How to Enroll in Medicare

When

The general enrollment age for Medicare is 65, though that doesn’t mean you have to sign up for it the day of your 65th birthday. You have a 7 month window for your Initial Enrollment Period, starting 3 months before the month of your 65th birthday and ending 3 months after that, during which you may sign up for Medicare and avoid any penalties for late enrollment.

Another crucial factor in deciding when you should enroll is your employment status, as well as your spouse’s, if you’re married. After all, you may already have health insurance and don’t need Medicare. You’re entitled to a Special Enrollment Period if you have employer health coverage and your employer has 20 employees or more. This special enrollment period lasts 8 months from when your group health coverage ends or your employment ends—whichever comes first. If you sign up for Medicare during a special enrollment period, your coverage will begin the first of the month after you enroll.

Even if you’re covered by your employer’s insurance, you might want to sign up for Medicare Part A anyway since there’s generally no cost for Part A, and it could serve as secondary insurance, or else provide extra coverage.

You will not qualify for a Special Enroll Period if:

you’re paying for COBRA (which extends your employer health coverage);
you’re paying for private health insurance (that didn’t come from an employer);
your employer-provided group health plan covers less than 20 employees; or
you’re receiving retiree health benefits from an employer but you’re not actively employed (or your spouse isn’t actively employed).

If any of those situations apply to you, sign up for Medicare within the regular 7 month enrollment period to avoid the late penalties.

If you don’t sign up for Medicare during your initial enrollment period, you’ll have to wait for Medicare’s Open Enrollment Period, which is open from January 1st–March 31st every year. Your coverage will begin the month after you sign up when you enroll during this period.

How

After determining eligibility, you must determine how you’ll enroll in Medicare. There are 2 ways: auto-enrollment and self-enrollment.

You will automatically be enrolled in Medicare the first day of the month you turn 65 if you’re already receiving Social Security benefits like:

retirement benefits,
widow(er) benefits, or
spousal benefits.

You will need to self-enroll if you’re not receiving Social Security benefits. During the 7 month initial enrollment period, you can choose to enroll in both Medicare Part A and Part B. The process of signing up for Medicare takes 30 minutes or less when you apply online.

If you sign up for Medicare before the month you turn 65, your coverage begins the month you turn 65.
If you sign up during the month you turn 65 or afterward, your coverage begins the month after you enroll.

Once you receive your Medicare card, you’ll carry it with you like your previous insurance card, unless you purchase a Medicare Advantage plan, in which case, your Medicare Advantage card will be what you show your healthcare providers. You’ll find your Medicare number on the front of the card below your name. It is made up of 4 letters and 5 numbers, and always begins and ends with a number.

Medicare & Other Insurance

If you or your spouse work for a company with less than 20 employees, you must enroll since those insurance plans move to the second payor position once you’re Medicare-eligible. If the company has 20 or more employees, you can delay enrolling since that insurance will be considered creditable coverage, allowing you a special enrollment period. However, your employer insurance plan will stay as the first payor if you choose to sign up for Medicare. Here, the decision on whether or not to enroll should depend upon a cost-benefit analysis between your employer’s plan and any potential Medicare plan.

COBRA

You need to start Medicare at age 65 if you have a COBRA plan. It provides coverage, but it’s costly and ill-suited for the long-term, since COBRA moves to the second payor position once you become Medicare-eligible, which means that you’ll be the first payor unless you enroll in Medicare. Because COBRA isn’t considered creditable coverage by Medicare standards, failing to enroll in time may result in lifelong penalties and delayed enrollment.

TRICARE

TRICARE also assumes the secondary payor role once you reach Medicare eligibility, so any military personnel with TRICARE will have to enroll in Medicare at age 65. This obligation extends to eligible members of the military family as well.

ACA

Given the fact that you can’t receive subsidies from 2 separate government programs, it’s logical to transition to Medicare, where you won’t have to bear the brunt of paying the full premiums and all out-of-pocket costs.

Enrollment Periods

Initial Enrollment Period:

3 months before birth month–3 months after birth month
1st time you’re eligible to enroll in Medicare
Can enroll in all parts of Medicare
Best time to enroll in a Medigap/supplemental plan without medical underwriting and enroll in Medicare Part B without penalty

Special Enrollment Period:

Special enrollment period that allows you to enroll in Medicare outside your Initial Enrollment Period (IEP)
Length varies depending on situation; can range between 2–8 months
Can enroll in all parts of Medicare
Can change Medicare Advantage plan

General Enrollment Period:

Similar to the open enrollment period on a standard market plan
January 1–March 31 every year
Can enroll in Part A and B if you missed your IEP or didn’t qualify for a SEP
You may be subject to a lifelong penalty on your Part B premium if you sign up during this time

Annual Enrollment Period:

October 15–midnight, December 7.
Can change your Medicare Advantage and Prescription Drug Plans; any plan changes made during this period takes effect on January 1

Late Enrollment Penalties

You do not want to sign up for Medicare late. You will incur penalties, and they will not go away.

There is a 10% penalty on your Part B premiums for each 12-month period in which you were eligible for coverage but didn’t enroll. This 10% surcharge will be added to the cost of your monthly premiums for life.

What to Consider When Choosing or Changing Coverage

Coverage: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

Your Other Coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or give us a call before making any changes.

Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

Doctor & Hospital Choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?

Prescription Drugs: Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?

Quality of Care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?

Convenience: Where are the doctor's offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail? Do the doctors use electronic health records (EHRs) or E-prescribe? Can you get an electronic copy of your information by email or to store in a personal health record? Which pharmacies can you use? Is the pharmacy you use in the plan’s network? If it’s in the network and your plan offers preferred cost sharing, does your pharmacy offer preferred cost sharing? You may pay less for some drugs at pharmacies that offer preferred cost sharing. Can you get your prescriptions by mail?

Travel: Will the plan cover you if you travel to another state or outside the U.S? Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.