Essential Medicare Deadlines to Keep in Mind
If you are 65 or older (or under 65 and meet certain criteria), you are eligible for Medicare. It’s important to know that you are not automatically enrolled in Medicare. You will need to know when to sign up in order to avoid penalties. These Medicare deadlines are essential to know so you can avoid any surprises.
But first, a quick intro to Medicare
Medicare is basic health insurance provided by the Federal government for people 65 and older and people under 65 who meet certain criteria. When you sign up for Medicare, you are signing up for Part A and Part B. This is the first step to completing your Medicare coverage.
Medicare consists of 4 separate parts:
- Part A (Part of Original Medicare offered by the Federal government)
- Part B (Part of Original Medicare offered by the Federal government)
- Part C (Medicare Advantage plans offered by private insurance companies)
- Part D (Drug coverage offered by private insurance companies)
Here’s the rundown on Medicare deadlines
Signing up for Part A and Part B
Your specific Medicare deadlines depend on your age, if you are still working, are ready to retire, or get your health coverage from your spouse’s employer.
Medicare deadline: Almost 65 and ready to retire
There is a 7-month window for signing up for Medicare Part A and Part B. You can sign up 3 months before the month of your 65th birthday, during your birthday month, or 3 months after your 65th birthday month. This is called the Initial Enrollment Period.
If your birthday falls on the 1st of the month, Medicare treats it as if your birthday took place in the previous month. For example, if your birthday is on June 1, Medicare treats it as a May birthday and your 7-month window is shifted back 1 month.
When does your coverage begin once you sign up?
It depends when you sign up within the 7-month window.
3 months before your birthday
If you sign up for Medicare Part A and/or Medicare Part B during the first 3 months of your Initial Enrollment Period, your coverage begins on the first day of the month that you turn 65.
Your 65th birthday is on May 20. If you sign up for Medicare in February, March, or April, your coverage will start on May 1.
Your birthday month or within 3 months after your birthday month.
If you sign up...
Your coverage begins...
The month you turn 65
1 month after you sign up
1 month after you turn 65
2 months after you sign up
2 months after you turn 65
3 months after you sign up
3 months after you turn 65
3 months after you sign up
Medicare deadline: 65 or older and ready to retire
If you work past the age of 65 and get health care coverage through your employer, you can wait to sign up for Medicare (Part A and Part B) until you retire or your coverage with your employer ends. In this scenario, you have an 8-month window (from when you retire) to sign up for Medicare (Part A and Part B). This is considered a Special Enrollment Period.
Medicare deadline: 65 or older and still working
If you are 65 or older, currently employed, and get health care coverage through your employer, you can wait to sign up for Medicare (Part A and Part B) until you retire or your coverage with your employer ends. In this scenario, you have an 8-month window (from when you retire) to sign up for Medicare (Part A and Part B). This is considered a Special Enrollment Period.
Medicare deadline: 65 or older and have health insurance through your spouse
If you have health insurance through your spouse’s employer, you don’t need to sign up for Medicare (Part A and Part B) when you turn 65 or retire. You can sign up for Part A and Part B up to 8 months after your spouse’s employer coverage ends. This is considered a Special Enrollment Period.
Important reminder: You are not automatically covered by Medicare through your spouse. Unlike health insurance you may have had through your employer, Medicare does not allow you to receive coverage through your spouse. In order to receive Medicare coverage, you must apply for it individually.
Medicare deadline: Special Enrollment Periods
There are certain Special Enrollment Periods (SEPs) for Medicare that let you make changes to your Medicare Advantage plan and Medicare prescription drug coverage. Some situations that qualify as Special Enrollment Periods include moving, losing your current coverage, and more. Rules about when you can make changes and the type of changes you can make are different for each Special Enrollment Period. You can view a more comprehensive list of these scenarios on the Federal government’s Medicare website.
What about Part C and Part D?
Signing up for Medicare Part A and Part B is the first step, but it isn’t the only step. Many people discover that relying on Original Medicare (Part A and Part B) doesn’t provide enough coverage. For example, Original Medicare only covers 80% of Par B expenses after the annual Part B deductible is met. The remaining 20% is your responsibility and could add up to thousands of dollars each year. Plus, Original Medicare doesn’t include Part D prescription drug coverage.
Medicare Advantage plans (Part C) offer additional coverage not included with Original Medicare such as prescription drug coverage, vision and hearing exams, preventive dental coverage, and discounts on fitness programs. Plus, many Medicare Advantage plans include Part D prescription drug coverage.
In addition, Medicare Advantage plans can help save you money with monthly premiums as low as $0 and an out-of-pocket maximum that limits what you pay for medical services in a year.
Medicare deadlines to sign up for Part C and Part D
To add a Medicare Advantage plan (Part C) and prescription drug coverage (Part D), you need to first sign up for Medicare Part A and Part B. Once enrolled in Part A and Part B, you can sign up for Part C and Part D during the same Initial Enrollment Period (3 months before the month of your 65th birthday, during your birthday month, or 3 months after your 65th birthday month) or, if you work past 65, you can sign up once you retire during your 8-month Special Enrollment Period.
Are there penalties for missing Medicare deadlines?
Yes, if you don’t sign up for Part A, Part B, or Part D during your initial enrollment period or your special enrollment period, Medicare assigns you a penalty.
Medicare Part A late enrollment penalty
Some people have to buy Part A because they don't qualify for premium-free Part A. If you have to buy Part A, and you don't buy it when you're first eligible for Medicare, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you didn't sign up.
Medicare Part B late enrollment penalty
If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your Part B premiums, for as long as you have Part B.
Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
Medicare Part D late enrollment penalty
Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" times the number of full, uncovered months you didn't have Part D or creditable prescription drug coverage. For example, if you go 12 months without coverage, the penalty will be 12% of the "national base beneficiary premium". The "national base beneficiary premium" is the average monthly premium for Medicare drug plans in the nation, as determined by Medicare. In 2021 this average premium amount is $33.06. The penalty amount is then rounded to the nearest $.10 and added to your monthly Part D premium.
12% X 33.06 = $3.96 rounded to $4.00
The national base beneficiary premium may change each year, so your penalty amount may also change each year.
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