Medicare Initial Enrollment Period
Fact checked Contributing expert: Kelly Blackwell, Certified Senior Advisor - Published: February 16, 2021
You can enroll in Medicare, the federal health insurance program, if you’re 65 or older, or if you’re younger and live with disabilities or permanent kidney failure. Some people get automatic Medicare enrollment, but it’s likely you’ll need to enroll as you turn 65. Your initial enrollment period is in the seven months around your 65th birthday. If you don’t enroll during the initial enrollment period, you’ll need to sign up during the general enrollment period that opens each year.
What you should know:
- 1 Most people enroll in Medicare when they turn 65.
- 2 You’ll be automatically enrolled in Medicare if you’re receiving benefits from the Social Security Administration or the Railroad Retirement Board.
- 3 If you miss your initial enrollment period, you can sign up for Medicare during the general enrollment period which happens every year from January 1 to March 31.
- 4 Part A Medicare coverage can start as soon as the first of your 65th birthday month or the month prior if you were born on the first.
You should prepare for Medicare enrollment in the months leading up to your 65th birthday. If you are already receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically be enrolled in Medicare when you are 65. If you are not yet receiving these benefits, and you do not have other healthcare insurance, you should enroll in the seven-month initial enrollment periodaround your 65th birthday. This seven-month period begins three months before you turn 65, includes your birthday month, and extends three months after your birthday month. For example, if you turn 65 on October 11, 2021, your initial enrollment period begins on July 1, 2021 and ends January 31, 2022.
How to enroll in Medicare
Enrolling in Medicare means enrolling in Part A and Part B, known as Original Medicare. You can enroll in both, or one or the other. If you are automatically enrolled, you will be enrolled in Parts A and B, but you can opt out of Part B because you must pay monthly premiums for Part B. However, if you choose to opt out of Part B, you can only enroll during certain periods and will most likely incur a late penalty and perhaps a gap in coverage.
You must be enrolled in both Part A and Part B in order to choose a Medicare Advantage Plan (Part C), which is an alternative to Original Medicare; or a drug coverage plan (Part D); or Medigap, which is a supplement to Original Medicare.
If you miss your initial enrollment period, you can sign up for Medicare during the general enrollment period which happens every year from January 1 to March 31. You may incur a higher Part A and Part B premium if you wait to enroll until this time.
You may choose to defer Medicare enrollment if you or your spouse are still working and have health insurance through an employer. If you do not sign up for Medicare when you are first eligible because you had group health plan coverage based on current employment, you may sign up during a special enrollment period (SEP). This enrollment period is eight months long and begins after employment or coverage ends, whichever comes first.
Where to enroll in Medicare
The Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program. However, Social Security processes your application for Original Medicare. To enroll in Medicare, contact your local Social Security office, call 1-800-772-1213 (TTY 1-800-325-0778), or access the Social Security website. If you worked for the railroad and are not already receiving retirement benefits, contact the RRB at 1-877-772-5772 to enroll in Medicare.
If you want your Medicare Part A and B benefits to start by the time you are 65, be sure to enroll in the first three months of the initial enrollment period.
How does Medicare automatic enrollment work?
If you are already receiving retirement benefits from Social Security or RRB, you will be automatically enrolled in Medicare Part A and Part B. You will receive your red, white, and blue card in the mail three months before you turn 65. Your Part A premium will be free because you have worked and paid Medicare taxes, but you will pay a premium ($148.50 per month in 2021) for Part B if you decide to keep it.
Persons who are receiving at least 24 months of disability benefits from Social Security or the RRB are also automatically enrolled in Medicare, as are people with Lou Gehrig’s disease, also known as ALS (amyotrophic lateral sclerosis).
Understanding your Medicare enrollment package
You will receive a Welcome to Medicare package three months before you turn 65 if you are automatically enrolled. It is important to read through this information to help you make decisions. You will have the opportunity to choose which way you want to get your healthcare coverage.
You can purchase supplemental insurance (Medigap) through a private insurance company to help cover costs such as deductibles and coinsurance that are incurred when you use Parts A and B. You can also purchase drug coverage (Part D) through a private insurance company. Alternatively, you can enroll in a Medicare Advantage Plan (Part C) which combines Parts A, B, and usually D into one plan. Medicare Advantage Plans are offered through private insurance companies that are approved by Medicare. They offer all the medically necessary benefits from Original Medicare Parts A and B, usually have a drug coverage benefit, plus other things that are not covered through Original Medicare, such as dental, vision, and hearing benefits.
In addition to providing information about which way you choose to get your healthcare coverage, the Medicare enrollment welcome packet will walk you through decisions and consequences related to opting out of Part B, and purchasing Medigap and/or drug coverage (Part D) during the initial enrollment period versus waiting until later.
When does Medicare coverage start?
If you are automatically enrolled in Medicare, or if you are eligible for premium-free Medicare Part A and you sign up anytime during your initial enrollment period and up to six months after your 65th birthday, your Part A Medicare coverage will start on the first of your 65th birthday month (or the month prior if you were born on the first). If you enroll after that for premium-free Medicare Part A, your coverage will be retroactive six months from when you sign up. However, Part B coverage will be delayed unless you enroll in the first three months of your initial enrollment period.
For people who are automatically enrolled in Medicare due to disability, coverage starts in the 25th month of disability benefits. There is no waiting period for Medicare coverage to start for people who have ALS. Their coverage starts the same month that disability benefits begin.
If you have to pay premiums for Part A, your coverage will start based on when you enroll. If you enroll during the first three months of your initial enrollment period, your coverage will start the month of your birthday. If you enroll during your birthday month, your coverage will begin one month after you sign up. If you enroll one month after you turn 65, your coverage will start two months after you sign up. If you enroll two or three months after you turn 65, your coverage will begin three months after you sign up. All of these start dates hold true for Part B coverage as well.
If you enroll during the general enrollment period from January 1 to March 31, your coverage will start on July 1. If you enroll during an SEP, coverage starts on the first day of the month following the month you enroll.
The exact start dates for your Part A and Part B coverage will be on your Medicare card.
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Kelly Blackwell, Certified Senior Advisor (CSA)
Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.