Medicare Advantage

When to Apply for Medicare

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When it comes to subjects like Medicare, keeping up with important dates and deadlines can be difficult, especially if you already have a lot on your plate. Each portion of Medicare has its own enrollment deadlines that largely depend on your situation and eligibility.

It’s important to keep up with the deadlines because you may be charged late fees if you don’t enroll on time. Don’t get caught in the rush during enrollment season. Get all of the facts now as to when exactly you should apply for Medicare.

When to Sign Up for Medicare

How can you make sure that you’re adhering to the deadlines? Rest assured that we’re here to help you sort through the important dates, so that you never fall behind. If you’re approaching your 65th birthday, then read on to discover more about the dates and deadlines to keep in mind when it comes to Medicare enrollment.

Medicare Part A Enrollment Deadlines

Some people get enrolled in Medicare Part A automatically. If you meet one of the following conditions, you may be enrolled in Medicare Part A three months prior to your 65th birthday or during the 25th month of your disability, depending on circumstance:

  • You currently receive benefits from the Railroad Retirement Board (RRB) or Social Security
  • You are younger than 65 and have a disability
  • You have been diagnosed with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
  • You live in Puerto Rico and draw benefits from the Railroad Board or Social Security

Those who meet the above qualifications won’t need to worry about enrollment deadlines.

If you are enrolled into Medicare Part A automatically due to health conditions or retirement status, you don’t have to do anything. But if not, your ability to enroll in Medicare begins three months prior to your 65th birthday and ends three months after the month you turn 65. Essentially, you have a total of seven months to enroll in Medicare when you first become eligible.

If you don’t enroll during your Initial Enrollment Period (IEP), then you may be charged a penalty fee if you enroll later. Penalty fees are assessed for as many months as you lacked Medicare coverage; this sum can add up over time. Numbers and dates tend to run together for some people. So, let’s take a look at an example to give you an idea of the reality of Medicare Part A deadlines.

  • Meet Janice Dowry. Janice’s 65th birthday is on June 30. Her IEP will begin March 1 of the year she turns 65 and continue through September 30 of the same year.
  • In other words, Janice has a total of seven complete months to sign up for Medicare: the three months leading up to her 65th birthday, the month containing her 65th birthday and the three months that follow the month of her 65th birthday.
  • Janice decides to enroll as soon as she can to avoid any late fees. She enrolls in Medicare in March, when she’s first eligible. Because she enrolled within the initial three-month period before her birthday, Janice’s Medicare Part A coverage will begin on the first of the month that contains her birthday. In this case, her coverage will start on June 1.

What if Janice had waited to enroll until after her 65th birthday? You have a full seven months to enroll initially in Medicare. You can take as much time as you need during this initial enrollment phase to make a well-informed decision about your coverage. However, your coverage will begin later, the longer you wait to enroll.

  • Janice hasn’t quite made up her mind about the portions of Medicare in which she wants to enroll. By her 65th birthday, Janice is still uncertain.
  • Finally, Janice decides to enroll in Medicare a few weeks after her birthday in July. She enrolls in Medicare Part A on July 23.
  • Because she waited, Janice now has to wait for her coverage to begin a full two months after signing up. This means that her coverage will start toward the end of September.

If Janice had waited until the very end of her seven-month enrollment period, then her coverage would have begun three months after the date she finally signed up. However, this three-month gap is still much shorter than the gap that might have happened if Janice had chosen to forgo enrollment entirely. In that case, Janice would have had to wait until the beginning of the general enrollment period on January 1 of the following year. Her coverage wouldn’t begin until July of the next year.

Of course, there are always exceptions to the rule. Medicare enrollment deadlines generally apply to all eligible beneficiaries. However, you may qualify for a Special Enrollment Period (SEP), provided that you meet certain qualifications. Let’s go back to Janice to see if she might qualify for an SEP.

  • Janice is still working when she turns 65. She has a group health plan through her current employer that covers her and her spouse. She decides to forgo Medicare Part A because she doesn’t need the coverage right now.
  • Six months later, Janice decides to retire. She now needs Medicare Part A coverage, since her group health plan no longer provides the insurance she needs.
  • Fortunately, people who have group health plans when they first become eligible for Medicare have an SEP that allows them to enroll in Medicare within eight months of losing their work-based coverage. Think of this eight-month period as a floating enrollment extension.
  • Janice enrolls in Medicare Part A one month after losing her group health insurance. She won’t be charged a late enrollment penalty because she acted within her allotted time frame.

Under certain circumstances, Janice may not have been able to enroll during the SEP. These include having Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, retiree coverage or end-stage renal disease (ESRD). These conditions do not qualify individuals to delay Medicare Part A enrollment.

However, you may also qualify for a special enrollment period if you’re volunteering out of the country when you first become eligible. For additional special conditions, you can check with your local Social Security office or visit the Medicare website. Suffice it to say that earlier is usually better when it comes to Medicare enrollment.

Medicare Part B Enrollment Deadlines

Medicare Part B enrollment deadlines mimic those of Part A enrollment deadlines. Initial enrollment into Part B is automatic for the same people listed above in Part A. You have seven months to enroll in Part B if you don’t qualify for automatic enrollment. However, there are a few differences when it comes to Medicare Part B.

First, Part B requires a premium, whereas most people don’t have to pay a premium for Medicare Part A. Because of this, you may be tempted to forgo Part B coverage. You should note that if you cancel Part B coverage or decide against enrolling in it, then you may not be able to enroll in Part B until the general enrollment period. This runs from January 1 through March 31 each year.

Medicare Part B penalties are also different from Part A penalties. In essence, you get charged a 10 percent penalty fee for each full year that you lacked Medicare Part B coverage when you could have enrolled. For the following example, we’ll return to Janice to see how much her premium would be if she failed to enroll in Medicare Part B on time.

  • When Janice enrolled in Medicare Part A, she declined Part B coverage. This was because she had insurance through a private source and didn’t want to bother with the monthly Medicare premium. She should have enrolled in Medicare Part B during her initial enrollment period of March 1 through September 30 since her 65th birthday was on June 30.
  • More than two years later, Janice realizes that Part B premiums might be cheaper than her current private insurance. So, she decides to enroll in Medicare Part B during open enrollment, which lasts from January 1 through March 31 every year.
  • Janice enrolls in Medicare Part B coverage about 18 months after her IEP. Medicare charges a 10 percent fee for every full 12-month period that you lack coverage. In Janice’s case, she’ll be charged 10 percent above the cost of the usual premium, which amounts to about $187 a month in her case, instead of the $170.10 that most people pay.

Unfortunately, Janice will have to pay this late penalty fee indefinitely. Unlike the penalty fee for missing the Medicare Part A enrollment deadline, the penalty for missing the Part B deadline lasts for as long as you have Medicare Part B. As long as Janice keeps Medicare Part B, she’ll have to pay the higher premium.

However, there may be hope yet. Janice may qualify for an SEP that helps her avoid the late penalty fee. Medicare Part B shares the same guidelines for special enrollment with Medicare Part A. For example, Janice might have been working at the time she qualified for Part B coverage. In this case, she could delay her enrollment until she retires or loses the work-based coverage.

Medicare Part C Enrollment Deadlines

Medicare Part C is usually referred to as a Medicare Advantage Plan. In these plans, you get the benefits of Medicare Parts A, B and D at once. Many people choose Medicare Advantage because there are more flexible options, in terms of benefits and premium costs. But some simply like the convenience of having a private insurer administer their health insurance.

Typically, Medicare Advantage Plans have their own set of enrollment and modification guidelines because they’re administered by private insurers. However, if you decide to enroll in a Medicare Advantage Plan, there are some dates you should keep in mind.

  • You can enroll in a Medicare Advantage Plan during your IEP, when you become eligible for Medicare. In other words, you have seven months surrounding your 65th birthday to enroll in an Advantage plan, rather than in Original Medicare.
  • From April 1 through June 30, you can enroll in a Medicare Advantage Plan if you have Medicare Part A and you enrolled in Part B during the general enrollment period (January 1 to March 31).
  • From October 15 through December 7, you can switch from Original Medicare to Medicare Advantage, switch from one MA plan to another, drop MA coverage for original Medicare, change your Part D plans or make other modifications. It’s called Medicare Open Enrollment, and it’s the one time a year everyone with Medicare can make changes to their plans.
  • From January 1 through March 31, you can switch from an existing Medicare Advantage plan to another one, or disenroll from Medicare Advantage and enroll in an Original Medicare plan. This is called Medicare Advantage Open Enrollment, and it’s only for people with an Advantage plan in place.

Let’s say that your birthday is October 5. You have an initial enrollment period that lasts from July 1 through January 31 to enroll in a Medicare Advantage Plan. Medicare now gives you a three-month “trial run” of your MA plan. If you don’t like it, you can switch to a new MA plan or drop it in favor of original Medicare within those first three months. If you don’t change plans during the trial period, you can use the Medicare Advantage Open Enrollment to change your plan one time during that period as long as it’s before March 31. Otherwise, you’ll have to wait until open enrollment starts in the fall (October 15 to December 7) for coverage that starts in a new calendar year.

Confused? Enrollment isn’t always black and white, especially when there are so many exceptions to the rules set by Medicare. We can help. Contact a Medicare specialist today for more information about when to sign up for and/or change a Medicare Advantage plan.

Medicare Part D Enrollment Deadlines

For people who need a lot of prescriptions or those with costly prescriptions, a Medicare Part D drug plan may help offset the cost of monthly prescriptions. The enrollment guidelines for Medicare Part D are similar to those for Medicare Part C or Advantage Plans. You have the seven-month period surrounding your 65th birthday to enroll in Part D coverage. But you can also add this coverage later, under certain conditions. Let’s return to Janice Dowry to see how she might enroll in a Medicare Part D drug plan.

  • Janice enrolled in Medicare Part A when she was eligible. But she waited until the general enrollment period to enroll in Medicare Part B. She declined additional drug coverage at the time, because she was in relatively good health.
  • Since enrolling in Parts A and B, Janice has developed a chronic condition that requires costly prescriptions. She decides to enroll in a Part D plan to offset the cost of her medical care.
  • Janice can enroll in Medicare Part D from April 1 through June 30 – since she signed up for Part B during general enrollment –  and make changes to her plan from October 15 through December 7.

You should also keep in mind that the Medicare Advantage Open Enrollment period is reserved specifically for disenrolling from Medicare Advantage or switching to a new MA plan. It cannot be used to modify or cancel a Medicare Part D plan. You can only switch Part D plans during the allotted period. (But if you disenroll from an MA plan during that period and enroll in original Medicare, you can sign up for a new Part D plan at the same time.)

Medigap Enrollment Deadlines

Are you looking for ways to supplement your coverage through Medicare? You may want to consider buying a Medigap policy. Medigap insurance helps pay for medical care and services that Medicare Parts A and B don’t cover.

It’s a supplemental form of insurance that you can buy only if you already have Parts A and B. Medigap is sold through private insurance companies that must adhere to federal standards. As with other portions of Medicare, you can only enroll in Medigap policies at certain times. However, Medigap works a little differently from other plans in the following ways:

  • You have a six-month initial enrollment period to apply for Medigap coverage. The six-month IEP begins the month you turn 65 and enroll in Medicare Part B. Let’s say that your birthday is November 14. In this case, you have from November 1 through April 30 to enroll in a Medigap policy assuming that you have a Part B plan in place.
  • After this IEP, you may not be able to get a Medigap policy at all. Insurers must sell you an available Medigap policy during your initial signup window without subjecting you to medical underwriting, but outside of that window, those rules don’t apply. Insurers can use your medical history against you to deny you a Medigap policy.
  • Some states may require insurers to sell Medigap policies to people who miss their initial eligibility window without medical underwriting.
  • If you’re working when you turn 65, then you may not need Medicare Part B. Likewise, you probably don’t need a Medigap policy. You may decide to enroll in Part B and a Medigap policy once you lose your work coverage. If so, then you may qualify for an SEP without incurring a late enrollment fee.

You should enroll in Medigap during your IEP if you have a pre-existing condition or frequent health problems. If you enroll during your six-month IEP, you can choose any plan that an insurer offers, without getting denied coverage for medical conditions or other issues. Otherwise, an insurer can deny you coverage for these conditions, depending on their underwriting requirements.

Why Enrollment Deadlines Matter

Why do these deadlines matter? As mentioned above, you could be charged late enrollment penalties for enrolling after your initial enrollment period. Enrolling in Medicare on time ensures that you avoid paying the late enrollment fees, some of which last for as long as you have Medicare. Over time, penalty fees for signing up late could make this low-cost health insurance option less cost-effective for you, without any recourse.