Overview

Most people enroll in Medicare when they turn 65, but the timing for signing up for coverage and changing plans isn't that simple. With an Initial Enrollment Period, Special Enrollment Periods, a General Enrollment Period, and many more, the options can be daunting. Plus, if you're still working at age 65 and beyond, you may want to wait to enroll. But if you don’t sign up on time, you may face penalties that can last for as long as you have Medicare.

    Benefit Period

    is the way the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.
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  • When can I enroll in Medicare?

    Short Answer:

    You typically have a seven-month window to sign up for Medicare. This Initial Enrollment Period spans the three months before the month you turn 65, your birthday month, and the three months afterwards. So if your birthday is in April, you have from January 1 to July 31 to enroll.

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    If you have already been collecting Social Security or Railroad Retirement Board benefits, you'll be automatically enrolled in Medicare Part A and Part B the first day of the month you turn 65. If not, the onus is on you to sign up.

    When you enroll during the first three months of your Initial Enrollment Period, your Medicare coverage will begin on the first day of your birthday month. If your birthday is on the first of the month, your coverage kicks in a month earlier.

    When you wait to sign up until your birthday month or one of the last three months of the Initial Enrollment Period, your coverage starts the month following your enrollment.

    There are two other times when you may be able to enroll in Medicare: the Special Enrollment Period (SEP) and the General Enrollment Period.

    The Special Enrollment Period applies if you didn’t enroll in Medicare when you were first eligible because you had coverage from a group health plan (such as a spouse’s current employer). In that case, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) at any time you’re still covered by the group health plan, or during the eight-month period beginning the month the employment ends or the plan coverage ends, whichever comes first.

    The Special Enrollment Period does not apply if you have COBRA, a retiree health plan, or individual health coverage.

    You can also sign up for Part A and Part B during the General Enrollment Period, which runs between January 1 and March 31 each year. Note that if you sign up during the General Enrollment Period instead of when you were first eligible, your coverage won’t start until July 1, and you may have to pay higher premiums.

  • How do I enroll in Medicare?

    Short Answer:

    You can enroll in Medicare by signing up with the Social Security Administration (SSA), either in person, on the SSA website, or by calling 800-772-1213.

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    There are three ways to enroll in Medicare, and completing your application typically takes between 10 and 30 minutes.

    1. Online:  https://www.ssa.gov/retireonline/
    2. Over the phone: 800-772-1213
    3. In person at your local Social Security office. Look up your office here.

    In some cases, you’ll be automatically enrolled and won’t have to contact Social Security. That exception applies if you are already receiving Social Security or Railroad Retirement Board (RRB) benefits, are receiving disability benefits, or have either end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

  • When can I enroll in Medicare Advantage?

    Short Answer:

    There are three main times you can enroll in Medicare Advantage (Part C), the same as with Original Medicare: You can sign up during your Initial Enrollment Period (a seven-month period beginning three months before your 65th birthday and ending three months after your birthday month); during a later eight-month Special Enrollment Period, if you're currently working and get health insurance from your job or other specific circumstances apply; or during Medicare's annual open enrollment period, which runs from October 15 to December 7.

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    Most people enroll in Medicare Advantage (Part C) when they first become eligible for Medicare, during their Initial Enrollment Period. This is a seven-month period covering the three months before the month of your 65th birthday, your birthday month itself, and the three months following your birthday month.

    Another popular time to enroll is during the Annual Election Period (AEP), which runs from October 15 to December 7 each year. If you already have Medicare Advantage, you can also switch plans during this period or elect to go with Original Medicare instead.

    If you do nothing during the Annual Election Period, your current health coverage under Medicare will be automatically renewed, as long as it continues to be available.

    If you (or your spouse) are still working and have delayed signing up for Medicare Part B because you still get health coverage from a current employer, you can sign up for a Medicare Advantage plan (or Original Medicare, for that matter), when you stop working and that health coverage ends during what's known as a Special Enrollment Period (SEP). The SEP lasts for two months after the month your work coverage ends.

    There are a few other circumstances when you can sign up for Medicare Advantage during a Special Enrollment Period. They are:

    • Your current plan is discontinuing coverage in your area, or you move out of the service area.
    • You have Original Medicare and Medicare SELECT (a type of Medigap policy a Medigap policy that limits your coverage to a specific network of hospitals and, in some cases, doctors), and you move out of the Medicare SELECT plan’s service area.
    • You dropped your Medicare Supplement (Medigap) plan for a Medicare Advantage plan for the first time, and you want to switch back within the first year of coverage.
    • Your insurance company goes bankrupt, or otherwise your coverage ends through no fault of your own.
    • Your insurance company hasn’t followed the rules, or has misled you.

    From December 8 to November 30 (the following year), you also have a one-time opportunity to enroll in a Medicare Advantage plan that is rated 5-stars by the Centers for Medicare & Medicaid Services (CMS). You may only use this SEP if there is a 5-star plan in your area.

    For a complete list of SEPs, check out the official U.S. Government site for Medicare here.

  • When can I enroll in a Medicare Supplement plan?

    Short Answer:

    You can buy a Medicare Supplement (Medigap) policy during your six-month Open Enrollment Period, which begins the first day of the month you're both 65 or older and enrolled in Medicare Part B (hospital insurance).

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    This means that if you turn 65 on May 4 but enroll in Part B on June 4, your Open Enrollment Period starts July 1. If you enroll in Medicare Part B before you turn 65, your Medicare Supplement Open Enrollment Period starts the first day of the month after your birth month, which in the example here would be June 1.

    Once your Medicare Supplement Open Enrollment Period ends, insurers are not legally obligated to sell you a Medicare Supplement plan. You can still buy a plan at any time, but you may be subject to medical underwriting, in which case you could end up paying a higher premium or having certain pre-existing conditions excluded from coverage. Some states, however, prohibit this practice.

    There are also a few other times outside of your Open Enrollment Period when you can enroll and be guaranteed coverage, including:

    • If you have group health insurance, such as the kind provided by an employer or union, and lose it through no fault of your own, you can sign up for a Medicare Supplement plan within 63 days of losing that coverage.
    • If you join a Medicare Advantage (Part C) plan for the first time, and decide to switch back to Original Medicare within your first year of coverage, you can enroll in Medicare Supplement plan at any time.
    • Some states have an open enrollment period for eligible residents who are not yet 65. Check with your state’s insurance department to see if you qualify for other enrollment periods.

     

  • What is the Medicare Annual Election Period?

    Short Answer:

    The Medicare Annual Election Period (AEP) runs from October 15 to December 7 each year. During this annual open enrollment window, you may change your Medicare Advantage plan (Part C) or Prescription Drug Plan (Part D) or sign up for one, and switch between a Medicare Advantage plan and Original Medicare (Parts A & B). 

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    You can also do nothing and stay with the Medicare set-up you already have, though your current plan's coverage rules and costs may be changing. Be sure to read your Annual Notice of Change (ANOC) document for what's new with your plan.

    Even if you're happy with your coverage, it’s worth comparing plans each year to ensure your coverage and costs fit your healthcare needs and your budget.

    You may make as many changes as you want during the AEP, but you will be enrolled in the last plan you signed up for prior to December 7.

    The plans you sign up for during the AEP become effective on January 1 of the following year.

     

  • What is the Initial Enrollment Period for Medicare?

    Short Answer:

    The Initial Enrollment Period (IEP) is the seven-month window when you are first eligible to sign up for Medicare. It spans the three months before the month of your 65th birthday, the month you turn 65, and the three months afterwards. For example, if you turn 65 on May 7, 2019, your IEP is February through August 2019.

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    Your coverage starts based on when you sign up, and it always begins on the first of the month.

    If you enroll...

    • Before you turn 65, coverage begins the month you turn 65
    • The month you turn 65, coverage begins the month after your birthday
    • The month after you turn 65, coverage begins three months after your birthday month
    • Two months after you turn 65, coverage begins five months after your birthday month
    • Three months after you turn 65, coverage begins six months after your birthday month

    Keep in mind that if you don't sign up for Medicare when you first become eligible, you may be hit with late-enrollment penalties when you do sign up later.

    If you're eligible for Medicare because you've been receiving disability benefits from Social Security or the Railroad Retirement Board (RRB), your IEP is the 22nd through 28th months of benefits.

    See the complete Social Security guide to Medicare here.

     

     

  • When is the General Enrollment Period for Medicare?

    Short Answer:

    The General Enrollment Period for Medicare runs from January 1 to March 31 each year.

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    If you missed your Initial Enrollment Period or your Special Enrollment Period, you can sign up for Medicare Part A and Part B during the General Enrollment Period, which runs from January 1 to March 31.

    When you sign up during the General Enrollment Period, your coverage won’t start until the following July 1, and you might face higher premiums due to a late enrollment penalty.

  • What is a Special Enrollment Period?

    Short Answer:

    A Special Enrollment Period (SEP) is a span of time when you can make changes to your Medicare coverage outside of the regular enrollment periods, such as your Initial Enrollment Period (IEP) and the Annual Enrollment Period (AEP).

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    When you sign up for a Medicare plan during a Special Enrollment Period (SEP), you usually don't pay a late enrollment penalty.

    If you didn't enroll in Medicare when you first became eligible because you were covered by a group health insurance plan through your or your spouse's job, a SEP allows you to sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) at any time you are still covered or within an eight-month window beginning the month the employment or group plan coverage ends, whichever comes first. This SEP does not apply if you have COBRA, a retiree health plan, or individual health coverage.

    You also have Special Enrollment Periods to make changes to your Medicare Advantage (Part C) plan and Prescription Drug Plan (Part D) if events negatively affect or cause you to lose insurance coverage.

    Typical changes that qualify you for an SEP include:

    • You lose coverage from an employer or union
    • You move outside of your plan's service area
    • You lose creditable drug coverage
    • Your plan changes its contract with Medicare
    • You qualify for Extra Help

    For a complete list of SEPs, click here.

  • What is the 5-Star Special Enrollment Period?

    Short Answer:

    You are allowed to switch into a Medicare Advantage plan (Part C) or a Medicare Prescription Drug Plan (Part D) that earns a 5-star rating any time between December 8 and November 30 of the following year.

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    Medicare awards 1- to 5-star ratings to Medicare Advantage and Prescription Drug Plans based on member satisfaction surveys and information from the plans and healthcare providers. The highest 5-star rating is considered excellent.

    You can switch into a 5-star Medicare Advantage Plan, Medicare Cost Plan, or Prescription Drug Plan (PDP) in your area outside of the Annual Enrollment Period (AEP) during all but one week of the year (December 1 to 7). Your coverage starts the first day of the following month.

    You can't keep switching, though. You can use only one 5-star Special Enrollment Period per year.

  • What’s the new Medicare Advantage Open Enrollment Period?

    Short Answer:

    Beginning January 1, 2019, a Medicare Advantage Open Enrollment Period (MA OEP) will run from January 1 to March 31 each year. This replaces the old Medicare Advantage Disenrollment Period, which ran from January 1 to February 14.

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    If you are already enrolled in a Medicare Advantage plan (Part C) on January 1, you can disenroll from your current plan and sign up for a different Advantage plan during the new Medicare Advantage Open Enrollment Period (MA OEP). You may do this only once.

    During this time, you can also drop your Medicare Advantage plan and return to Original Medicare (Parts A & B), at which point you could add a Medicare Supplement (Medigap) plan or Prescription Drug Plan (Part D).

  • Should I enroll in Medicare if I’m still working?

    Short Answer:

    It depends. If you have health insurance through your employer, you may want to delay enrolling in Medicare Part B (medical insurance). In most cases, Medicare Part A (hospital coverage) is free, and it makes sense to sign up for it when you first become eligible.

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    If your employer has fewer than 20 employees...

    If you have coverage through your job and your employer has fewer than 20 employees, you should sign up for both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) when you first become eligible. If you instead wait to enroll, you’ll likely have to pay a Part B late enrollment penalty.

    If your employer has 20 or more employees...

    If your employer has more than 20 employees and you have group health coverage, you likely won’t have to pay a late enrollment penalty if you delay taking Part A or Part B. You can enroll in premium-free Part A at any time, and your coverage will retroactively begin six months from when you apply. The exception is if you’re not eligible for premium-free Part A: In that case, you may have to pay a penalty if you choose to delay.

    If you are funding a Health Savings Account (HSA), which paired with a high-deductible health insurance plan lets you set aside pre-tax money for healthcare expenses, keep in mind that you cannot contribute to that HSA once you have either Medicare Part A or B. You should stop contributing to your HSA six months before you apply for Medicare. You can, however, still spend the money in the account.

    Once your employer health coverage ends, you’ll have eight months to sign up for Part B without paying a penalty. The eight-month period applies whether or not you continue your group coverage by signing up for COBRA, so don’t wait until your COBRA coverage ends to apply for Part B.

    If you apply for Medicare Part B after your employer coverage ends, you will have a 63-day Special Enrollment Period (SEP) to sign up for a Medicare Supplement (Medigap) plan, a Prescription Drug Plan (Part D), or a Medicare Advantage (Part C) plan.

  • Will I be enrolled in Original Medicare at age 65 automatically?

    Short Answer:

    You won't be automatically enrolled in Original Medicare (Parts A & B) unless you meet certain conditions. If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits and are turning 65, you’re under 65 and disabled, or you have amyotrophic lateral sclerosis (ALS), you’ll be enrolled in Original Medicare automatically. Otherwise, you must actively sign up.

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    If you are already receiving Social Security or RRB benefits, Medicare coverage will automatically begin the first day of the month in which you turn 65.

    Those who are under 65 and disabled will be enrolled automatically after receiving disability benefits for 24 months; for ALS patients, this waiting period doesn’t apply; their Medicare coverage begins the same month that disability benefits do.

    As an automatic enrollee you will receive your Medicare card in the mail three months before turning 65, or in the 25th month of disability benefits.

    If you aren’t automatically enrolled, you need to sign up for Medicare by contacting the Social Security Administration, either at their website or by calling 800-772-1213.

  • What is the late enrollment penalty for Medicare?

    Short Answer:

    A late enrollment penalty is an amount added to your premium when you enroll in Medicare after your Initial Enrollment Period has ended. If you’re eligible for a Special Enrollment Period, you can usually avoid a late enrollment penalty. The penalty varies depending on which part of of Medicare you failed to sigh up for.

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    Medicare Part A (hospital insurance):

    Part A is usually premium-free. If you aren't eligible for premium-free Part A and don't buy it when you first qualify, the late enrollment penalty will raise your premium by 10%. You’ll have to pay the higher rate for double the number of years you were eligible for Part A but didn’t sign up. So if you wait to get Part A until a year after you become eligible, you’ll pay a 10% higher premium for two years.

    Medicare Part B (medical insurance):

    You may be subject to a late enrollment penalty if you don’t sign up for Medicare Part B when you first become eligible, and you may continue to pay this penalty every month for as long as you have Part B. The penalty could raise your Part B premiums by 10% for every 12-month period during which you were eligible for Part B but didn’t enroll. For example, if you sign up 28 months after the end of your Initial Enrollment Period, your Part B premium will be 20% higher since two full 12-month periods have passed.

    Medicare Part D (prescription drugs):

    A Part D late enrollment penalty may apply if your Initial Enrollment Period ends and you don’t have Part D or any other creditable prescription drug coverage for 63 or more days in a row. Coverage is considered creditable if it is at least as good as the standard Medicare Prescription Drug Plan.

    The penalty for Part D is 1% of the “national base beneficiary premium,” or an estimated average of Part D monthly plan costs, multiplied by the number of months you delayed enrollment. This amount is rounded to the nearest $.10 and added to your premium. You’ll pay this penalty for as long as you’re enrolled in Part D, and it may go up as the national base beneficiary premium changes each year. The national base beneficiary premium is $35.02 in 2018 and $33.19 in 2019.

    You can avoid late enrollment penalties by signing up for Medicare during your Initial Enrollment Period when you first become eligible. Even if you don’t think you need a prescription drug plan (Part D), you may want to enroll to avoid paying higher premiums if you decide you need coverage in the future.

  • What is the late enrollment penalty for Medicare Part A?

    Short Answer:

    If you don't qualify for premium-free Part A (hospital insurance) and don't buy it when you are first eligible, you monthly premium may go up by 10% for twice the number of years you were eligible but didn't get Part A.

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    Medicare Part A (hospital insurance) is usually premium-free. If you aren't eligible for premium-free Part A and don't buy it when you first qualify, the late enrollment penalty will raise your premium by 10%.

    You’ll have to pay the higher rate for double the number of years you were eligible for Part A but didn’t sign up. So if you wait to get Part A until a year after you become eligible, you’ll pay a 10% higher premium for two years.

    If you’re eligible for a Special Enrollment Period (SEP), you usually won’t pay a late enrollment penalty.

  • What is the late enrollment penalty for Medicare Part B?

    Short Answer:

    If you don't enroll in Medicare Part B (medical insurance) when you are first eligible, you may pay a 10% higher monthly premium for each 12-month period you were eligible for Medicare Part B and delayed signing up. This penalty continues for as long as you have Part B.

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    You may be subject to a late enrollment penalty if you don’t sign up for Medicare Part B when you first become eligible, and you may continue to pay this penalty every month for as long as you have Part B. The penalty could raise your Part B premiums by 10% for every 12-month period during which you were eligible for Part B but didn’t enroll.

    For example, if you sign up 28 months after the end of your Initial Enrollment Period, your Part B premium will be 20% higher since two full 12-month periods have passed.

    Also, if you fail to enroll in Medicare Part B on time, you may have to wait until the General Enrollment Period to sign up for coverage.

    You usually won’t pay a late enrollment penalty, however, if you have health insurance coverage from an employer with 20 or more workers or if you’re eligible for a Special Enrollment Period (SEP).

     

  • What is the late enrollment penalty for Medicare Part D?

    Short Answer:

    A late enrollment penalty is an amount added to your premium when you enroll in Medicare after your Initial Enrollment Period (IEP) has ended. For a Prescription Drug Plan (Part D), the penalty is 1% of the national average plan premium for each full month you delay enrollment, and it applies for as long as you have a drug plan.

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    A Part D late enrollment penalty may apply if your Initial Enrollment Period ends and you don’t have Part D, another Medicare plan with drug coverage, or any other creditable prescription drug coverage for 63 or more days in a row. Coverage is considered creditable if it is at least as good as the standard Medicare Prescription Drug Plan.

    The penalty for Part D is 1% of the “national base beneficiary premium,” or an estimated average of Part D monthly plan costs, multiplied by the number of months you delayed enrollment. This amount is rounded to the nearest $.10 and added to your premium. You’ll pay this penalty for as long as you’re enrolled in Part D, and it may go up or down as the national base beneficiary premium changes each year. The national base beneficiary premium is $35.02 in 2018 and $33.19 in 2019.

    You can avoid a late enrollment penalty by signing up for Medicare during your Initial Enrollment Period when you first become eligible. Even if you don’t think you need a prescription drug plan (Part D), you may want to enroll to avoid paying higher premiums if you decide you need coverage in the future.

    If you’re eligible for a Special Enrollment Period (SEP), you usually won’t pay a late enrollment penalty. If you receive what’s called “Extra Help”—a program designed to assist people with limited incomes and resources with drug plan costs—you are typically exempt from paying the late enrollment penalty.