When Should You Enroll in Medicare? Don’t Miss These Medicare Enrollment Windows

More than 65 million Americans get their health insurance through Medicare, but confusion surrounding when and how to enroll is common. Since late enrollment in Medicare may result in expensive penalties and coverage gaps, it’s important not to miss your Medicare enrollment window.

Who Can Enroll in Medicare?

Medicare is available to people who meet one of two criteria:

• People aged 65 and above are eligible for Medicare. If you have been receiving Social Security benefits for at least four months before you turn 65, you’ll be enrolled in Medicare automatically. You should receive a welcome package three months before your coverage starts. If you’re not receiving Social Security benefits, you’ll need to contact Social Security to sign up for Medicare.
• Health status. People with a disability, end-stage renal disease, or ALS/Lou Gehrig’s disease may be eligible for Medicare regardless of their age. If you are receiving Social Security disability benefits, you will automatically receive Medicare coverage after 24 months. If you have ALS, you’ll receive Medicare as soon as you start receiving Social Security benefits.

The Initial Enrollment Period for Medicare

If you want your Medicare coverage to start as soon as you turn 65 but you won’t be enrolled automatically, you need to enroll during your Initial Enrollment Period. This is a seven-month period that covers the three months before you turn 65, your birthday month, and the three months after you turn 65.

• If you want coverage to start during your birthday month, sign up over the three months leading up to your birthday month.
• If you sign up during your birthday month or the three following months, coverage will start the next month.
• If your birthday is on the first of the month, your initial enrollment period is a little different. It covers the four months before you turn 65, your birthday month, and the two months after your birthday month. Coverage can start as early as the first day of the month before you turn 65.
• Coverage always starts on the first of the month.

Timely enrollment is critical! If you miss your Initial Enrollment Period, you will have to wait to enroll, which may lead to coverage gaps. You may also face a lifetime late enrollment penalty that increases the premiums you pay.

Delaying Enrollment in Medicare

If you have group health insurance through your job or your spouse’s job, you may want to delay enrollment in Medicare. The good news is it is possible to delay enrollment in Medicare without facing a late enrollment penalty provided you have qualifying group coverage.

The bad news is the rules are complicated. If you make a mistake, you may face those expensive lifetime late enrollment penalties.

• Certain types of coverage, including COBRA coverage, may not qualify you for penalty-free late enrollment.
• If you qualify for penalty-free late enrollment, you can choose to sign up for Medicare Part A (because you don’t have to pay for this) but delay enrollment in Medicare Part B (which requires a monthly premium). However, enrolling in Medicare Part A will mean you can no longer contribute to an HSA.
• You can delay enrollment in Medicare Part D prescription coverage without a penalty if your job-based benefits are at least as good as Medicare benefits. However, Kiplinger warns that recent changes to Medicare prescription costs mean some plans that used to qualify may no longer do.

If you delay enrollment in Medicare because you have qualifying group coverage, you will receive an eight-month Special Enrollment Period to sign up for Medicare when you stop working or lose job-based insurance.

Medigap Open Enrollment

If you want to stay in Original Medicare, you can buy a Medicare Supplement Insurance plan (also known as a Medigap plan) to control your out-of-pocket costs and make your expenses more predictable.

You will have a six-month Medigap Open Enrollment Period that starts the first month you have Medicare Part B and are aged 65 or above. If you enroll in a plan during this time, your application will not be subject to medical underwriting. If you try to enroll later, your application could be denied or you may be charged more.

You cannot enroll in both Medicare Advantage and Medigap.

Switching Plans: AEP and MA-OEP

Medicare Advantage and Medicare Prescription D plans are offered by private insurance companies. Most Medicare enrollees have access to multiple plans, which may change every year. Your needs may also change. As a result, the plan you picked when you turned 65 may be unsuitable in future years. The good news is you have the option of changing your plan each year. Even if you’re happy with your plan, you should take advantage of this opportunity to see if a better plan has become available.

• The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can switch Medicare Advantage or Medicare Part D plans. If you have Original Medicare, you can switch to Medicare Advantage. Your new plan will start on January 1.
• The Medicare Advantage Open Enrollment Period (MA-OEP) runs from January 1 to March 31 each year. If you have Medicare Advantage and are unhappy with your plan, you can switch plans or return to Original Medicare during MA-OEP.

You may also qualify for Special Enrollment Periods based on your unique circumstances – for example, if you move.

Do You Need Help Navigating Medicare Enrollment?

In addition to knowing when to sign up for Medicare, you need to decide which plans to enroll in. You can stay in Original Medicare and pick a Medicare Part D plan to provide prescription coverage, add a Medicare Supplement plan to control out-of-pocket costs, or enroll in a Medicare Advantage plan that takes care of all your health insurance needs. Confused? Don’t worry. An insurance agent can help you navigate your Medicare enrollment. Contact Heffernan Insurance Brokers.