Medicare Insurance Enrollment

Medicare insurance is available to you beginning the year you turn 65. It is also available to individuals who meet certain eligibility requirements, such as being diagnosed with End-Stage Renal Disease (ESRD), amytrophic lateral sclerosis (ALS), or anyone with a disability that qualifies them for federal health insurance benefits. There are several enrollment periods that occur when you become eligible for Medicare, beginning with your Initial Enrollment Period. These enrollment periods affect how and when you access Medicare benefits.

Medicare Enrollment Requirements

You may enroll in Medicare if you are age 65 or older and either an American citizen or a permanent, legal resident who has lived in the United States for at least five years. You may also enroll in Medicare if you under the age of 65 and meet at least one of the following special conditions:

  • You are entitled to Social Security Disability Insurance benefits for at least 24 months (you need not be qualified for 24 months in a row or have received those benefits in order to qualify for Medicare).
  • You receive a disability pension benefit from the Railroad Retirement Benefit Board.
  • You currently suffer from amyotrophic lateral sclerosis (aka Lou Gehrig’s disease).
  • You have kidney failure that requires regular dialysis (or a kidney transplant), often referred to as End-Stage Renal Disease (ESRD).

Any of these triggers will make you eligible to apply for or receive Medicare. The two initial parts of Medicare that you qualify for are Part A hospital insurance, which pays for expenses associated with hospitalization, and Part B medical insurance, which covers expenses associated with physician services, preventive care, and medical supplies on an outpatient basis.

Medicare Parts A and B are referred to collectively as Original Medicare. You may also sign up for Medicare Part D, otherwise known as the Medicare Prescription Drug Plan. In addition, you may choose Medicare Advantage (Medicare Part C) instead of Original Medicare. Medicare Supplement Insurance, commonly referred to as Medigap, helps pay for costs not covered by Original Medicare.

Medicare Initial Enrollment Period

Your Initial Enrollment Period (IEP) begins three months before your 65th birthday and ends three months after your birth month. For example, if your birthday is July 10, your IEP begins on April 1 and ends on October 31. During this period, you can enroll in Medicare Part A, which does not charge a premium (assuming you or your spouse paid Medicare taxes for at least 10 years during your working lifetime). You may also sign up for Part B and D or choose a Medicare Advantage Plan. If you sign up for Original Medicare, you may also enroll in a Medigap plan.  Costs for Parts B, C, and D, as well as Medigap, vary according to the plan you choose and your income.

If you fail to enroll during your Initial Enrollment Period, you will have to pay a penalty unless you qualify for Special Circumstances. Typically, this means having coverage through an employer (or your spouse’s employer) when it’s a matter of missing your IEP, as most Special Circumstances apply to making changes to current Medicare coverage. If you miss your IEP and do not qualify for a Special Circumstance, you must wait for the General Enrollment Period (GEP), which occurs every year from January 1 through March 31. When you wait to enroll during the GEP, your Medicare coverage does not begin until July 1.

The late penalty for failing to sign up for Part A upon becoming eligible depends on whether you qualify for premium-free Part A. If you have a Part A premium, you will pay a 10 percent penalty for twice the number of years you delayed enrollment. For example, if you became eligible in February 2017 but did not enroll until April 2018, you will pay a 10 percent penalty for two years. However, if you waited less than one full year, you pay zero penalty.

The late penalty for failing to sign up for Part B is 10 percent for every 12-month period you delayed enrollment. That means 10 percent for one year, 20 percent for two years, etc. You pay this penalty for the entire time you have Part B.

Medicare Enrollment Application

Upon turning 65, if you already receive retirement benefits from Social Security or the Railroad Retirement Board (and have for at least four months), receive Social Security and have a disability, or suffer from ALS, you automatically receive Original Medicare without having to apply. Everyone else needs to apply. You also need to apply for Medicare Part D, as well as Medigap or Medicare Advantage if you choose one of these plans.

  • If you are not receiving benefits from either Social Security or the RRB for at least four months before your 65th birthday, you need to apply for Medicare via Social Security. You may also apply in person at your local Social Security office or call 800-772-1213 (TTY 800-325-0778).
  • If you already have Medicare Part A, you can complete your Application for Enrollment in Medicare Part B and return it to your local Social Security Office. The form is available in English and Spanish.
  • If you wish to enroll in a Medicare Advantage Plan, Medigap insurance, or Medicare Part D, you must first enroll in Original Medicare.

You may wish to seek expert assistance to guide you through the application process and answer any questions you have about Medicare. This includes helping you understand how Original Medicare, Part D, and Medicare Advantage Plans work together, and when or if you should apply for Medigap.

Medicare Solutions, operated by HealthPlanOne, LLC, is a provider of solutions to help meet your Medicare needs. Whether you need Medicare Advantage, Medigap, a Medicare Prescription Drug Plan, or assistance with managing your Original Medicare enrollment, Medicare Solutions provides you with the information you need to choose the options that meet your health insurance needs.