When should you enroll in Medicare? It’s not strictly a “turn 65 and get Medicare” scenario. What if you decide to work past age 65 and have employer insurance? What if you’re still on your spouse’s insurance plan?
When it comes to Medicare enrollment, every individual’s needs and circumstances are unique. You have several Medicare enrollment periods and opportunities you can take advantage of, based on your coverage needs. Rely on the expertise of the Medicare Advocates and Advisors at Wandacare to guide you through these periods and help you avoid any late enrollment penalties.
Initial Enrollment Period
You’re first eligible to enroll in Medicare during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday, includes your birthday month, and continues for three months after your birthday month. If you are receiving disability benefits or are already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you will be automatically enrolled in Original Medicare Part A (hospitalization) and Part B (medical insurance).
During your IEP, the team at Wandacare will help you complete your initial enrollment for Medicare through the Social Security Administration (SSA) to verify your eligibility and then choose to either enroll in Original Medicare Part A and Part B or a Medicare Advantage Plan (Part C). If you choose Original Medicare, you can also elect to enroll in Medicare Part D prescription drug coverage and supplemental Medigap coverage. Your Medigap Open Enrollment Period begins the month you turn 65 and lasts for six months.
General Enrollment Period
You have seven months total for your Initial Enrollment Period. However, if you miss your IEP you can enroll during the Medicare General Enrollment Period (GEP), which runs from January 1 to March 31 every year. However, your coverage won’t take effect until July 1, and you may incur late enrollment penalties for failing to enroll during your IEP.
Special Enrollment Period
Perhaps you’re elected not to enroll during your IEP because you’re still covered by your employer’s healthcare plan, or you’re on your spouse’s plan. When that coverage ends, you’ll be able to enroll for Medicare during a Special Enrollment Period (SEP). You typically have eight months from the time your other coverage ends to enroll in Medicare without facing late enrollment penalties.
The SEP also applies to current Medicare enrollees (Original Medicare and Medicare Advantage) who need to drop or change their plan coverage due to certain events, such as moving out of your plan’s service area, international relocation, or having to move to a long-term care facility.
Annual Enrollment Period
The Medicare Annual Enrollment Period (AEP), is when individuals already enrolled in Medicare can make changes to their coverage and plans. The Annual Enrollment Period runs from October 15 to December 7 every year and applies to everyone enrolled in Original Medicare (Parts A and B), Medicare Advantage Plans (Part C), and Medicare Part D prescription drug plans.
AEP is your opportunity to make any plan changes or adjustments based on your healthcare needs and budget, including switching plans (between Original Medicare and Medicare Advantage or from one Medicare Advantage Plan to another) and adding any “parts” you may be eligible for. Any changes you make during AEP go into effect on January 1 of the following year.
Medicare Advantage Open Enrollment Period
If you enroll in a Medicare Advantage Plan, you’ll have two opportunities to make changes to your plan coverage: the Medicare Annual Enrollment Period and the Medicare Advantage Open Enrollment Period.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 every year (the same timeframe as the Medicare General Enrollment). This period gives those with Medicare Advantage plans an additional, one-time, either-or choice to switch to a different Medicare Advantage Plan or move from Medicare Advantage to Original Medicare, along with the ability to enroll for prescription drug coverage (Part D). Any changes then take effect the first day of the following month.
Medicare Late Enrollment Penalties
If you are eligible for Medicare and do not have other acceptable coverage but fail to enroll for Medicare coverage within the appropriate enrollment periods, you could be facing a late enrollment premium penalty for the life of your Medicare coverage. That’s right! Late enrollment penalties are not one-time late fees. They are added to your monthly premium, assessed based on how long you went without coverage, and you’ll pay them for as long as you have that coverage.
Here’s how late enrollment penalties are assessed based on the “part” of coverage:
Medicare Part A Late Enrollment Penalty
You’ll have 10% added to your monthly premium and you’ll pay the penalty for twice the number of years you didn’t have Part A coverage. For example, if you were eligible for Part A for a year but failed to enroll, you’ll pay the penalty on your premium for two years. The Part A late enrollment penalty is the only one not assessed for the life of your coverage.
Medicare Part B Late Enrollment Penalty
You’ll have 10% added to your monthly premium based on every year you didn’t have Part B coverage. For example, if you were eligible for Part B for two years but failed to enroll, you’ll pay a 20% late enrollment penalty for the life of your coverage.
Medicare Part D Late Enrollment Penalty
If you don’t enroll in Medicare Part D and go without a Part D plan or other creditable prescription drug coverage for 63 days or more in a row, you’ll pay a monthly Part D late enrollment penalty assessed at 1% of the monthly “national base beneficiary premium” times the number of full months you didn’t have Part D or creditable coverage.
For example, if you go a whole year before enrolling in Part D and don’t have creditable coverage during that 12 months, your penalty and new premium would be calculated as:
.12 (12% penalty) × $34.70 (2024 base beneficiary premium) = $4.16
$4.16 rounded to the nearest $0.10 = $4.20, the penalty added to your monthly Part D premium for 2024.
You’ll have to pay the assessed penalty (recalculated annually) for as long as you have Medicare drug coverage.
Avoiding Late Enrollment Penalties and Gaps in Coverage
Ensuring timely enrollment is vital to avoiding penalties and securing the coverage you need. However, the most effective approach is to rely on the expertise of the Wandacare team. By entrusting us with your enrollment, you can navigate the complexities at no additional cost and guarantee the receipt of all entitled benefits without the worry of potential penalties. Even if you anticipate coverage from an employer plan, a spouse’s plan, or another federal program (such as VA benefits) when you turn 65, it’s essential to verify your coverage. Eligibility may change upon reaching 65, making it even more imperative to let Wandacare handle your enrollment seamlessly.
For a hassle-free enrollment experience and to ensure you don’t miss out on any benefits, take the first step today. Visit our website at wandacare.com and submit a form, or give us a call at (863) 880-1616. Our dedicated team is ready to assist you in securing your Medicare coverage and avoiding unnecessary penalties.
