Many people assume Medicare begins automatically when they turn 65. That is true for some people, but not everyone. Whether you are enrolled automatically often depends on whether you are already receiving Social Security or Railroad Retirement Board benefits.
Understanding this before your 65th birthday may help you avoid a gap in coverage, late enrollment penalties, or a delay in getting your Medicare card. The key is knowing whether Medicare will contact you or whether you need to take action yourself.
Who is automatically enrolled in Medicare?
You will generally be enrolled automatically in Medicare Part A and Part B if you are already receiving Social Security retirement benefits at least four months before you turn 65. The same may apply if you receive certain Railroad Retirement Board benefits.
Medicare Part A helps cover inpatient hospital care, skilled nursing facility care in qualifying situations, hospice care, and some home health services. Medicare Part B helps cover doctor visits, outpatient care, preventive services, medical equipment, and other medically necessary care.
If automatic enrollment applies to you, your Medicare card will usually arrive in the mail before your coverage begins. For most people who qualify because of age, Medicare coverage begins on the first day of the month they turn 65.
If your birthday falls on the first day of a month, your coverage may begin on the first day of the month before your birthday. For example, a person born on June 1 may generally have Medicare start on May 1.
What if you are not receiving Social Security yet?
If you are not receiving Social Security benefits before age 65, you will usually not be enrolled in Medicare automatically. This is common for people who plan to keep working, have chosen to delay Social Security, or are covered through a spouse's job.
In that case, you may need to sign up for Medicare through Social Security. You can generally apply online, by phone, or through a local Social Security office. Social Security handles Medicare enrollment even though Medicare is a separate federal health insurance program.
You do not have to start Social Security retirement benefits just because you are enrolling in Medicare. These are separate decisions. Many people choose Medicare at 65 but wait until later to claim Social Security.
Do you need both Medicare Part A and Part B?
Not always. Whether you should enroll in both parts may depend on your work situation and the health coverage you already have.
Many people qualify for premium-free Part A based on their work history or a spouse's work history. Even when Part A has no monthly premium, there can be an important reason to look carefully before enrolling: Medicare enrollment may affect your ability to contribute to a health savings account, also called an HSA.
Part B has a monthly premium for most people. If you are still working and have health coverage through an employer, you may be able to delay Part B without a penalty. However, this usually depends on the size of the employer and the type of coverage you have.
Coverage from a current employer with 20 or more employees can often allow a person to delay Part B. Rules can be different for smaller employers, COBRA coverage, retiree coverage, and Marketplace coverage. It is wise to confirm how your group health plan works with Medicare before you turn 65.
Can you decline Part B if Medicare enrolls you automatically?
Yes, in many cases you can decline Part B if you are automatically enrolled but do not need it yet. Your Medicare card and enrollment materials may include instructions for refusing Part B coverage.
Do not simply ignore the card or paperwork. If you want to delay Part B, follow the instructions carefully and keep records of what you send. You may also want to speak with your employer benefits department to make sure delaying Part B is appropriate for your situation.
Declining Part B can make sense for some people with qualifying employer coverage. But delaying Part B without qualifying coverage may lead to a late enrollment penalty and a period without outpatient coverage. The Part B penalty can continue for as long as you have Part B, so this decision deserves careful attention.
When should you expect your Medicare card?
If you are enrolled automatically, you may receive your red, white, and blue Medicare card about three months before your coverage starts. Your card shows your Medicare number and the effective dates for Part A and Part B.
If you sign up yourself, your card may arrive after your application is processed. It is a good idea to keep your card in a safe place and avoid sharing your Medicare number except with health care providers, plans, or trusted organizations that need it for Medicare-related business.
Medicare may send important notices by mail, so make sure Social Security has your correct address. You can also create a secure online Medicare account to view coverage information and manage certain Medicare details.
What happens after you enroll in Original Medicare?
After you have Medicare Part A and Part B, you may have other choices to consider. Original Medicare does not usually include routine prescription drug coverage, so many people consider a standalone Medicare Part D prescription drug plan.
You can also choose how to help with costs that Original Medicare does not pay. Some people choose a Medicare Advantage plan, which is another way to receive Medicare-covered benefits through a private insurance company. Others keep Original Medicare and consider a Medicare Supplement insurance policy, also called Medigap, which may help pay certain out-of-pocket costs left by Original Medicare.
Medicare Advantage and Medicare Supplement plans work differently. Benefits, provider rules, premiums, and availability can vary by plan, carrier, and state. Your enrollment timing can matter, especially if you are considering a Medicare Supplement policy.
What is the best next step before age 65?
About six months before you turn 65, check whether you are already receiving Social Security. Then review any employer or spouse's employer coverage you have. Ask the benefits department whether the coverage is based on active employment and whether it remains primary after you become eligible for Medicare.
- Confirm whether Medicare enrollment will be automatic.
- Check the start date for your current health coverage.
- Find out whether you can safely delay Part B.
- Review whether you are contributing to an HSA.
- Consider prescription drug coverage and how you want to manage Medicare out-of-pocket costs.
Medicare timing can feel confusing, especially when work coverage, Social Security, and prescription drug coverage are involved. Eric can help you understand your Medicare Supplement options and timing in your area with free, no-pressure guidance.