Medicare is the United States’ federal government’s insurance for people aged 65 years and older, as well as those with certain disabilities. Most people sign up for Medicare around their 65th birthday within a specific enrollment window. However, people may sign up earlier under certain circumstances.
If a person does not sign up for Medicare in their enrollment window, they could face financial penalties. Signing up within the required window is the most cost effective approach to securing Medicare benefits.
In this article, we explain when a person can enroll in Medicare and Medicare Advantage, their privately administered bundle plan.
We also define Special Enrollment Periods and when they apply, as well as the penalties for applying outside the enrollment window.
When can a person enroll in Medicare?
Most people have a 7-month time period in which they can enroll in Medicare. This is true for Medicare parts A and B.
The 7-month time period begins 3 months before the month in which their 65th birthday falls. It ends 3 months after an individual’s 65th birthday.
For example, if a person’s birthday is April 10:
The earliest they could sign up without a penalty is January 1 of the year of their 65th birthday.
The latest they could sign up without a penalty is July 31 of the year they reach 65 years of age.
While a person can enroll in Medicare at any time during the enrollment period, the sooner they enroll, the sooner their coverage begins.
Waiting until a person’s birth month or the months after could lead to a delay in Part B coverage until Medicare processes their enrollment.
What about Special Enrollment Periods?
Some people may qualify for additional times when they can apply for Medicare benefits outside of their enrollment periods. Medicare calls these Special Enrollment Periods.
Some examples of these periods include, but are not limited to, the following:
- A person is moving to a new area in which providers do not offer the benefits included in their Medicare Advantage plan. The services these plans offer may be different between regions and states.
- A person moves back to the U.S. after living outside the country for some time.
- A person moves into or out of an institution, such as a skilled nursing facility or long term care facility.
- A person recently finished a jail sentence.
These Special Enrollment Periods still only leave about 2 months to enroll in Traditional Medicare or a new Medicare Advantage policy before an enrollee faces penalty fees or gaps in coverage.
Penalty fees for late enrollment
Medicare charges penalty fees for those who do not enroll in their Initial Enrollment Period, or they do not qualify for an exception due to employer insurance or other coverage.
Unless a person qualifies for a special exception, they will pay a monthly premium that is 10% higher for every 12-month period they were eligible for Medicare but did not sign up.
Enrollment criteria before 65 years of age
A person can qualify for a Medicare plan before 65 years of age if they meet certain criteria:
- They have end stage renal disease (ESRD) and need dialysis or are on the kidney transplant list.
- They have amyotrophic lateral sclerosis (Lou Gehrig’s disease).
- Their doctor confirms that they have a disability.
An estimated 6.2 million people qualify for Medicare because they are disabled, according to the Medicaid and CHIP Payment and Access Commission. However, significantly fewer people use these benefits
A doctor may declare a disability for people due to several types of medical conditions, including:
- Intellectual or developmental disabilities: These might include Down syndrome, cerebral palsy, or autism.
- Physical conditions: Traumatic brain injury, severe back injuries, or quadriplegia qualify as disabilities.
- Severe behavioral or psychological disorders: People with bipolar disorder or schizophrenia can qualify for Medicare early.
A doctor must submit paperwork to Medicare, declaring that a person has a disability. The individual may have a waiting period before they qualify for full Medicare benefits.
Are there other key dates to know?
If someone did not sign up for Medicare Part B during their Initial Enrollment Period, they could apply during a General Enrollment Period that runs from January 1 through to March 31.
If a person signs up during this time, their Medicare benefits will start on July 1 of the same year.
A Medicare Advantage Open Enrollment Period is also available between the same dates, during which a person can make one change to their Medicare coverage.
Such a change might involve switching from one Medicare Advantage plan to a different plan or returning to Traditional Medicare.
However, a person cannot switch from Original Medicare to Medicare Advantage during this time.
Medicare outlines specific periods during which a person can complete their initial sign up or switch the type of plan they have. Being aware of these periods can ensure a person does not incur late penalties and can maintain a lower premium.
Now that you know the right time to enroll in Medicare read about these important aspects next: Medigap vs. Medicare Advantage: key differences
By David Lasman – “Ask Medicare Dave” | President – Senior Healthcare Team
wwww.SeniorHealthcareTeam.com | 866-333-7340
Selecting the right healthcare plan through Medicare can be overwhelming and downright stressful. Senior Healthcare Team is a nationwide resource that provides guidance and support about Medicare to seniors at no cost to them and helps them to choose the most suitable insurance plan tailored to their specific needs and budget. Our goal is to educate and empower our clients to make the best decisions regarding their healthcare and clear up the confusion of Medicare. At Senior Healthcare Team, we aren’t partial to any one insurance company. Our loyalty is to our clients and our mission is to provide them with the best healthcare options at the very lowest cost.