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.
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.
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 include parts A and B, as well as additional benefits, such as prescription drug coverage.
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 Traditional Medicare, they have 12 months to switch back if the plan does not meet their needs.
A person with Original Medicare can also sign up for Medicare Advantage during the Fall Open Enrollment Period. This time slot runs between October 15 and December 7.
A person can also switch from one Medicare Advantage plan to the other during that time.
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.
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.
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.
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).
A note on insurance
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