When Should You Enroll In Medicare?
Learning Medicare > When Should You Enroll In Medicare
Key Takeaways
There are several different enrollment periods in which you can enroll in Medicare. Finding the correct one is paramount so you will not incur any penalties or loss of options.
Many people become eligible and sign up for Medicare when they turn 65 during their 7-month Initial Enrollment Period.
Only people who have certain disabilities can enroll in Medicare under age 65.
For those working and covered under a qualified and creditable employer group health insurance plan, Medicare can be delayed until retirement and/or loss of group health insurance.
Starting Medicare Before You Turn 65
Only certain individuals can enroll in Medicare before they turn 65: those with a qualifying disability, those with End Stage Renal Disease, and those with Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig’s disease.
Qualifying Disability
To enroll in Medicare before turning 65, individuals must have a qualifying disability to sign up. This means that after receiving disability benefits (SSDI) for 24 months or more they become eligible for Medicare coverage. Those who qualify automatically receive Medicare Parts A and B.
Beneficiaries with qualifying disabilities will promptly receive Medicare Part A upon eligibility. This coverage includes hospital insurance and helps cover inpatient care. Following this, around 24 months later, they will start receiving Medicare Part B.
End Stage Renal Disease and ALS
Those who have End Stage Renal Disease (ESRD) can sign up for Medicare at any age, as long as they meet the guidelines for ESRD, which include having kidney failure, needing regular dialysis, and have worked the required amount of time under Social Security requirements to receive Social Security Disability Insurance (SSDI). There is usually a 4 month waiting period for those who are receiving dialysis before their Medicare coverage begins, and it will start on the first day of the fourth month.
Similar to ESRD, those with Amyotrophic Lateral Sclerosis (ALS) can sign up for Medicare at any age, as long as the guidelines are met, mainly being diagnosed with ALS as well as being approved for Social Security Disability Insurance (SSDI). Fortunately, the Social Security Administration fast-tracks anyone with ALS and waives the standard 24 month SSDI waiting period so those people can get the care they need without waiting for 24 months.
Starting Medicare When You Turn 65
Most people will begin Medicare when they turn 65, but others will continue working and stay on their employer group health insurance. Some people will have to enroll when they turn 65 and others will not have to enroll at 65. Read below to find which circumstance applies to you:
Turning 65 And NOT Covered By Employer Group Health Insurance
Your enrollment into Medicare is the simplest our of the other enrollments! Your Initial Enrollment Period or “IEP” is a 7-month period that spans 3 months before your birth month, your birth month, and 3 months after the month you turn age 65. You must enroll in Medicare at this time to avoid lifetime penalties and enrollment delays!
Turning 65 And Covered By Employer Group Health Insurance
The Medicare rules for signing up are different based on the number of employees your or your spouses employer has.
If you or your spouse are currently working and covered under an employer group health insurance plan and that employer has under 20 employees, Medicare becomes the primary insurer. This means you must enroll in Medicare when you turn 65.
If your employer has over 20 employees, you do not have to enroll in Medicare at this time because your group insurance will be your primary insurance.
Note, sometimes it makes more sense financially and from a coverage perspective to enroll in Medicare and leave the group health insurance. Schedule a call with us if you want us do give you an analysis on which would make the most sense for your needs and budget.
Starting Medicare After 65
For those who delayed enrollment in Medicare after turning 65, there is a Special Enrollment Period available to those who were originally allowed to delay Medicare.
Special Enrollment Period (SEP)
If you (or your spouse) continued to work past age 65 and/or were covered under your spouses (or your own) qualified group health insurance, you will need to enroll in Medicare once you retire and/or lose your group health insurance. This transition triggers a Special Enrollment Period which grants an 8-month window to sign up for Medicare Part B after losing job-based health coverage or retiring, whichever comes first.
If you don’t enroll in Medicare during this 8 month window, you will be penalized for life and might have to wait until the next year to enroll.
Final Remarks
Understanding the nuances of enrolling in Medicare at different stages is crucial for making the correct decisions about your healthcare coverage. Whether starting before, at, or after turning 65, individuals must decide a dozen different factors to make sure they’ve made the best possible decision on their health insurance needs.
Schedule a call with one of our advisors, we’d be more than happy to help you with your Medicare decisions!
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If you don’t have creditable health insurance coverage and you fail to enroll in Medicare, you will charged a lifetime penalty when you do decide to enroll in Medicare.
If you are covered under creditable health insurance coverage, many times it makes sense to delay your enrollment into Medicare. When you sign up for Medicare in the future, you should not have any penalties.
No, as long as you have qualified, creditable employer group coverage you will not have a penalty nor any loss of options for delaying Medicare Part B.
There is no way to know for sure without doing a full Cost-Benefit Analysis to compare your options versus group coverage. We'd be happy do to this analysis for you!
Technically, you don't have to sign up for Medicare if you don’t want to. Even if you have it currently, you are able to cancel your Original Medicare and go without health insurance coverage.
However, if you don’t have qualified and creditable health insurance coverage, you will incur a lifetime penalty if you ever decide to take Medicare in the future.
If you miss enrolling in Medicare when you turn 65 and you were not covered under a qualified group health plan, you can sign up during the General Enrollment Period (GEP) from January 1 to March 31 each year.
Keep in mind lifetime late enrollment penalties may apply if you miss these deadlines!