Medicare Enrollment

Enrolling in Medicare is how a person becomes a Medicare Beneficiary – one who benefits from Medicare.  For our purposes here, we will assume that you are eligible for Medicare.  If you are uncertain about your eligibility, click here to go to our Eligibility page. 

We will begin with a few common scenarios related to enrollment into Parts A & B.  I like to think of enrollment in Parts A and B as the gateway to all the other options.  One must be enrolled in Parts A & B to enroll in a Medicare Advantage Plan.  Also, one must have at least Part A to enroll in Part D or to apply for a Medigap Plan.  So, enrollment in Original Medicare (Parts A & B) is the first step.  For those who only want to enroll in Part A now, and later enroll in Part B, that process has a little more to it, so we’ll come back to that scenario later, but you can jump to it by clicking here.  

One more tidbit before moving on.  Regardless of when you enroll, your Coverage always starts on the first of the month.  It doesn’t matter what day of the month you were born or what day of the month you signed up, Part A & B effective dates are ALWAYS on the first. 

AUTOMATIC ENROLLMENT 

There are two situations for which enrollment in Parts A & B simultaneously occurs automatically.   

  1. If you are already receiving retirement benefits from Social Security at least four months before your 65th birthday, then you will automatically be enrolled in Medicare Parts A&B.  Here’s an excerpt from the Medicare.gov page about this situation:  

Because you’re getting Social Security benefits at least 4 months before you turn 65, you don’t need to do anything to sign up. We’ll automatically enroll you in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). We’ll mail you a welcome package with your Medicare card 3 months before your Medicare Part A and Part B coverage starts.  

  1. The second situation for which enrollment in Parts A & B is automatic involves a disability or specific health condition.  Again, from the Medicare.gov page: 

If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits.  

TURNING 65 ONLINE ENROLLMENT 

Another enrollment situation that is very common (but not automatic) is when a person enrolls in both Parts A & B when first eligible at age 65.  To do this, one simply needs to visit the SSA.GOV website and follow the link to “Sign up for Medicare” found on the home page.  This action can be done as early as 3 months prior to your 65th birth month, during your 65th  birth month, or three months after your 65th  birth month.  In total, there is a 7- month window to enroll.   

Pro Tip: If you have not already signed up for a “My Social Security” account online, the links you follow to enroll in Medicare will require you to do so before proceeding.  Therefore, I suggest you sign in to your personal “My Social Security” account before clicking on the Sign up for Medicare link.  Note that creating a Username and Password is not the same thing as applying for Social Security retirement benefits.     

After Age 65 Enrollment 

If you’re like, “Crud, I turned 65 last month and I forgot to enroll in Medicare!  Now what?”  Then take a breath and remember that the initial enrollment period lasts for 3 months after the month you turn 65.  So, relax, there’s still time.  However, after that 7-month enrollment period which ends 3-months after you turn 65, then the enrollment process changes.  From that point forward, you can only enroll during certain periods.  Some of these periods are related to the annual calendar.  Some of these periods are related to personal life events.  Some of these periods last for several weeks.  Some of these periods last for months.  Buckle up, let’s get into the Enrollment Periods, but remember – we are talking here about enrollment into Parts A & B only, not Medicare Advantage Plans, Medigap Plans or Part D. 

INITIAL ENROLLMENT PERIOD – Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.  The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. If you sign up before the month you turn 65, then your coverage begins on the month you turn 65.  And remember, your effective date will always be the first day of the month.  For example, Jill turns 65 on May 13 and signs up for Medicare Parts A & B on March 9th.  Since she enrolled prior to May, her effective dates will be May 1.  However, if Jill waited until May 23 to sign up, her coverage will become effective on June 1.  (Caution: In my last example, Jill’s coverage will become effective on June 1, but she will not receive her Medicare Card that fast, so if she needs care on June 3, she’ll need to find another way to prove to her provider that she has Medicare coverage.  This can be stressful.) 

GENERAL ENROLLMENT PERIOD – This period starts on January 1 each year and goes through March 31.  “This is called the General Enrollment Period. Your coverage starts the month after you sign up. You might pay a monthly late enrollment penalty, if you don’t qualify for a Special Enrollment Period.” https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start 

SPECIAL ENROLLMENT PERIODS – “A Special Enrollment Period is only available for a limited time. If you don’t sign up during your Special Enrollment Period, you’ll have to wait for the next General Enrollment Period and you might have to pay a monthly late enrollment penalty.” https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start 

(Notice, I’m pulling a lot of this verbiage directly from the Medicare.gov page titled, When does Medicare coverage start?, April 23, 2024, but I’m adding my edits to focus on the points that I think are most helpful.  For the unedited version, go directly to the source here.) 

There are several Special Enrollment Periods (SEP) that cover various “special” situations.  I won’t go through them all, but you can visit the Medicare.gov page here to read more.  However, I want to highlight one SEP that is very commonly used.  That is, 

“Have or had health insurance through your job, your spouse’s job.” 

This particular SEP “Starts the first month after your Initial Enrollment Period ends.”  That means, the fourth month after you turn 65. And “Ends 8 months after the group health plan coverage or the employment ends, whichever happens first... (Emphasis mine.) 

Quick story about the clause, “whichever happens first” before we continue.  I worked with a fellow whose employer was kind enough to pay for his group coverage through the end of the year after he retired, although his last day of employment was March 31.  Naturally, he figured, “since I have group coverage, why sign up for Medicare until January 1 the following year?”  Unfortunately, those dates fell outside of the 8-month window.  See, Medicare doesn’t care when your group coverage ends; it cares about which ends first – employment or coverage?  In his case, his employment ended before his coverage so that is when the 8-month clock started.  So, his SEP closed prior to his enrollment, and he had to wait until the General Enrollment Period to sign up.  Now this slight delay may not seem too bad to you, but for him it was a big deal because at the time this occurred, a person who used the General Enrollment Period to sign up for Medicare was required to wait until July 1 for the Part B coverage to kick in.  Thankfully, Congress has since updated this quirky rule and coverage begins the following month if the GEP is used. 

Back to when coverage begins when you use the SEP related to losing health coverage through your job or your spouse’s job:  

“…Coverage begins: Generally, the month after you sign up. In some situations, you can choose to have your coverage start on the first day of any of the 3 following months.” 

Note that Medicare emphasizes a point about Cobra Coverage: “COBRA isn’t considered group health plan coverage.  Getting COBRA doesn’t change when this Special Enrollment Period ends.”  I’ll add, COBRA is also not considered “Credible Coverage” so having it will not prevent a Late-enrollment Penalty. 

ENROLLMENT IN PART B AFTER PART A IS ALREADY EFFECTIVE 

Many people choose to enroll in Part A when they are first eligible at age 65, but delay their enrollment into Part B.  

 Why does someone do this? Probably because Part A does not have a premium, so it seems like it is free; Why not enroll in Part A?  

(Obviously, no government program is free; they all must be funded somehow.  Part A is funded mainly through the FICA tax so there is not a premium for Part A.*)   

Why delay enrollment into Part B?  Most commonly, the enrollment into Part B is delayed because the person already has health insurance coverage through their employer or spouse’s employer, and they want to keep it.  Sometimes this happens because the one who is eligible for Medicare is the employee and the spouse and family’s health coverage is connected to the group plan through him.  If he drops his group plan and moves over to Medicare, then the spouse and family will lose their coverage too.  That’s no good.  So the one eligible for Medicare chooses to delay Part B enrollment (and the monthly premiums that go with it) until the spouse is ready to enroll in Medicare or can get other coverage elsewhere. 

For enrollment in Part B that will have a different Effective date than Part A, you can apply online or complete a paper application to be submitted to one’s local Social Security office.  Additionally, to avoid a late enrollment penalty, form CMS L564 should accompany the application.  Click here for download link.  For the SSA.GOV page dealing with this topic and to enroll online, click here. 

* Here is what Medicare.gov has to say about Premium-free Part A and the exceptions:  

Part A costs $0 for most people (because they or a spouse paid Medicare taxes long enough while working – generally at least 10 years). If you get Medicare earlier than age 65, you won’t pay a Part A premium. This is sometimes called “premium-free Part A.”  If you don’t qualify for premium-free Part A: You might be able to buy it. You’ll pay either $278 or $505 each month for Part A, depending on how long you or your spouse worked and paid Medicare taxes. 

https://www.medicare.gov/basics/costs/medicare-costs

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