Paul Sanchez
Medicare is a federal health insurance program for people aged 65 and over. If you are turning 65, you can apply for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). If you are already receiving Social Security retirement benefits, you will be automatically enrolled in Medicare Part A. If you do not receive Social Security benefits, you can apply for Medicare online. Your coverage will typically begin the month after you sign up. If you miss the 7-month Initial Enrollment Period, you may have to pay a monthly late enrollment penalty.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare? | People aged 65 or older. Individuals under 65 may be eligible if they have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease). |
| What is Medicare Part A? | Hospital Insurance covering hospitalization, home or skilled nursing, and hospice. |
| What is Medicare Part B? | Medical Insurance. |
| When to sign up for Medicare? | During the Initial Enrollment Period (IEP), which is a 7-month period beginning 3 months before an individual turns 65, including their birthday month and ending 3 months after they turn 65. |
| What if I miss the Initial Enrollment Period? | You may have to pay a monthly late enrollment penalty for Part B coverage and Part A if you have to pay a premium for it. |
| What if I have job-based insurance? | If you have insurance through your job, you can sign up anytime while working and still covered by the group health plan. You have an 8-month Special Enrollment Period (SEP) after you lose your job-based insurance or stop working. |
| What if I'm still working at 65? | You can apply for Medicare only if you're not ready to receive Social Security benefits. |
| How to apply for Medicare? | Contact your local Social Security Office or apply online. |
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What You'll Learn
Understanding Medicare Parts A and B
Medicare is federal health insurance for anyone aged 65 and older and some people under 65 with certain disabilities or conditions. Most people sign up for Part A (hospital insurance) and Part B (medical insurance) when they first become eligible at 65.
Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. If you don't have to pay a premium for Part A, you can choose to sign up when you turn 65 or anytime later. If you are 65 or older and receive Social Security benefits, you will be automatically enrolled in Part A. Part A coverage begins up to 6 months before the month you apply if you are over 65. If you qualify for premium-free Part A, your coverage starts the month you turn 65. If your birthday is on the first of the month, coverage starts the month before you turn 65.
Part B is medical insurance. You can wait until you (or your spouse) stop working (or lose your health insurance) to sign up for Part B, and you won't pay a late enrollment penalty. Once you stop working or lose your insurance, you have an 8-month Special Enrollment Period (SEP) to sign up for Medicare or add Part B to existing Part A coverage. If you don't sign up for Part A and Part B, your job-based insurance might not cover the costs for services you get.
Original Medicare includes Part A and Part B. You pay for services and items as you get them. You must be lawfully present in the US for Medicare to pay for Part A and Part B-covered services. You can also shop for and buy supplemental coverage that helps pay your out-of-pocket costs.
If you or your spouse have health insurance through your job, you can sign up at any time while working and still covered by the group health plan. You can also sign up within 8 months of the day you or your spouse stop working, even if your group health plan continues for a time. Your coverage typically begins the month after you sign up.
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Eligibility and enrolment
Medicare is the federal health insurance program for people aged 65 and over. If you are under 65, you may be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
Eligibility and Enrollment
- If you are aged 65 or older and receive Social Security benefits, you will be automatically enrolled in Medicare Part A.
- If you are not receiving Social Security benefits at 65 because you are still working, you can apply online for Medicare only.
- If you are not eligible to receive Social Security benefits, you must file an application for Medicare by contacting the Social Security Administration.
- Part A coverage begins the month the individual turns 65, provided they file an application for Part A within 6 months of turning 65.
- If you do not enroll in Part B or premium Part A when first eligible because you were performing volunteer service outside of the US for at least 12 months, you may enroll using the Special Enrollment Period (SEP).
- If you or your spouse have health insurance through your job, you can sign up at any time while working and still covered by the group health plan.
- If you have retiree coverage from a previous job, it may not pay for your health services if you don't have both Medicare Part A and Part B.
- If you don't have to pay a premium for Part A, you can choose to sign up when you turn 65 or anytime later.
- To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child.
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Deadlines and penalties
It is important to be aware of the deadlines and penalties associated with signing up for Medicare insurance after your 65th birthday to avoid any gaps in coverage or late enrollment penalties. Here is some information regarding these:
Deadlines
The Initial Enrollment Period for Medicare insurance typically begins three months before you turn 65 and ends three months after you turn 65, giving you a total of seven months to sign up. This is the ideal time to enroll to ensure you have coverage by the time you turn 65.
If you or your spouse are still working and have health insurance through your job, you have additional flexibility. You can sign up for Medicare at any time while you are still covered by your employer's group health plan. Additionally, you have an eight-month Special Enrollment Period that starts when you or your spouse stop working or lose your health insurance, whichever comes first. During this period, you can sign up for Medicare without incurring late enrollment penalties.
Penalties
If you miss the Initial Enrollment Period and do not qualify for a Special Enrollment Period, you may be subject to late enrollment penalties. The penalty for Part B (Medical Insurance) is an extra 10% for each full year that you could have had Part B but did not enroll. For example, if you waited two full years to sign up for Part B and did not qualify for a Special Enrollment Period, you would pay a 20% late enrollment penalty on top of the standard monthly premium.
The Part A (Hospital Insurance) penalty is calculated differently. If you need to buy Part A because you don't qualify for premium-free Part A, your monthly premium may increase by 10% for twice the number of years you delayed signing up. For example, if you were eligible for Part A for two years but didn't sign up, you'll have to pay a higher premium for four years.
It's important to note that these penalties are usually charged for as long as you have that type of coverage, which could result in a lifetime penalty. Therefore, it is advisable to enroll during the Initial Enrollment Period or Special Enrollment Period to avoid these additional costs.
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Applying for Medicare while working
If you're still working at 65, you may not need to enrol in Medicare right away. The rules vary depending on what type of health insurance you have. If you have health insurance through your job, you can sign up anytime while working and still covered by the group health plan. If you don't pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 or anytime later.
If you have group health insurance that's available to everyone at your company, you can wait until you stop working or lose your health insurance to sign up for Part B (Medical Insurance) without paying a late enrolment penalty. Once you stop working or lose your health insurance, you have an 8-month Special Enrollment Period (SEP) to sign up for Medicare or add Part B to existing Part A coverage.
If you have retiree coverage from a previous job, it may not pay for your health services if you don't have both Medicare Part A and Part B. It's important to ask your employer or insurance provider whether you need to sign up for Medicare when you turn 65 to avoid a monthly late enrolment penalty.
If you have coverage under a group health plan through an employer with 20 or more employees, you don't have to enrol in Medicare right away. However, if your employer has fewer than 20 employees, you need to take Medicare Parts A and B as your primary insurance. If you don't enrol, your employer plan may pay less or nothing at all for your care.
Medicare eligibility starts at age 65, with an initial window to enrol in the seven-month period beginning three months before your 65th birthday and ending three months after it. Seniors are advised to sign up on time to avoid penalties, such as a 10% surcharge on Medicare Part B premiums for each year without coverage upon eligibility.
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Additional Medicare options
There are two main ways to get your Medicare coverage: Original Medicare and Medicare Advantage.
Original Medicare
Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Most people sign up for Parts A and B when they first become eligible, typically at 65. If you're already covered through an employer group health plan, you may want to delay signing up for Medicare or Part B. If you're 65 or older and receiving Social Security benefits, you will be automatically enrolled in Part A. You can choose to sign up for Part A when you turn 65 if you don't have to pay a premium for it.
Medicare Advantage
Medicare Advantage Plans (Part C) are offered by Medicare-approved private companies and must follow rules set by Medicare. Most plans include drug coverage (Part D). You must have both Part A and Part B to join a Medicare Advantage Plan. You can be disenrolled from a Medicare Advantage Plan for several reasons, including moving outside the plan's service area or losing Medicare eligibility.
Supplemental Coverage
You can also purchase Medicare Supplement Insurance (Medigap) from a private company to help pay your share of costs in Original Medicare. Medigap policies generally do not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs. Some policies offer coverage for when you travel outside the U.S. Generally, you need Part A and Part B to buy a Medigap policy.
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Frequently asked questions
You can apply for Medicare Insurance online. If you are not ready to receive Social Security benefits at 65 because you are still working, you can apply for Medicare only. If you are already covered through an employer group health plan, you may be able to delay signing up for Medicare Part B.
Medicare Part A covers hospital insurance, home or skilled nursing, and hospice. Most people get Part A for free. Medicare Part B is medical insurance, and some people have to pay a premium for this coverage. Medicare Part C is a private insurance option that covers hospital and medical costs, and Part D covers prescription medications.
If you qualify for premium-free Part A, your coverage starts the month you turn 65. If your birthday is on the first of the month, coverage starts the month before you turn 65. The date your coverage starts depends on which month you sign up during your Initial Enrollment Period (IEP). Coverage always starts on the first of the month.
Yes, there may be a monthly late enrollment penalty for as long as you have Part B coverage. The penalty increases the longer you wait. If you have to pay a premium for Part A, you may also have to pay a penalty.
