment Period.
You must have Medicare Part A or Part B, and you can enroll when you first become eligible for Medicare. People can enroll in a Medicare Part D plan for the first time using their Medicare Initial Enrollment Period described above.
If you don’t enroll in a Medicare Prescription Drug Plan when you’re first eligible, a penalty may be added to your drug plan premium for each month if you decide to get this coverage later.
When can I enroll in a Medicare Advantage plan?
You must have Medicare Part A and Medicare Part B to enroll in a Medicare Advantage plan. People can enroll in a Medicare Advantage plan for the first time using the Initial Coverage Election Period. If you enroll in Medicare Part B when you are first eligible to do so, using the Initial Enrollment Period for Medicare Part A and Part B, the Initial Coverage Election Period will be the same as the Medicare Part B Initial Enrollment Period.
For example, Mary Doe Jones’s Medicare Initial Enrollment Period is January 1, 2019 through July 31, 2019. She went to Social Security and filled out an application on January 15, 2019. Her Medicare Part B coverage was effective April 1, 2019. Her Initial Coverage Election Period for Medicare Advantage is also January 1 – July 31, 2019. If she chooses a Medicare Advantage plan in January and submits an enrollment request, her Medicare Advantage plan would typically begin April 1, 2019.
If you delayed your enrollment in Medicare Part B, your Initial Coverage Election Period is only the three months before Medicare Part B coverage begins.
For example, John Doe Jones was first eligible to enroll in Medicare Part B in September, 2018. He delayed his enrollment, enrolling for the first time using the General Enrollment Period for 2019 (January 1 – March 31). His coverage for Medicare Part B was effective July 1, 2019. His Initial Coverage Election Period was April– June 2019.
If you delay Part B enrollment, you may have to wait until the Annual Election Period, which runs from Oct. 15 – Dec. 7 each year, to enroll in a Medicare Advantage plan.
When can I sign up for a Medicare Supplement insurance plan?
There are no cost penalties for late enrollment, but your eligibility for some Medicare Supplement insurance plans can be impacted if you delay enrollment. Usually the best time to enroll is during your Medicare Supplement Open Enrollment Period.
When is the Medicare Supplement Open Enrollment period? This six-month period runs from the first day of the month in which you are both age 65 (or older) and enrolled in Medicare Part B.
What happens if I miss my Medicare Supplement Open Enrollment Period?
Your eligibility may be impacted if you miss the Medicare Supplement Open Enrollment Period:
- Your application could be declined if you have a pre-existing medical condition.
- Your premium may be higher if you have a pre-existing medical condition.
- Some plans may require you to pay the plan premium but wait for a few months before they’ll cover any expenses related to your pre-existing medical condition.
When can you change your Medicare Advantage or Medicare Part D prescription drug coverage?
- During your Initial Enrollment Period for Medicare, described above
- During Medicare’s Annual Election Period
- During the Medicare Advantage Open Enrollment Period (January 1- March 31)
- During a Special Election Period (SEP), if you qualify for one. Medicare allows SEPs for certain situations, such as losing your health-care coverage
Read more about Medicare election periods here.
When is Medicare’s Annual Election Period?
- The Medicare Advantage and Prescription Drug Plan Annual Election Period runs from October 15 to December 7 each year.
What can you do during the Annual Election Period (AEP)?
Plan benefits can change from year to year, so you have the option to change your Medicare coverage every year during Medicare’s Annual Election Period (AEP), also known as the “Open Enrollment for Medicare Advantage and Medicare prescription drug coverage” which runs from October 15 to December 7 each year. What you can do during this timeframe:
- Change from Original Medicare to a Medicare Advantage plan.
- Change from a Medicare Advantage plan back to Original Medicare.
- Switch from one Medicare Advantage plan to another Medicare Advantage plan.
- Switch from a Medicare Advantage plan that doesn’t offer prescription drug coverage to a Medicare Advantage plan that offers prescription drug coverage.
- Switch from a Medicare Advantage plan that offers prescription drug coverage to a Medicare Advantage plan that doesn’t offer prescription drug coverage.
- Enroll in a stand-alone Medicare Part D Prescription Drug Plan.
- Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug plan.
- Drop your Medicare prescription drug coverage completely.
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