Are you turning 65 and not sure how to enroll in Medicare?
If so, do not assume your enrollment into Medicare is automatic.
Unless you are receiving Social Security or Railroad benefits prior to your 65th birthday, there are necessary steps you must take to enroll in to Parts A and/or B.
Here’s how it works:
✔ If you are already receiving Social Security or Railroad benefits prior to your 65th birthday, do nothing.
You will be automatically enrolled in Medicare Parts A and B starting the 1st of the month you turn 65. Be on the lookout for your red, white and blue card in the mail approximately 90 days prior to your 65th birth month.
But what if you are receiving SSA/Railroad benefits, and do NOT want Parts A and/or B?
You must contact Social Security and make a formal request to decline these benefits. You can contact Medicare at 800-633-4227 or visit your nearest SSA office.
✔ If you are not currently receiving Social Security benefits, but want to enroll in Medicare when you turn 65, you need to take action.
You should not expect to receive any official notice on how or when to sign up – which means that you must take the necessary steps to initiate your enrollment into Parts A and/or B.
There are four ways to initiate enrollment in Part A and/or B:
- Online – by visiting the SSN website at ssa.gov
- Phone – by calling 1-800-772-1213
- Person – by visiting your local SSA office
- Mail – by mailing a signed and dated letter to SSA requesting enrollment, which must include your name, social security number and effective date that you would like your coverage to begin (coverage will begin the first day of the month you request).
So what happens after you enroll in Parts A and/or B?
Once you have successfully enrolled in Parts A and B, you can expect to receive your red, white and blue Medicare card, as well as a “Welcome to Medicare” packet, in the mail from SSA, and your Medicare Parts A and B coverage will begin the first day of your 65th birth month.
Make sure that you enroll on time! Be aware of your personal deadlines depending on your circumstances to avoid the risk of late enrollment penalties.
When do you enroll in Medicare if you are not receiving Social Security or Railroad benefits?
First, remember that you must be eligible for Medicare benefits. Assuming you are, there are three different time periods during which you can enroll in Parts A and B.
Initial Enrollment Period
For most, this will be the first time to enroll in Medicare Parts A and B benefits. Your Initial Enrollment Period (IEP) is triggered by your 65th birthday and provides you the opportunity to enroll penalty-free in Medicare Parts A and B. IEP is a 7-month window that begins 3 months prior to your 65th birth month, includes your birth month, and the 3 months that follow your birth month.
Also, during your IEP, you have the opportunity to enroll in a Medicare Prescription Drug plan (Part D). By doing so, you will avoid any late enrollment penalties (LEP) associated with missing your IEP.
NOTE: You must have Part A and/or B to enroll in a Part D plan.
General Enrollment Period
If you didn’t sign up during your Initial Enrollment Period, and you’re not eligible for a Special Enrollment Period, you still have an opportunity to enroll in Parts A and B during the General Enrollment Period (GEP).
This enrollment period is from January 1 through March 31 of each year for Parts A and/or B, and from April 1 through June 30 of each year for Part D, Part C (Medicare Advantage) and Medicare Supplement. Your coverage will start on July 1 of the same year.
Note: The GEP is not the ideal time for you to sign up for Original Medicare as you still risk facing coverage gaps and penalties that could last for the rest of your life. Therefore, it is best to sign up for Parts A and B during your Initial Enrollment Period.
Special Enrollment Period
Today, many people are choosing to work past 65. By doing so, you might elect to keep your employer benefits until you decide to disenroll from these benefits or retire, and therefore don’t need Parts A and/or B quite yet. In many cases, Medicare eligible beneficiaries are not in need of Part B, but will elect for Part A. In these situations, you could be eligible for an SEP that would provide you a period of time to enroll in Part B and Part D at a later date without incurring a late enrollment penalty.
During your IEP, you should discuss your SEP eligibility with your employer to understand how your existing health plan coordinates with Medicare enrollment and benefits. Employer size is an important factor in determining if you are required to enroll in Medicare Parts A and/or B, or if you can continue to receive the existing coverage provided by your employer health plan. Additionally, the type of health care plan your employer offers is an important factor as well, such as H.S.A. or H.R.A plans, which are not compatible with Medicare.
Note: If you elect not to enroll for Parts B and D during your IEP, you will need to provide documentation of your SEP eligibility to CMS in order to avoid any penalties.
What if you work for a company with 20 employees or less?
If you work for an employer with under 20 employees, your health plan will be considered secondary and Medicare will become your primary. Therefore, by failing to enroll into Medicare Parts A and B in this situation, you would, by default, become the primary payor of your medical claims and bills.
You can apply for Medicare Parts A and/or B during your IEP, or any time during your 8-month SEP. Your SEP begins the month that your coverage ends or you stop working, whichever happens first.
What if you work for a company with over 20 employees?
If you work for a larger company with over 20 employees, you must first find out if your benefits are deemed creditable by Medicare. Assuming so, your employer benefits would be primary and all Medicare benefits would be secondary. You can elect to enroll in Medicare Parts A, B and D anytime whether working or retiring.
Late Enrollment Penalties (LEP)
Avoiding penalties is crucial as Medicare costs are already expensive enough as it is.
If you didn’t sign up for Parts B and/or D during the appropriate enrollment period, you assume the risk of incurring a late enrollment penalty (LEP).
An LEP is a dollar amount that will be added to your monthly premium if you don’t enroll when first eligible for Part B and/or Part D. The cost of the LEP depends on how long you went without Part B or Part D (without creditable prescription drug coverage) when first eligible. The penalty for Part B is 10% for every 12-month period you go without Part B benefits, and the penalty for Part D is 1% per month for every month you go without these benefits.
Generally, you will have to pay your LEP for as long as you continue to have Medicare Part B or prescription drug coverage, even if you change your Medicare plan. The late enrollment penalty amount changes each year.
LEP’s can last for your lifetime, so please make sure you understand your enrollment periods and how to comply. Get all the answers regarding your enrollment periods as well as any current coverage or benefits you currently receive.
Contact one of our agents to understand more, we offer free education on Medicare eligibility, enrollment, and utilization.