Turning 65 can bring a lot of mail, decisions, and questions about Medicare. One of the biggest questions is simple: How do I actually enroll in Medicare?
For some people, Medicare enrollment happens automatically. For others, it requires an application through Social Security. Knowing which situation applies to you can help you avoid a gap in coverage or a late enrollment penalty.
This guide explains the basic Medicare enrollment steps, what to expect, and which decisions you may need to make before your coverage starts.
Is Medicare enrollment automatic?
Medicare enrollment is often automatic if you are already receiving Social Security retirement benefits when you turn 65. It may also be automatic if you have been receiving certain Social Security disability benefits for the required period.
If you are automatically enrolled, you will generally receive your Medicare card in the mail before your coverage begins. Most people in this situation are enrolled in both Medicare Part A and Part B.
Part A is hospital insurance. It may help cover inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice care, and some home health services.
Part B is medical insurance. It may help cover doctor visits, outpatient care, lab work, preventive services, medical equipment, and other medically necessary services.
If you are not receiving Social Security benefits yet, Medicare may not enroll you automatically. You will likely need to sign up yourself.
Who needs to sign up for Medicare?
You may need to actively enroll in Medicare if you are nearing age 65 and have not started Social Security retirement benefits. This is common for people who plan to wait until a later age to claim Social Security.
You may also need to make your own enrollment decision if you are still working and have health coverage through an employer. Whether you should enroll in Part A, Part B, or both can depend on the size of the employer and the type of coverage you have.
For example, people with health coverage through a large employer may be able to delay Part B without a penalty. That is not always true for people covered by a small employer, COBRA, retiree coverage, or an individual health plan. It is important to confirm how your current coverage works with Medicare before you delay enrollment.
When can you sign up for Medicare?
Your first chance to enroll is usually called your Initial Enrollment Period. This is a seven-month window around your 65th birthday month.
- It begins three months before the month you turn 65.
- It includes your birthday month.
- It continues for three months after your birthday month.
Enrolling before your birthday month may help your Medicare coverage start sooner. For many people, Part A and Part B can begin on the first day of their birthday month. If your birthday falls on the first day of a month, coverage may generally begin the month before.
If you wait until later in your enrollment window, your coverage start date may be delayed. That can be especially important if you are losing employer coverage or another health plan.
How do you apply for Medicare?
Most people apply for Medicare through Social Security, not directly through Medicare. You can generally apply online, by phone, or through a local Social Security office.
Applying online may be the most convenient option for many people. The application can allow you to enroll in Part A and Part B, or in Part A only if that fits your situation.
Before applying, it may help to have basic information ready, such as:
- Your Social Security number
- Your date and place of birth
- Information about your current health coverage
- Your preferred Medicare start date, if you are eligible to choose one
- Details about your work history or spouse’s work history, if requested
After your application is processed, you should receive your Medicare number and Medicare card. Keep your card in a safe place. You will use that number when you join other Medicare coverage, such as a prescription drug plan or Medicare Supplement plan.
Should you enroll in Part A and Part B?
Many people enroll in both Part A and Part B when they first become eligible. However, the right choice can depend on your work status and current insurance.
Part A is often premium-free for people who have worked and paid Medicare taxes for enough years. Still, enrolling in Part A may not be the best choice for everyone. If you contribute to a Health Savings Account, also called an HSA, enrolling in any part of Medicare can affect your ability to keep making HSA contributions.
Part B has a monthly premium for most people. If you are actively working and covered by a qualifying employer group health plan, you may be able to delay Part B. Before doing that, consider asking your employer benefits office whether the group plan pays first or second after you become eligible for Medicare.
COBRA and retiree health plans work differently than active employer coverage. They may not protect you from a Part B late enrollment penalty or a gap in coverage. It is wise to check carefully before relying on either one.
What choices come after you enroll in Original Medicare?
Once you have Part A and Part B, you may have additional decisions to make. Original Medicare does not cover every health care expense. It can include deductibles, coinsurance, and other out-of-pocket costs.
Some people choose a Medicare Supplement insurance plan, also known as Medigap, to help pay certain out-of-pocket costs left by Original Medicare. Medicare Supplement plans generally let you see any doctor or hospital that accepts Medicare, although benefits and premiums can vary by plan, carrier, and state.
You may also consider a Medicare Advantage plan, which is another way to receive Medicare benefits through a private insurance company. These plans may include extra benefits, but they can have provider networks and plan rules that differ from Original Medicare.
Most people also need Medicare Part D prescription drug coverage. Even if you do not take medications now, consider whether enrolling in a Part D plan makes sense. Waiting without other creditable prescription coverage may lead to a late enrollment penalty later.
What happens if you miss your enrollment window?
If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you may have to wait for another enrollment opportunity. You could also face a late enrollment penalty for Part B or Part D, depending on your situation.
A Special Enrollment Period may be available if you delayed Part B because you had qualifying coverage through active employment. The rules and deadlines matter, so it is usually best not to wait until after your coverage ends to explore your options.
Medicare enrollment can feel complicated, but it becomes much easier when you take it one step at a time. If you would like free, no-pressure help reviewing your Medicare enrollment choices and Medicare Supplement options, reach out to Eric. With 25 years of experience, he can help you understand the options available in your state.