Most people sign up for Medicare around their 65th birthday within a specific enrollment window. However, some people may sign up earlier under certain circumstances.
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 are eligible to enroll in Medicare a few months before their 65th birthday. 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.
Most people have a 7-month time period, known as the Initial Enrollment Period (IEP), in which they can enroll in Medicare. This is true for Medicare parts A and B, also known as Original Medicare.
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 late enrollment penalties and a delay in coverage.
A person can enroll in Medicare using one of the following approaches:
- Sign up online through the Social Security Administration website.
- Sign up in person at a nearby Social Security Administration location. Click here to find the nearest office.
- Call the Social Security Administration at 1-800-772-1213 (Text Telephone: 1-800-325-0778).
Each of these options helps make sure that a person receives their Medicare benefits on time and has protection if they need medical treatment.
Medicare Advantage is an alternative to Traditional Medicare for which a person selects a plan through a private insurance company. The private insurer then administers and pays their benefits.
Medicare Advantage plans, also known as Part C, include parts A and B, as well as additional benefits, such as prescription drug coverage, known as Part D.
A person can sign up for Medicare Advantage during their initial 7-month Enrollment Period. If a person signs up for a Medicare Advantage plan during that time but wishes to make changes or revert to Original Medicare, they have 12 months to switch back if the plan does not meet their needs.
There are also different time periods where a person can make changes to their Medicare Advantage plan:
- Open Enrollment Period (OEP): This period runs from October 15 to December 7 and allows a person to join, drop, or switch to another Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period: If a person is already in a Medicare Advantage plan, they can switch or drop their plan between January 1 to March 31. A person is also eligible to make changes within the first 3 months they get Medicare.
- Special Enrollment Period (SEP): SEPs refer to certain situations that allow a person to join or switch plans. These circumstances can include moving to a new address, losing or changing current coverage, or getting Medicaid.
Generally, it is not necessary for a person to reenroll for Medicare every year. Typically, Medicare offers an automatic renewal each year, although there are exceptions.
If an individual is satisfied with their Medicare coverage, they do not usually have to reenroll or fill out paperwork annually.
In September each year, all Medicare Advantage companies will send an Annual Notice of Change (ANOC). This is a document outlining any potential coverage changes that will be effective from the following January. This may have an effect on costs, coverage levels, and service areas.
If a person is not satisfied, they may wish to enroll in a new plan or return to Original Medicare. They can make these changes during the Medicare Open Enrollment Period (OEP), which runs from October 15 to December 7 every year.
Possible exceptions to auto-renewal include when a plan no longer offers services, or if Medicare terminated the plan for underperformance.
Read on to learn more about exceptions to Medicare reenrollment.
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 (SEPs).
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 SEPs still only leave about 2 months to enroll in Original Medicare or a new Medicare Advantage policy before an enrollee faces penalty fees or gaps in coverage.
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 Original Medicare but did not sign up. For Medicare Part D, a person may need to pay an extra 1% for each month.
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.
More than 10 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.
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.
If a person is not sure about when to sign up for Medicare, they should contact the Social Security Administration on 1-800-772-1213 (Text Telephone: 1-800-325-0778).