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When to Apply for Medicare

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When to Apply for Medicare

Most beneficiaries are still confused on when to apply for Medicare. Here are some of the frequently asked questions and the answers on when and how to apply for Medicare.

Who needs to apply for Medicare?

Aside from the Original Medicare Part A and B, there are other different options about the type of Medicare coverage you get.

You must be either a U.S. citizen or a legal permanent resident of at least five continuous years for you to apply to Medicare. If you’re 65 and receiving Social Security or Railroad Retirement Board (RRB) benefits, you’ll be automatically enrolled in Medicare.

    You qualify for automatic enrollment as well, if:

  • You’re under 65
  • You have been a beneficiary of disability benefits from Social Security
  • or You have been getting disability benefits from the RRB for two years,
  • You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease)

Initial Enrollment Period (IEP)

You might want to think about the type of coverage you’d like to get because it is best to change or add something to your Medicare coverage during the Initial Enrollment Period. The IEP for Original Medicare, Part A and B is where you become first eligible for this coverage and which also means you can still make changes to your Medicare plan options.

    How to know when your IEP will start?

  • If you’re turning 65, your IEP will start three months before your birth month and ends three months after your birth month. So, if your birthday is in March then your IEP will start December 1 until June which means your IEP will last for seven months.
  • If you’ve been receiving disability benefits from Social Security or the RRB, your IEP will also last for seven months which will start three months before the 25th month until the end of your 28th month of your disability benefits.
  • If you are receiving disability benefits from Social Security or RRB because you have ALS (Lou Gehrig’s disease), the coverage starts the same month you started collecting your disability benefits.
  • If you have ESRD or End-Stage Renal Disease and you’re receiving benefits from Social Security or RRB, or if you are a beneficiary of a family member who is eligible for the same benefits. Your IEP will start as soon as you’re eligible for medicare which lasts for three months.

If you sign up for Medicare drug prescription coverage whether through a Part D Prescription Drug Plan or Medicare Advantage Prescription Drug Plan, you can avoid late-enrollment fees by enrolling in this coverage as soon as you are eligible for Medicare.

The Medigap plan must accept you If you sign up for Medigap during the 6-month period after you turn 65 or older and enrolled in Part B if you stay with the Original Medicare and add Medicare supplement, the Medigap should include you. You may not be included if you don’t buy a Medigap Plan at this moment.

General Enrollment Period

Every January 1 to March 31 is the Original Medicare’s General Enrollment Period (GEP). If you are not enrolled automatically, you can now be listed for Medicare Part A or Medicare Part B

Late-enrollment fees

    You could pay late-enrollment fees:

  1. If you don’t qualify for premium-free Medicare Part A and signed up during the GEP instead of during your IEP. If you have been working for a minimum of 10 years or 40 quarters and regularly paying Medicare taxes, typically, Part A coverage is premium-free.
  2. If you are listed for Medicare Part B during the GEP instead of during your IEP, the penalty is usually 10% of your Part B premium for each 12-month period during which you qualified for Part B but didn’t include it.

But if you qualify for a Special Enrollment Period (SEP) for Medicare Part A or Part B, you might not have to pay a late-enrollment penalty; see Special Enrollment Periods.

Annual Election Period

The Annual Election Period (AEP) which happens within every October 15th to December 7th, is a time period when you can add, drop, or exchange Medicare Advantage (Medicare Part C) plans and Medicare Prescription Drug Plans.

You may have to pay a Medicare Part D late-enrollment penalty, if you want Medicare prescription drug coverage, and you sign up during the AEP instead of during your IEP.

Medicare Supplement Open Enrollment Period

If you want to add a Medigap Plan to your Original Medicare coverage, your six-month Open Enrollment Period starts the month that you turn 65 and are enrolled in Medicare Part B. If you don’t sign up at this time, there is no guarantee that you will be accepted.

Special Enrollment or Election Periods (SEPs)

There are cases that might qualify you to be listed for Medicare during a Special Election Period (SEP).

    Below are the examples but not limited to for Original Medicare:

  • You are under an employer’s or union’s group health plan (yours, your spouse’s, or a family member’s if you are disabled). As long as you (or your spouse, or family member if you’re disabled) is working, you can be listed for Original Medicare (Part A and Part B) anytime.
  • You are under an employer’s or union’s group health plan ends. Starting the month after the employment ends, or the employment-based health plan insurance ends, you have eight months to be listed for Medicare,
    We have other Special Election Periods for some Medicare plans, such as Medicare Advantage plans and Medicare Prescription Drug Plans. Examples are listed below but are not limited to for Medicare Advantage and Medicare Prescription Drug Plans include:

  • Transferring to a new place where Medicare does not operate.
  • Transferring to, living in, or moving out of a facility (e.g. long-term care hospital or skilled nursing facility)
  • If you are not covered for anything, Medicare cancels your plans.

Qualified age to apply for Medicare

If you don’t qualify for the automatic enrollment, or you have a qualifying disability then you can enroll three months before you turn 65. For more information regarding Medicare eligibility and enrollment please contact the Social Security Administration on their website https://www.ssa.gov/benefits/medicare/ or over the phone, at 1-800-772-1213 (TTY users can call 1-800-325-0778) from 7AM to 7PM Monday-Friday. You can also visit a local Social Security Office in person.

Is rescheduling or delaying Medicare enrollment will be subjected to penalty?

You are allowed to postpone Medicare enrollment without penalty while you are covered under an employer’s or union’s health insurance plan, or your spouse’s plan after you’ve turned 65. But you must be listed in Medicare as soon as your employer’s insurance coverage ends.