How & When to Enroll in Medicare

You have several options when the time comes for you to enroll in Medicare. For some, Medicare enrollment is automatic, while for others, it may depends on when and how they become eligible.

How to Enroll in Original Medicare Part A & Part B
  • You can enroll online at www.SocialSecurity.gov or,
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM or,
  • In-person at your local Social Security office.

If you worked at a railroad, you can enroll in Medicare by contracting the Railroad Retirement Board (RRB) at 1-877-772-5772 (TTY users 1-312-4701). You can call Monday through Friday 9AM to 3:30PM, to speak with a Railroad Retirement Board representative.

When to Enroll in Original Medicare Part A & Part B

There are a few situations where Medicare enrollment may occur automatically:

  1. If you are receiving retirement benefits: If you’re already collecting RRB or Social Security retirement benefits when you turn 65, you will automatically be enrolled in Original Medicare Part A (hospital insurance) and Part B (medical insurance) if you sign up for Medicare Part B at the time you sign up for your retirement benefits.
  2. If you are under 65 and receive disability benefits: After 24 months of disability benefits, you will be automatically enrolled in Original Medicare Part A and Part B. The exception to this is if you have end-stage renal disease (ERSD). If you have ERSD and had a kidney transplant or need regular kidney dialysis, you can apply for Medicare. If you have amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease), you will automatically be enrolled in Original Medicare Part A & Part B in the same month that your disability benefits start.
If You Don’t Want Medicare Part B

If you’re automatically enrolled in Original Medicare Part B, but do not wish to keep it you have a few options to drop coverage. If your Medicare coverage has not started yet and you were sent a red, white, and blue Medicare card, you can follow the instructions that come with your card and send the card back. If you keep the card, you keep Original Medicare Part B (medical insurance) and will need to pay your Part B premiums. If you have signed up for Medicare through Social Security, then you will need to contact Social Security for instructions on how to submit a signed request. Your coverage will end the first day of the month after Social Security receives your request.

If you have health coverage through current employment (either through your work or your spouse’s employer), you may decide to delay Medicare Part B enrollment. However, you should speak with your employer’s health benefits administrator to get a better understanding of how your current coverage works with Medicare and what consequences would be if you drop Medicare Part B. You can also contact your Medicare advocate at Medicare Pathways by calling 866-466-9118 to learn more.

Original Medicare Part B Late-Enrollment Penalty

If you do not sign up for Medicare Part B when you are first eligible, you may need to pay a late enrollment penalty for as long as you have Medicare. Your monthly Original Medicare Part B premium could be 10% higher for every full 12-month period that you were eligible for Part B, but did not enroll. This higher premium could be in effect for as long as you are enrolled in Medicare. For those who are not automatically enrolled, there are various Medicare enrollment periods during which you can apply for Medicare.

Medicare Initial Enrollment Period

For most people, enrolling in Original Medicare Part A is automatic. However, there are several instances where you may have to manually enroll in Original Medicare Part A and/or Part B during your Initial Enrollment Period (IEP). Your IEP is the seven-month period that begins three months before you turn 65, includes the month of your 65th birthday, and ends three months later.

Some situations where you would enroll in Medicare during your initial enrollment include:

If you aren’t receiving retirement benefits: If you are not receiving retirement benefits but close to turning 65, you can sign up for Original Medicare Part A and/or Part B during your IEP. If you decide to delay your Social Security retirement benefits or Railroad Retirement Benefits (RRB) beyond age 65, there is an option to enroll in just Medicare and apply for retirement benefits at a later time.

If you do not qualify for retirement benefits: If you are not eligible for retirement benefits from Social Security or the RRB, you will not be automatically enrolled into Original Medicare. However, you can still sign up for Original Medicare Part A and/or Part B during your IEP. You may not be able to get premium-free Medicare Part A (hospital insurance), and the cost of your monthly Part A premium will depend on how long you worked and paid Medicare taxes. You will still have to pay a Original Medicare Part B (medical insurance) premium.

Medicare General Enrollment Period

If you did not enroll during the IEP when you were first eligible, you can enroll during the General Enrollment Period. The general enrollment period for Original Medicare is from January 1 through March 31 of each year. You may have to pay a late enrollment penalty for Original Medicare Part A and/or Part B if you did not sign up when you were first eligible.

Medicare Special Enrollment Period

You may decide to not enroll in Original Medicare Part B when you are first eligible because you are already covered by group medical insurance through an employer or union. If you lose your group insurance, or if you decide you want to switch from your group coverage to Medicare, you can sign up at any time that you are still covered by the group plan or during a Special Enrollment Period (SEP).

Your eight-month special enrollment period begins either the month that your employment ends or when your group health coverage ends, whichever occurs first. If you enroll during an SEP, you generally do not have to pay a late enrollment penalty.

The Special Enrollment Period does not apply if you’re eligible for Medicare because you have ESRD. Please also keep in mind that COBRA and retiree health coverage are not considered current employer coverage and would not qualify you for a special enrollment period.

Medicare Advantage Insurance Plan Enrollment

Medicare Advantage, also known as Medicare Part C, is another way to receive Original Medicare benefits and is offered through private insurance companies. At minimum, all Medicare Advantage plans must offer the same Medicare Part A and Part B benefits as Original Medicare. Some Medicare Advantage plans also include additional benefits, such as prescription drug coverage. You must have Original Medicare, Part A and B, to enroll in a Medicare Advantage plan through a private insurer.

You can enroll in a Medicare Advantage Insurance plan during two enrollment periods, the Initial Coverage Election Period and Annual Election Period.

Medicare Advantage Insurance Plan – Initial Coverage Election Period: Most beneficiaries are first eligible to enroll in a Medicare Advantage Insurance plan during the Initial Coverage Election Period. Unless you delay Medicare Part B enrollment, this enrollment period takes place at the same time as your Initial Enrollment Period (IEP), starting three months before you have both Medicare Part A and Medicare Part B and ending on whichever of the following dates falls later:

  • The last day of the month before you have both Medicare Part A and Part B, or
  • The last day of your Medicare Part B Initial Enrollment Period.
  • If you’re under 65 and eligible for Medicare due to disability, your IEP will vary depending on when your disability benefits started.

Medicare Advantage Insurance Plan – Annual Election Period: You can also add, drop, or change your Medicare Advantage plan during the Annual Election Period, which occurs from October 15 to December 7 of every year. During this period, you may:

  • Switch from Original Medicare to a Medicare Advantage plan, and vice versa.
  • Switch from one Medicare Advantage plan to a different one.

Switch from a Medicare Advantage Insurance plan without prescription drug coverage to a Medicare Advantage Insurance plan that covers prescription drugs, and vice versa.

Medicare Advantage Insurance Plan Disenrollment Period: You’ll have the opportunity to disenroll from your Medicare Advantage Insurance plan and return to Original Medicare during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. You cannot use this period to switch Medicare Advantage plans or make other changes. However, if you decide to drop your Medicare Advantage plan, you can also use this period to join a stand-alone Medicare Part D Prescription Drug Plan, since Original Medicare doesn’t include prescription drug coverage.

Outside of the Annual Election Period and the Medicare Advantage Disenrollment Period, you cannot make changes to your Medicare Advantage plan unless you qualify for a Special Election Period.

Medicare Part D Prescription Drug Plans

Medicare prescription drug coverage is optional and does not occur automatically. You can receive coverage for prescription drugs by either signing up for a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage, also known as a Medicare Advantage Prescription Drug plan. Medicare prescription drug plans and Medicare Advantage plans are available through private insurers. Please note that you cannot have both a stand-alone Medicare prescription drug plan and a Medicare Advantage plan that includes drug coverage.

Initial Enrollment Period for Medicare Part D Prescription Drug Plans: You can enroll in a stand-alone Medicare prescription drug plan during your Initial Enrollment Period for Part D. You are eligible for drug coverage if:

  • You live in a service area covered by the health plan, and
  • You have Medicare Part A AND/OR Medicare Part B.

Generally, your Initial Enrollment Period for Part D will occur at the same time as your Initial Enrollment Period for Medicare Part B (the seven-month period that starts three months before your eligibility for Part B, includes the month you are eligible, and ends three months later).

Once you are eligible for Medicare Part D, you must either enroll in a Medicare prescription drug plan, Medicare Advantage Prescription Drug plan, or have creditable prescription drug coverage (that is, drug coverage that is expected to pay at least as much as standard Medicare prescription drug coverage). Some people may choose to delay Medicare Part D enrollment if they already have creditable drug coverage through an employer group plan.

However, if you do not sign up for prescription drug coverage when you are first eligible for Part D, you may have to pay a late-enrollment penalty for signing up later if you go without creditable prescription drug coverage for 63 or more consecutive days.

Medicare Part D Annual Election Period: If you did not enroll in drug coverage during IEP, you can sign up for prescription drug coverage during the Annual Election Period that runs every year from October 15 to December 7.

During AEP, you can:

  • Sign up for a Medicare prescription drug plan.
  • Drop a Medicare prescription drug plan.
  • Join a Medicare Advantage plan that includes prescription drug coverage.
  • Switch from a Medicare Advantage plan that doesn’t include drug coverage to a Medicare Advantage plan that does (and vice versa).

 

Outside of the Part D Initial Enrollment Period and the Annual Election Period, the only time you can make changes to prescription drug coverage without a qualifying Special Election Period is during the Medicare Advantage Disenrollment Period (MADP)–but only if you are dropping Medicare Advantage coverage and switching back to Original Medicare. The Medicare Advantage Disenrollment Period runs from January 1 to February 14.

Original Medicare Part A and Part B do not include prescription drug coverage, and if you switch back to Original Medicare during the Medicare Advantage Disenrollment Period, you will have until February 14 to join a stand-alone Medicare prescription drug plan.

Medicare Supplement Insurance Plan Enrollment

Medicare Supplement Plans (or Medigap) are voluntary, additional coverage that helps fills the gaps in coverage for Original Medicare. The best time to enroll in a Medicare Supplement plan is during your individual Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month you turn 65 and have Medicare Part B. If you decide to delay your enrollment in Medicare Part B for certain reasons such as having health coverage based on current employment, your Medigap Open Enrollment Period will not begin until you sign up for Part B.

During your Medigap Open Enrollment Period, you have a “guaranteed-issue right” to buy any Medigap plan sold in your state. This means that insurance companies cannot reject your application for a Medicare Supplement plan based on pre-existing health conditions or disabilities. They also cannot charge you a higher premium based on your health status. Outside of this open enrollment period, you may not be able to join any Medigap plan you want, and insurers can require you to undergo medical underwriting. You may have to pay more if you have health problems or disabilities.