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Medicare Special Needs Plans

Key Points

If you are receiving Social Security Benefits at least 4 months before your 65th birthday month you’ll be automatically enrolled in Medicare.

The time to apply for Medicare is during your Initial Enrollment Period unless you qualify for a Special Enrollment Period.

You can apply for Medicare online, by phone, or in person at Social Security.
Applying for Medicare can feel intimidating, but your Medicare enrollment will be easier than you might think. We walk thousands of people through how to sign up for Medicare every year, so read on for everything you need to know to apply for Medicare. The Social Security Administration handles Medicare eligibility and applications for Parts A (hospital insurance) and B (outpatient medical insurance). They offer several easy options so you can choose how to apply for Medicare. If you are aging into Medicare, you may apply as early as 3 months prior to the month of your 65th birthday. You’ll find that getting started early is a plus so that you’ll have your new Medicare card in hand before your effective date. This is your Medicare Initial Enrollment Period to enroll in Part A and Part B. It is also your enrollment period for Medicare Part D. Since prescription drugs are not covered by Original Medicare, you purchase Part D separately from an insurance company. You do not enroll in it through Social Security because Part D is voluntary. Next, we’ll cover when to apply for Medicare.

When to Apply for Medicare

Medicare is separate from your application for Social Security income benefits. People age into Medicare at age 65, regardless of whether they are taking retirement income benefits yet. If you are a U.S. citizen aged 65 or older and need medical insurance, you are entitled to enroll in Medicare. You can also qualify for Medicare early due to certain disabilities, having Amyotrophic Lateral Sclerosis (Lou Gehrig disease), or End-Stage Renal disease (ESRD), and needing a transplant or on dialysis. Don’t expect that Medicare will notify you of when it’s time to sign up either. This can be especially important for those who live out of the country. If you are already taking Social Security income benefits or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Parts A and B at age 65. Your card should arrive 1-2 months before you turn 65. This timeframe also applies to those who qualify early due to disability. However, you will not automatically receive Part B benefits if you live in Puerto Rico. This means you will need to apply for Part B even if you receive Social Security benefits before age 65. If you are NOT yet taking retirement benefits, then you will need to submit a Medicare application yourself. The government expects you to know when to enroll. Let’s look at the timeline for when and how to register for Medicare.

Initial Enrollment Period

Your Initial Enrollment Period (IEP) for Medicare Parts A, B, and D last 7 months. It begins 3 months before your 65th birthday month and runs for 3 months after your birth month. Enrolling in Medicare during your IEP means that you will have no late penalties. There are also no pre-existing condition waiting periods.

When to register for Medicare Parts A, B, and D depends on whether Medicare will be your primary coverage, or whether you still have employer coverage.

Applying for Medicare As Your Primary Coverage

If Medicare will be your primary coverage, you should enroll in Medicare during the 3 months before your birth month. Your Medicare will start on the first of the month in which you turn 65. Enrolling before your birthday will ensure your benefits begin on the first of your birthday month.

If you apply for Medicare during your 65th birthday month or during the 3 months after, your Medicare benefits will start on the first of the following month after you apply.

Also, if you are leaving employer coverage in the middle of your Medicare Initial Enrollment Period, then your IEP trumps any other election period. We’ve seen this a number of times where people assume their Medicare coverage will start immediately after the group coverage ends.

However, if you are in your IEP and your birth month has already passed, this chart demonstrates that you must wait for your coverage.

It’s easy to see why applying for Medicare before your 65th birthday month is generally in your best interest. Although, it is ultimately your choice on when to apply.

Applying During the General Enrollment Period

If you have no other health insurance and you fail to enroll during your 7-month IEP, then you will be subject to a Part B late enrollment penalty of 10% for every full 12-month period that you were not enrolled.

You would need to wait until the General Enrollment Period to apply which is from January 1 to March 31 each year. Your Part A coverage and Part B coverage would not be effective until the 1st of the month after you apply. You also would not have hospital insurance or medical insurance and that could be financially devastating.

Key Takeaways

There are three enrollment periods for you to apply for Medicare: The Initial Enrollment Period, a Special Enrollment Period, and the General Enrollment Period.
If you are covered by creditable employer insurance past 65, you can delay Medicare and qualify for a Special Enrollment Period.
If you are not automatically enrolled in Medicare and need to apply, you can do so by phone, online, or in person through the Social Security office.