Home » When to apply for Medicare

When to apply for Medicare

Everyone needs medical insurance for a better and secure future and when to apply for Medicare is confusing for most people. Here you can get to know when you need to apply for it.

Most people get original Medicare hospital insurance and Medical insurance subscription automatically. Automatic subscription is given to those who take social security benefits or Railroad Retirement benefits. Some people might not get enrolled automatically so they need to get their subscription when they get eligible for that.

Eligibility criteria for Medicare

To get a subscription the eligibility criteria that one must fulfill are as follows:

  • You should be a citizen of the US or be a permanent legal resident of the US and be continuously living there for 5 years.
  • When you reach the retirement age you get eligible for entitlement.
  • If you are suffering from any fatal disease like renal failure or are having amyotrophic lateral sclerosis (ALS) you get eligible before reaching the age of retirement.

To enroll yourself in it there are specific deadlines in which you can get your subscription. These deadlines are as follows:

Initial Enrollment Period (IEP)

When you are about to subscribe to an insurance scheme it is necessary to have a better understanding of the specific program you are subscribing for. This is a good time to get your coverage or to change the coverage. The initial entitlement time for part A and part B is when you first get eligible for the insurance program. The IEP varies for different situations or circumstances going on in one’s life.

  • At the age of 65, the IEP is seven months. This time starts three months before your birth month, including the month you turn 65, and ends three months after your birthday month. Like if your birthday is in March the IEP will start on the 1st of December and will end on the 30th of June.
  • If you are taking social security advantage or Railroad Retirement benefits for 24 months, there is a seven-month time of IEP. This seven-month time span starts three months before the 25th month of disability aids and ends at the end of the 28th month of disability aids.
  • In case you are taking disability assistance from Social security or RRB because of amyotrophic lateral sclerosis (ALS), the Medicare coverage starts in the same month when your disability assistance starts.
  • In the case of end-stage renal disease, if you are having social security assistance or railroad retirement assistance or qualify for these aids because of your spouse or any other family member, the IEP starts on the day you get eligible for Medicare. This time lasts for three months.
  • When you get eligible for its subscription you can avoid late subscription penalties by subscribing for Medicare prescription drug coverage that could be stand-alone Medicare part D or Medicare advantage prescription drug program as soon as you get eligible for the insurance scheme.
  • You can also stay with your original Medicare program or can add up a Medicare supplement plan (Medigap plan). You should subscribe to the Medigap plan within six months after turning 65 because after these six months, the program might not accept you.

General Enrollment Period (GEP)

If you are not automatically enrolled in Original Medicare, you can subscribe during this GEP. This time starts from the 1st of January and ends on the 31st of March.

Late enrollment penalty: Applying during GEP

  • Some people qualify for premium-free hospital insurance. However, if you do not qualify for it, you can apply during IEP, whereas if you fail to subscribe during this time and subscribe in GEP, you will have to pay a late subscription penalty. Hospital assurance is premium-free for people who have worked, or their spouse has worked for 10 years (40 quarters) and has paid Medicare taxes.
  • The Late-enrollment penalty is also applied if you subscribe for part B during GEP instead of subscribing in IEP. The fine will be 10% of the monthly premium for part B which applies for each 12 month time after your eligibility.

Initial Coverage Election Period

Most people get eligible for Medicare advantage plan subscriptions during ICEP. If you have delayed your medical insurance subscription you can subscribe during this time which is just like the initial subscription time. This time starts three months before your Hospital assurance and Medical insurance subscription. It ends on the last day of the month in which you have Medicare hospital insurance and medical insurance enrollment or the last day of your Medical assurance initial entitlement time.

Annual Election Period

This is the time in which you can subscribe or change the insurance for part C i.e. Medicare benefits or Medicare prescription drug plans. This time starts on the 15th of October and ends on the 7th of December. If you subscribe for Medicare prescription drug coverage during AEP instead of subscribing in Initial subscription time then a fine for Medicare part D will be applied.

Medicare Supplement Open Enrollment Period

You can add Medicare Supplement (Medigap plan) to your original part A and part B. The standard time for this is six months starting from the day when you turn 65. If you fail to get yourself enrolled during this time then the scheme might not accept you after that.

Special Enrollment Period or Special Election Period

There are some special circumstances in which you can sign up for it during SEP. While talking about its part A and part B, the special entitlement implies on:

  • If you have health care insurance from your employer or your spouse’s employer in case of disability, then you can sign up for it anytime while you or your spouse is working.
  • If you are taking health care advantages from your employer, you have an eight-month time span to sign up for the scheme whenever your health program or employment ends.

These were the SEP examples specific to part A and part B. There is also some SEP to subscribe for Medicare advantage plan or Medicare prescription drug plan.

  • If you have moved to a new area which is not under your plan’s service.
  • If you were taking a long-term facility like hospital care or nursing and have recently moved from this service.
  • If Medicare has canceled your program’s contract and you have lost your insurance.

When to enroll if you are still working?

If you or your spouse have worked for straight 10 years (40 quarters) and have paid Medicare taxes, you automatically get enrolled for part A and part B. If you have health assistance from your or your spouse’s employer, you can get its subscription when your employment or your employer’s health insurance ends. During your health insurance from your employer, you can delay your subscription to the Medicare plan.

Can a subscription be postponed without paying a fine?

There are specific deadlines that need to be met to get a timely subscription for the Medicare insurance scheme. However, you can postpone the subscription without paying any fine as if you are taking health care advantages from your employer or your spouse’s employer you do not need to sign up immediately you get eligible for it. You just need to immediately enroll yourself in the Medicare program on the day your health care insurance coverage ends.

FAQs

Who is eligible to apply for Medicare?

Generally, people get eligible for Medicare when they reach their retirement age if they are taking social security advantages but there are also some exceptional cases for eligibility. If you do not get an automatic subscription then you need to sign up for Medicare part A and part B. You are eligible if you are at the age of 65 and are a permanent citizen of the US or have a legal resident of the US and living there for continuous 5 years. Younger people are also eligible in case of disability or any fatal disease like end-stage renal disease or amyotrophic lateral sclerosis (ALS). If you are suffering from these conditions you do not need to wait till the age of 65.

Who needs to apply for Medicare?

People are eligible need to apply to medicare. Eligibility also varies according to certain circumstances. Like people at the age of retirement should apply for Medicare coverage if they are not taking social security advantages and are not automatically enrolled in Original Medicare. If you are having any disability or amyotrophic lateral sclerosis (ALS) you can apply for Medicare. Additionally, people having end-stage renal failure and needing daily dialysis or kidney transplant should apply for it. If you are having health care benefits from your employer and these benefits are ending soon you should subscribe for Medicare on the day your employment or health care coverage ends.

When should I apply for Medicare?

You should apply for Medicare immediately after getting eligible for it. The standard age for Medicare subscription is 65 i.e. retirement age. You should apply for Medicare if you have no social security and no automatic subscription into part A and part B. You should apply for the Medicare insurance program when your employer’s health benefits end. There are specific deadlines in which you need to subscribe, otherwise, you will have to pay a fine for late-entitlement. The specific standards time for subscription are as follows:

  • Initial Enrollment Period
  • General Enrollment Time
  • Specific Enrollment Period
  • Annual Election Time
  • Specific Election Time
  • Medicare Supplement Open Enrollment Time

What is an Initial Enrollment Period (IEP)?

Initial entitlement time is the seven months available for a penalty-free subscription. This time starts three months before you turn 65, including your birth month, and ends three months after your birthday month. You can enroll, add or change your coverage during this time.

What is a General Enrollment Period?

Generally, you automatically get enrolled in the Medicare program if you have social security benefits, otherwise, you can subscribe during this GEP. This time starts from 1st of January and ends on 31st of March. If you do not enroll during IEP you will have to pay a penalty as well during GEP.

What are Late-enrollment Fees?

Late-enrollment fees apply when you do not subscribe to the scheme during the Initial subscription time. If you apply for Medicare part A and part B during GEP instead of the initial one you will have to pay a fine for that.

What is an Annual Election Period?

The AEP starts on the 15th of October and ends on the 7th of December. During this time you can sign up, change or remove the coverage of the Medicare advantage plan i.e. part C, or you can say Medicare prescription drug plan. In case you apply throughout AEP instead of IEP, you perhaps have to pay a late-enrollment penalty for part D.

What is a Medicare Supplement Open Enrollment Period?

If you want an addition of Medicare supplement i.e. Medigap plan, in your Medicare hospital insurance and medical insurance, then you can apply during Medicare supplement open subscription. This is the six months that start immediately after you turn 65 and get eligible for a part B subscription. You will not be able to enroll for the Medigap plan once this six-month time is missed out.

What is Special Enrollment or Election Periods?

The special election period applies to special circumstances in which you can subscribe for Medicare without paying a penalty. For Medicare part A and part B, if you or your spouse have health benefits from your employer, you do not need to apply for Medicare. You can subscribe to it anytime until you or your spouse is working. Moreover, you can start the Medicare subscription on the day when your employment or employer’s health care benefits end.

The special election period implies a Medicare beneficiary program or Medicare prescription drug program. The special circumstances in which you can subscribe during this time include you losing your coverage. If you are moving away from the program’s coverage area or are moving away from the hospital facility, then you can subscribe during SEP.