Medicare Enrollment: A Quick Guide for “First Timers”

Do you know if you qualify or when you need to enroll if you do?

There is no one-size-fits-all path to Medicare enrollment and there are a number of different directions you might take depending on your circumstances, such as your age, employment status, or whether you receive Social Security or Railroad Retirement Benefits[1]. This guide will help you with the most basic elements, general plan information and when to enroll.

What is Medicare anyway?

Medicare is a federally funded and operated insurance program primarily designed to help the U.S. population of senior citizens. Over 67 million Americans[2] are currently enrolled. Before you enroll yourself, it’s important to understand when you’re eligible for Medicare coverage and the benefits and costs of each plan.

Let’s start by looking at the various Medicare plans. Here is brief description of each plan, in simple terms:

• Medicare Part A covers a wide range of inpatient stays at hospitals and skilled or critical care facilities. You will not pay a premium for Part A (premium-free Part A) if you are 65 or older and you (or another qualifying person, like your current or former spouse) paid Medicare taxes while working for a certain amount of time (usually 10 years of work). For detailed information on Part A coverage and costs, click here.
• Medicare Part B covers outpatient medical services from physicians and other healthcare providers, some home care visits and possibly medical equipment. For detailed information on Part B coverage and costs, click here.
• Medicare Advantage (Part C) is an alternative to Part A and B. It is a private option that offers additional benefits including Part D (see below) and vision and dental benefits. For detailed information on Advantage/Part C coverage and costs, click here.
• Medicare Part D subsidizes the cost of prescription drugs for Medicare enrollees. This can be a stand-alone benefit or automatically included if enrolled with Advantage/Part C. For detailed information on Part D coverage and costs, click here.

Should I enroll?

Once you have thoroughly reviewed the plans and have a firm understanding of cost and coverage, you still need to ascertain when you will need to enroll and what coverage you will need based on your life circumstances. Here are just a few points to consider when asking yourself whether you need to enroll:

• If you have already claimed Social Security, have been receiving Social Security disability benefits for at least 24 months prior to eligibility, or if you receive Railroad Benefits, you will automatically be enrolled in Part A and B. Your Medicare card will arrive 3 months prior to your 65th birthday.
• If you are not working or have no employer-sponsored health insurance, you should enroll during the Initial Enrollment Period (IEP) which is explained below.
• If you are still working and you do have employer sponsored group health insurance, it gets a little tricky:
• If your company has less than 20 employees, in most cases you must still enroll during the Initial Enrollment Period (IEP).
• If your company has more than 20 employees, you’ll be eligible to enroll in Part A, but you will most likely need to enroll in Part B during a Special Enrollment Period (SEP) after employer coverage ends.

What is an enrollment period and why is it important?

Like much in life, timing is everything. When you are approaching your eligibility time and have determined the right plan for you, make certain you enroll at the right time. Not doing so could make coverage more costly to you.

Remember if you are receiving Social Security, Social Security disability benefits, or Railroad Retirement benefits you are automatically enrolled when the time comes.

For everyone else, you need to pay attention to enrollment periods.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the 7-month window of time surrounding the month of your 65^th birthday.  For example, if your 65^th birthday is in July, your IEP will span from April until October.

But don’t wait until the last minute. To get coverage when you’re first eligible, you must enroll the month before you turn 65 to ensure you’re covered in the month you celebrate your milestone birthday.

Special Enrollment Period (SEP)

The Special Enrollment Period (SEP) applies to those over the age of 65, who are still covered by group health insurance through an employer in a company with more than 20 employees and who:

• become unemployed and/or
• no longer have group insurance coverage available to them.

The SEP enrollment window begins the month after you stop working or your group health coverage ends and lasts for 8 months.

The sooner you enroll the sooner your coverage begins (one month following your enrollment date).

Late Enrollment and Penalties

It is critical you sign up for Medicare when you are eligible, based on your life circumstances as we have discussed. If not, you can face some unnecessary and costly penalties in the form of late fees[3]. These fees are added into your premium and go up in cost the longer you wait to enroll. For example:

• If you do not qualify for premium-free Part A and you do not enroll during your IEP, your premium may go up 10% more than typical and you will pay that amount for twice the number of years you could have been covered.
• If you don’t enroll in Part B when you’re first eligible, your premium may go up 10% for each year you could have been covered.
• If you don’t enroll in Part D or another prescription drug coverage within three months of the expiration of your IEP or SEP, you will pay an additional 1% of the national base beneficiary premium for each month you went without coverage.

*In 2024, Plan A can cost up to $505/month.

Bottom line, when you are eligible for Medicare, based on your personal circumstance, it doesn’t pay to delay enrollment.

Do you have questions about your Medicare eligibility or other retirement planning matters? Schedule a call with one of our knowledgeable advisors today.