+ Initial Enrollment Period

For most people, the enrollment in Medicare Part A is automatic, but there are a few cases where manual enrollment is necessary for Part A and Part B. This manual enrollment would take place in what is called the Initial Enrollment Period (IEP). This is the seven-month period that begins three months before you turn 65, includes the month of your birthday, and then ends three months later.

To get the most out of your Medicare health benefits, it’s important for you to understand how and when to enroll in Medicare. Unless you qualify for automatic enrollment, you will need to sign up for Medicare Part A and/or Part B during the Initial Enrollment Period (IEP).

If you enroll in this month of your initial enrollment period: Then your Medicare coverage starts:
Social Security Medicare Site: http://www.socialsecurity.gov/pubs/10043.html
One to three months before you turn 65 years old The month you turn 65 years old
The month of your 65th birthday One month after your 65th birthday
One month after you turn 65 years old Two months after you enroll in Medicare
Two or three months after you turn 65 years old Three months after you enroll in Medicare

+ General Enrollment Period

If you missed enrolling in Medicare during your IEP, you are able to enroll during the General Enrollment Period, which runs from January 1 through March 31 annually. A late enrollment penalty may apply for Medicare Part A and/or Part B if enrollment was not done when first eligible.

If you enroll in Medicare during the General Enrollment Period, your coverage begins in July.

+ Special Enrollment Period

You may decide against enrolling in Medicare Part B when you are first eligible because you are already covered by group medical insurance with an employer or union. If you are 65 or older and are covered under a group health plan, either from your own or your spouse’s current employment, you have a Special Enrollment Period during which you can sign up for Medicare Part B. This means that you may delay your decision to enroll in Medicare Part B without having to wait for the General Enrollment Period and without having to pay the 10% premium penalty for late enrollment.

If you lose your group insurance, or decide you want to switch from your group coverage to Medicare, you can enroll at any time that you are still covered by the group plan or during a Special Enrollment Period (SEP). If you qualify for the Medicare Special Enrollment Period, you can enroll in Medicare outside of your Initial Enrollment Period (IEP) and the General Enrollment Period (GEP). Your eight-month special enrollment period begins either the month that your employment ends or when your group health coverage ends, whichever occurs first. Note, COBRA and retiree health coverage are not considered current employer coverage and would not qualify you for a special enrollment period.

If you enroll during an SEP, you generally do not have to pay a late enrollment penalty.

Most people get Medicare Part A without paying a premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes. However, if you don’t have enough work history to get premium-free Medicare Part A and delay Medicare enrollment when you turn 65 because you have employer-sponsored coverage, you can also use your Special Enrollment Period to sign up for Part A. Otherwise, a late-enrollment penalty could apply for Medicare Part A if you don’t enroll when you’re first eligible and need to pay a premium.

Under such circumstances, you may:

                  • Enroll in Medicare Part A and/or Part B any time while you’re covered under the group health plan based on your current employment.
                  • Enroll in Medicare Part A and/or Part B during the eight-month period that begins with the month your group health coverage ends or the month your employment ends, whichever comes first. Medicare Special Enrollment Period rules do not apply if employment or employer-provided group health plan coverage ends during your Initial Enrollment Period.

If you do not enroll in Medicare by the end of the eight-month period, you will have to wait until the next General Enrollment Period, which begins January 1 of the next year. You also may have to pay a higher premium for Medicare Part B. If you don’t qualify for premium-free Medicare Part A, you may owe a late-enrollment penalty for Part A as well.

People who receive Social Security disability benefits and are covered under a group health plan, from either their own or a family member’s current employment, also have a Medicare Special Enrollment Period. The Special Enrollment Period does not apply if you’re eligible for Medicare because you have End-Stage Renal Disease (ESRD). For more information on situations that may qualify you for a Special Enrollment Period, contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; TTY users can call 1-877-486-2048.

+ Annual Election Period (Open Enrollment)

If you want to make changes to your Medicare coverage you can do so during the Annual Election Period (AEP), which runs from October 15 to December 7 annually. During this time you can sign up for, change, or disenroll from Medicare Advantage (also known as Medicare Part C) and Medicare Prescription Drug plans.

If you didn’t sign up for one of these plans when you first became eligible for Medicare (during your Initial Enrollment Period), the AEP is generally your chance to make these changes, unless you qualify for a Special Enrollment Period (SEP).

What changes can you make during the AEP?

                      • Change to a Medicare Advantage plan from Original Medicare, Part A and Part B
                      • Change from a Medicare Advantage plan to Original Medicare, Part A and Part B
                      • Change from one Medicare Advantage plan to another (regardless of whether either plan offers drug coverage)
                      • Enroll in a Part D prescription drug plan
                      • Change from one Medicare prescription drug plan to another
                      • Opt out of Medicare prescription drug coverage completely

Changes you make during the AEP go into effect January 1 of the next year.

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