Chief Executive Officer

Anthony Kavouras

Is your 65th birthday around the corner? If so, it may be time for you to consider enrolling in Medicare. Medicare provides comprehensive, life-saving coverage to over 64 million Americans, and in most cases, it becomes available to you once you turn 65. 
Three months before your 65th birthday is when the Initial Enrollment Period (IEP) begins. Though it’s not necessary that you enroll during the IEP, it is recommended to enroll during this window to ensure there is no lapse in healthcare coverage and to avoid any penalties. That’s why it’s important to know how to enroll in Medicare before your IEP begins. With that timetable in mind, we devised this easy-to-follow guide instructing you on how to sign up for the first time.

Medicare is a national health insurance program provided by the U.S. federal government for individuals 65 years and older. Special allowances are provided to those under the age of 65 with disabilities — including those who have been diagnosed with end-stage renal disease (ESRD) resulting in permanent kidney failure — but generally, most people consider signing up for Medicare in preparation for their 65th birthday.
For some, enrollment into Medicare is automatic. If you already receive retirement or <a href="https://www.ssa.gov/benefits/medicare/" target="_blank" rel="noreferrer noopener">disability benefits from Social Security</a>, the online portal will also serve as your application for Medicare. When you get approved for those benefits, you’re also approved to start receiving Medicare coverage with no premiums when you turn 65.
If you haven’t applied for retirement or disability benefits from Social Security, you’ll need to apply for Medicare to receive your benefits. The easiest way to do this is to sign up for Medicare through the <a href="https://www.ssa.gov/help/iClaim_medSEP.html" target="_blank" rel="noreferrer noopener">Social Security website</a>. Believe it or not, applying only takes about 10 minutes.
Documentation may be needed to verify eligibility based on age, citizenship, income history, or military service. The following documents are good to have on hand when applying:
<ul>
<li>Social Security card</li>
<li>Your original birth certificate or a certified copy</li>
<li>Proof of U.S. citizenship such as a U.S. passport or driver’s license</li>
<li>Proof of legal residency if you are not a U.S. citizen</li>
<li>A record of your service or discharge papers if you had served in the U.S. Military</li>
<li>A W-2 or self-employment tax information</li>
</ul>

The Initial Enrollment Period (IEP) is a seven-month period around your 65th birthday, when you can apply to receive Medicare Part A and Medicare Part B benefits. It begins three months before your birth month, your birth month, and extends three months past it. If you do not apply for Medicare during this time, you may be risking a lapse in coverage and may incur penalties in the form of higher premiums when you do apply.
If you or your spouse are still working during your 65th birthday and are covered through a group health plan tied to that employment, you may not need to register for Medicare Part B during the IEP. Instead, you could qualify for a <a href="https://www.ssa.gov/help/iClaim_medSEP.html" target="_blank" rel="noreferrer noopener">Special Enrollment Period (SEP)</a>. In this case, you can apply for Medicare Part B while you’re still covered by the group health plan or within an eight-month window when the employment or group health plan benefits end.
Once you’re signed up for a Medicare plan, you can only adjust your coverage during Annual Enrollment periods. The <a href="https://www.openmedicare.com/guide/medicare-101/medicare-fall-open-enrollment-guide" target="_blank" rel="noreferrer noopener">Annual Enrollment</a> period occurs annually from October 15th through December 7th where you can join, switch, or drop Medicare plans. If adjustments are made during this time, they go into effect on January 1st of the following year. There is also Medicare Advantage Open Enrollment period from January 1st through March 31st each year. If you’re enrolled in a Part C Medicare Advantage plan, this is when you can make one adjustment to your plan, including altering your current coverage, switching Medicare Advantage plans, or switching to Original Medicare.

Individuals who meet at least one of the following criteria are eligible for Medicare:
<ul>
<li>Have certain disabilities</li>
<li>Have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)</li>
<li>Are 65 years old and over</li>
</ul>
You can visit the <a href="https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol" target="_blank" rel="noreferrer noopener">Centers for Medicare &amp; Medicaid Services’ webpage</a> to learn more about eligibility requirements. 
While veterans are not required to apply for Medicare, the Department of Veteran Affairs (VA) recommends that veterans do enroll during their IEP. VA health benefits only provide coverage for VA clinics, so Medicare may offer more coverage options. Delaying registration for Medicare Part A and Medicare Part B coverage until after the IEP can also result in penalties, which are costly percentages added to your monthly premium. These penalties sharply rise the longer you wait to sign up to incentivize hesitant enrollees. 
Each type of Medicare has its own enrollment penalty. You may be able to get around them if you qualify for a Special Enrollment Period — such as if you are still working and have health insurance through your employer. However, these situations are generally limited in nature, so it’s a good idea to double-check with a licensed insurance agent to make sure you don’t incur long-lasting fees.

There are four <a href="https://www.openmedicare.com/guide/medicare-101/parts-of-medicare" target="_blank" rel="noreferrer noopener">parts of Medicare</a>, so it’s important to familiarize yourself with each one to determine which is best for you.
<ul>
<li>Medicare Part A. Sometimes referred to as “Hospital Insurance” and part of Original Medicare, this covers in-patient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.</li>
<li>Medicare Part B. This is commonly referred to as “Medical Insurance,” and it covers doctors' services, outpatient care, medical supplies, and preventive services. Part B is also classified as Original Medicare.</li>
<li>Medicare Part C. Also called “<a href="https://www.openmedicare.com/guide/picking-a-plan/is-a-medicare-advantage-plan-right-for-me" target="_blank" rel="noreferrer noopener">Medicare Advantage</a>,” this type of Medicare coverage is provided by a private company that includes similar coverage as Medicare Parts A &amp; B. In many cases, it also includes prescription drug costs (Part D). Medicare Advantage may include benefits not offered in Original Medicare such as dental, vision, and other benefits.</li>
<li>Medicare Part D. Also known as “Prescription Drug Coverage,” this can help cover the cost of prescription medicine.</li>
</ul>

After applying during your IEP, it can take two to six weeks for approval. Once you have been approved for Medicare, it can take another two to four weeks to receive your Medicare card. However, you’ll receive your Medicare number when you are approved. 
The date your coverage starts depends on two things: the type of Medicare plan you’re applying for, and the month you sign up during your IEP. In both cases, coverage generally begins on the first day of the succeeding month.* If you sign up the month before you turn 65, you won’t need to wait if your birthday comes at the end of the month — you’ll have coverage immediately, and can begin other applications for supplement plans such as Medicare Advantage and Part D.
*A special provision is in place for those whose birthdays are on the first day of the month; they receive Part A coverage the month before turning 65. Their seven-month period also starts earlier: four months before turning 65 and ends two months after.

Do you still have questions or feel confused about the next steps in the Medicare sign-up process? We can help address the challenging enrollment process for Medicare. Discover more from our helpful library of resources, or talk to a professional — <a href="https://www.openmedicare.com/" target="_blank" rel="noreferrer noopener">OpenMedicare</a> can connect you with a licensed insurance agent who can find a plan that meets your needs.<hr />
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