Understand Your Initial Enrollment Period
Copyright © 2014 AARP. All rights reserved.
The initial enrollment period (IEP) is the earliest time that you’re entitled to sign up for Medicare. Typically, it occurs around the time you reach 65. But of course, if you’re getting Medicare because of disability, it takes place at some earlier age.
The Social Security Administration automatically enrolls you in Medicare Parts A and B if you’re already receiving Social Security (or Railroad Retirement Board) disability or retirement payments by the time your IEP rolls around. But if you’re not yet getting these benefits, you need to apply for Medicare.
Take a look at when your IEP begins and ends, and consider the circumstances in which you should use your IEP to actively enroll in Parts A and B — first if you’re doing so around age 65, and then if you’re qualifying for Medicare because of disabilities.
Be aware of the special enrollment period that allows you to delay Part B without penalty beyond the end of your IEP if you have health insurance from your or your spouse’s current work.
Use your IEP at age 65
This initial enrollment period lasts for seven months — beginning three months before the month of your 65th birthday and ending three months after that month. For example, if your birthday is in July, your IEP begins April 1 and ends October 31.
To avoid late penalties, you should use your IEP to sign up for Medicare Part A and Part B in the following circumstances:
You have no other health insurance.
You have individual (nonemployer) insurance that you pay for yourself.
You have other health insurance from your or your spouse’s current job but want to drop it as soon as possible to rely on Medicare, perhaps because the employer insurance costs too much or has inadequate benefits.
You’ve stopped working but have no health insurance from your spouse’s current job (even if you have retiree benefits or COBRA extension coverage from your former employer; these don’t count as employer coverage).
You aren’t covered by health insurance from your or your spouse’s current active employment, even though you’re continuing to work.
You’re covered by health insurance from your (or your spouse’s) job, but the employer has fewer than 20 employees and requires you to enroll in Medicare.
You have health benefits from the military’s TRICARE For Life (TFL) retiree program, which requires you to take Medicare Parts A and B as a condition for continuing to receive TFL coverage.
You’re a veteran and have health benefits from Veterans Affairs, which doesn’t require you to sign up for Medicare Part B. But if you don’t enroll during your IEP (or SEP, if applicable) and you decide in future years that you want Part B, you risk late penalties.
You’re a federal retiree and have health insurance under the Federal Employees Health Benefits Program, which doesn’t require you to enroll in Part B. But if you don’t take Part B during your IEP (or SEP, if applicable) and decide in the future that you want it, you risk late penalties.
You’re not entitled to premium-free Part A benefits, but you’re eligible to buy Part A services by paying premiums and/or you’re eligible for Part B coverage.
There are other specific, more-complicated situations in which you may need to sign up for Medicare during your IEP. These include not being a U.S. citizen; living abroad or in prison; being in a same-sex marriage; and being in a nonmarried relationship with a partner of the same or opposite sex.
Take advantage of your IEP when you have disabilities
When you qualify for Medicare on the basis of disability, your IEP also lasts seven months. But in this case the fourth month — when your Medicare benefits become effective — is typically the month in which you receive your 25th disability payment. For example, the 25th check is due in April, so your IEP begins January 1 and ends July 31.
In this situation, you don’t usually need to concern yourself about deadlines for signing up. Enrollment happens automatically, and Social Security mails your Medicare card to you in good time before your eligibility starts.
It sends a letter with the card, explaining that you’ve been enrolled in Part A and Part B. This letter also explains that you can decline Part B if you want to — and, if you do, provides instructions on how to go about it.
You need to be very careful about declining Part B. The issue of opting out of Part A and/or Part B is very important — and comes with some serious pitfalls that you must be aware of.