Each day, more and more Americans are reaching the age at which they qualify for Medicare enrollment. Since its inception in 1965, Medicare has helped millions of older Americans live full and healthy lives. It’s been reported that as of March 2023, 65,748,297 people in the United States are currently enrolled. Some of these people may even be your own friends and family.
As high as those numbers are, Medicare still remains perplexing to millions of Americans. It’s important to remember that if you are one of those confused about Medicare, that is totally understandable! Questions about enrollment dates and how to enroll can seem complicated, confusing, and even scary. After all, you will have Medicare for the rest of your life. Whether you are handling this situation on your own or trying to handle Medicare enrollment on behalf of a loved one, it can be mentally taxing. Do you sign up for Original Medicare (which consists of Medicare Part A and Part B) like 33,948,778 Americans? Or should you be one of the 51,591,776 million people who signed up for Medicare Part D?
Knowing when Medicare starts and what your options are is essential in ensuring you don’t experience gaps in coverage or penalties. But not to worry! In this blog, we’ll take a comprehensive look at when Medicare starts so you will be fully prepared.
Medicare for Those Turning 65 and Already Receiving Social Security Benefits
The first thing to look at is Automatic Enrollment, which isn’t as cut and dry as it sounds. We’ll also discuss when exactly your Medicare coverage would start and what to consider for those of you who are already receiving Social Security Benefits while signing up for Medicare.
Some information on Enrollment:
One of the significant benefits of Medicare is that if you meet a few conditions, you are automatically enrolled in Original Medicare when you turn sixty-five! There are no documents or websites to fuss with. Instead, you’ll receive a packet in the mail a few months before the big birthday. To qualify for Original Medicare, which consists of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), all you have to do is have had Social Security Disability Insurance (SSDI) or Railroad Retirement Benefits (RRB) for at least 24 months prior to your sixty-fifth birthday, and live in the United States or any U.S. territory with the exception of Puerto Rico. During the initial enrollment period, you can decide if you want Parts A and B or if you would prefer to keep Part A alone.
When Does Coverage Start?
Even with the benefit of Automatic Enrollment, you may still be confused about when your coverage starts. Thankfully, there is good news there too, as technically, you don’t actually have to wait until you turn sixty-five for a few reasons. The first is that your original Medicare coverage officially starts on the first day of the month of your sixty-fifth birthday. So, if your birthday is on the 28th, you are still covered as of the first of that month! In the event you are afflicted with an illness such as amyotrophic lateral sclerosis (ALS), then there is no waiting period at all for Medicare.
Important Things To Keep In Mind:
As great as all of that is, there are some important things to consider before your coverage starts. First, if you have any questions about your current enrollment status, contact the Social Security Administration at 800-772-1213 (TTY: 800-325-0778). You can also contact Medicare by phone by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
If you decide to opt out of Part B before your coverage begins, there are two ways to do so. The first is to send a letter with your signature to Social Security to inform them of your decision.
The second is to follow the instructions in your Medicare welcome packet to return your Medicare card. Please note that if you decide to keep the card, according to Medicare, you have agreed to keep Part B coverage. As a result, you will start paying the premiums for it.
Turning 65 Without Receiving Social Security Benefits
Now that we know a bit more about automatic enrollment, let’s take a look at how a person can enroll in Medicare if you don’t receive any SSDI or RRB Benefits. It’s important to note in this situation, Medicare enrollment is not automatic. However, you are still able to apply for Medicare during the Initial Enrollment Period as soon as you are of age to qualify.
The Initial Enrollment Period (IEP):
The IEP is a seven-month window in which you can enroll for Original Medicare. The clock starts ticking on this enrollment period three months before your sixty-fifth birthday, continuing during your birthday month until the enrollment window officially closes three months after you turn sixty-five. Considering this tight window, it’s a good idea to put these dates on your calendar to be safe.
Your Coverage Start Date:
The good thing about signing up during the IEP is that your Medicare coverage begins the month after you sign up. If you sign up in month one of seven, your coverage will start in the second month. On the other hand, if you enroll during month six of this seven-month window, your coverage will begin in your last month.
Unlike Automatic Enrollment, the start date of your coverage can vary wildly depending on when you choose to enroll. Because of this sliding time frame, it’s best to enroll as early as you can. It’s essential to remember NOT to wait until too long to enroll. If you do not enroll within that seven-month window, you may be forced to pay permanent penalties for your coverage.
The Enrollment Process:
Now, let’s look at the process of enrolling in Medicare. Simply go to the Social Security’s Medicare Sign Up page by clicking here to sign up for either Part A or Part B, a.k.a. Original Medicare. You can also sign up for Part A if you so choose. If you’ve previously turned down Part B coverage, you can sign up for it via that link. The website also provides a phone number where you can call to sign up.
Please note that to sign up for Medicare through the provided website, you must also provide basic information about yourself, including your Social Security number and specific information on where you were born. You’ll also have to provide health insurance information.
Once you’ve completed the application process, it’s a good idea to save the website. You can also check your application status through the site. Again, your coverage should start about a month after you enroll, but it’s always good to check for confirmation.
Medicare for Those Under 65 and Disabled
Something to keep in mind is that if you are under sixty-five years old, disabled, and have been receiving Social Security Disability Insurance or Railroad disability for up to twenty-four months, manual enrollment is not necessary. Instead, enrollment in the original Medicare program happens automatically. The coverage then begins in the twenty-fifth month. Like with standard Automatic Enrollment, you will receive a package in the mail containing your Medicare card three months before your coverage starts.
Meanwhile, if a person under the age of sixty-five has been diagnosed with Amyotrophic Lateral Sclerosis (ALS), they are eligible for automatic Medicare enrolment. In this situation, as soon as you are diagnosed with ALS, you should either submit an application for SSDI to Social Security or submit an application for Railroad Disability to the Railroad Retirement Board as soon as possible.
In this situation, there will be about a five-month wait before your original Medicare coverage begins. Once that waiting period is over, your Medicare benefits will start the same day that your disability benefits do. It’s vital to state very clearly that you have ALS when submitting your disability benefits application. Keep in mind that you can always contact the Social Security or the Railroad Retirement Board to check on the status of your application.
Late Enrollment Penalties
Penalty for Enrolling in Part B:
As previously mentioned, if you have to enroll in Medicare, you will have a seven-month window to do so. While that does seem like a long time, time can fly by. If you choose to not sign up for Part B during that window and instead choose to do so at a later time, you, unfortunately, will be charged an ongoing penalty. In other words, signing up late means you are permanently paying more. Also, if you are enrolled automatically and decide not to enroll in Part B during that time and choose to only stick with Part A, the same penalties will apply.
How the Penalty is Calculated:
Unfortunately, the late penalty can increase depending on how long you wait to sign up for Part B. Specifically if you wait until you are sixty-six or twelve months have gone by to enroll. You would have to pay an additional 10%. If you decide to wait two years, then you are paying an extra 20%. All this to say that each year you wait, your premium increases by 10%. Wait three years, and you’re looking at 30%, and so on and so forth. Again, we can’t stress enough the importance of putting that seven-month Initial Enrollment Period on your calendar if you enroll in Medicare.
Avoiding the Penalty:
While it’s understandable that concerns about late penalties can cause a lot of anxiety and even feelings of depression as you go through this major life transition, it’s important to remember that this penalty can still be avoided. The easiest way is to apply within that window.
However, there are some exceptions to the rules. For example, if you work for a company of more than twenty people and have group coverage, you have up to eight months to sign up for Medicare Part B after leaving the company without facing a penalty. Also, if you or your spouse is still working and you are covered by their insurance, then you would have the same eight-month window to enroll after your spouse leaves their job. Lastly, no matter how you enroll in Medicare, if you only have Part A coverage but are diagnosed with End Stage Renal Disease, you can also enroll in Part B without facing a penalty for it.
Special Enrollment Periods (SEPs) and Other Exceptions
Lastly, let’s take a look at Special Enrollment Periods and additional exceptions to Medicare enrollment dates that you should be aware of to see how they can affect the start date of your Medicare coverage.
What an SEP is and Common examples:
For those unaware of this term, according to healthcare.gov, the Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. If you didn’t sign up for Medicare Part B during your initial enrollment phase, you can do so during an SEP without facing a penalty.
What’s interesting is that SEP’s can be triggered in certain situations, for example if you lose your current health coverage, move to a new address that is outside of your current plan’s coverage area, or if your household grows due to marriage, childbirth, or adoption. In the event your household income drops below a certain point, you will also qualify for an SEP.
Coverage Start Date During SEP:
It’s extremely important to keep in mind that the start date for your Medicare can vary depending on when the SEP occurs, unlike Open Enrollment which happens at the same time every year, or the IEP, which is tied to your birthday. SEPs have a very short window, leaving only sixty days before or sixty days after a big life event to enroll. Thankfully, your coverage will start on the first day of the month after you enroll. If you are not sure of your coverage status, feel free to contact Medicare by clicking here, just to be sure. It’s always better to be safe than sorry.
If you feel that you may require an SEP but aren’t sure if you qualify, you can check by clicking here.
While we obviously can’t always predict the future, it’s best to contact your plan provider as soon as you know that a major life event such as a move or marriage is going to happen. This way, you can make the needed preparations.
Conclusion
All of this information can be a lot, and potentially overwhelming. The main things to keep in mind are that if you are approaching sixty-five and have Social Security Benefits, then your enrollment in Original Medicare is automatic. If you don’t qualify for automatic enrollment, you have almost a year to enroll in Medicare once you turn sixty-five. In this situation, keeping an eye on the calendar to get the coverage you need is vital. In either case, it’s a good idea to start looking at your options and preparing for life with Medicare as soon as you can. Knowledge is power, and hopefully, this blog helps empower you as you enter this exciting phase of your life!
