As you approach your 65th birthday, you become eligible for the national health insurance program, Medicare. However, the enrolling period can be a little hard to understand, and signing up at the wrong time may attract serious penalties.
You may not have to worry about signing up during an enrollment period if you get Social Security Benefits. You will automatically be signed up for part A and part B Medicare. You will get your Medicare card in your mail and your coverage starts on your 65th birthday. If you are already covered by non-Medicare insurance, you can decide not to enroll in part B Medicare.
The most obvious eligibility factor for Medicare is that you have to be 65 years old. However, you must also be a U.S citizen or a permanent resident (with a green card) that has legally lived in the country for up to 5 years.
You are also eligible if you have a disability and have been receiving a Social Security Disability Benefit or railroad retirement board disability benefit consecutively for at least 24 months. This is regardless of your age. Lastly, you are eligible if you have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Diabetes. Your Medicare coverage does not extend to your spouse except they meet Medicare’s Specific Eligibility requirement in which case, they get some benefits.
There are three broad Enrollment periods for Medicare. They include the Initial Enrollment Period, the General Enrollment Period, and the Special Enrollment Period.
The Initial Enrollment Period
This is a 7-month enrollment window to sign up for Medicare. During this period, you can sign up for Medicare parts A, B, C, and D. This period includes the three months before your birthday month, your birth month, and three months after your birthday.
If you enroll within the first three-month window, your coverage will start on your birth month. If you enroll in your birth month, your coverage begins in the fifth month. However, if you sign up in the last 3-month period, your coverage may be delayed for as much as another two or three months. This means that the best time to sign up even during the initial enrollment period remains the first 3 months before your birth month.
In certain situations, it is best to enroll during IEP to avoid strict penalties and delays in coverage. These situations include if:
- you have no other health insurance
- you are covered by COBRA insurance
- you are in a non-marital domestic relationship (same-sex or not) and you are covered by their employer insurance
- you have non-employer insurance paid for by yourself
- you have veterans’ health benefits from VA but no current insurance from an employer
- you have retiree benefit from a former employer
General Enrollment Period
If you failed to sign up during your IEP, you may wait until the general enrollment period to sign up. The GEP is for Medicare parts A, B, and C, and it is between January 1 and March 31 with your coverage starting on July 1.
There is also an open enrollment period between October 15 and December 7 when you can switch from Original Medicare to Medicare Advantage or vice versa, from one Medicare Advantage plan to another, or join or disenroll in a Part D plan. Your coverage for an open enrollment period starts on January 1 of the following year.
Special Enrollment Period
If you are still employed when you turn 65 in a company with more than 20 employees with medical insurance from your employer, union, or spouse, you may wait until the Special Enrollment period to sign up for Medicare. In this case, you can apply for Medicare parts A and B within 8 months after your coverage ends or for Medicare Advantage and Part D within 63 days after your coverage ends.
Make sure you have a good understanding of your situation when signing up for Medicare. If you have read this article, there is a good chance you understand the circumstances under which you can delay your application if necessary, without facing any penalty when you finally enroll for your plan.