How to Sign Up For Medicare and When

How Do I Sign Up for Medicare?

Are you just getting started in researching Medicare and you need to know to apply for Medicare, when you can apply for Medicare or even how to delay your Medicare enrollment?  This blog post covers that and includes changes in enrollment made during the pandemic as well as changes implemented as of 2023.

How Do I Apply for Medicare and When?

As soon as you turn 64-years of age you should start researching how to sign up for Medicare. The first question people ask themselves is How do I sign-up for Medicare?  You will also need to know whether you qualify to apply for premium free Part A or are qualified to delay your Medicare health care insurance without penalty.

Medicare Part B Automatic Enrollment

Let’s start with the easy part first.  There are to groupsHow to sign-up for Medicare of people who will automatically be enrolled in Medicare.  Everyone else will need to sign up for Medicare coverage.

The first group are those under 65 and on Social Security disability income. People under 65 and on disability income will be eligible for Medicare and automatically enrolled in Part A and Part B coverage (aka Original Medicare) after 24-months of disability income. In that case, your Original Medicare coverage starts on first day of the 25th month of receiving disability income. Your Medicare card will arrive in the before benefits start.

The second group:  includes those who are not disabled but decided to start Social Security retirement benefits early, before age 65.  If you have been receiving Social Security or Railroad Retirement Board benefits for at least four months prior to the month you turn 65, you too will have automatic enrollment.   You will be automatically enrolled and should receive your Part A and Part B Medicare card at least 60-days before your medical insurance start date.

FYI – for eligibility, whenever I mention Social Security Income you can also include Railroad Retirement Board Income. Social Security or the Railroad retirement board are interchangeable.

In either case, you will be provided with the option to opt-out of Medicare benefits if you so choose.  There will be an opt-out card in your welcome packet from the United States Government centers for Medicare and Medicaid Services.

Everyone else must physically sign up for Part A and Part B coverage. If you are eligible for premium free Part A, you will automatically receive Part A when you sign up for Medicare Part B coverage.

What I am going to cover first is how, then when to enroll.

What Is Medicare?

When you apply for Medicare, you will receive a red, white, and blue card as proof of enrollment in Part B and / or  Part A.  We will cover Part A and Part B very shortly.

In this blog we will focus solely on how and when to sign up for Part A and Part B coverage, also known as Original Medicare.  Your Medicare Part D prescription drug coverage is separate.  I have details on your insurance for Part D prescription drugs at my PartDShopper.com website.  You want to avoid the Part D Penalty as well.

How to sign-up for MedicarePart A is your inpatient hospital insurance coverage.  It is the part of Medicare that helps pay for your care whenever you are an inpatient in a hospital or other medical facility.

As you worked over the years you have likely noticed Medicare taxes deducted from your paycheck.  That tax deduction paid for Part A. If you or your spouse have worked for at least 40-quarters during your lifetime and Medicare taxes, you are eligible for Part A premium free.

Medicare Part B is your medical insurance for outpatient and physician care. Any outpatient services and durable equipment are covered under Part B.  Basically, if your health care is not covered under Part A it is covered under your Part B. Keep in mind, Medicare’s intent is to cover everything that is medically necessary and they rely on your doctor to determine medical necessity.

Medicare Part B has a monthly premium.  Most people will pay the standard monthly premium which changes every year.   Higher income beneficiaries will pay an extra surcharge.  Your Part B cost the government more than $600 per month. The higher your income the closer you get to paying that full amount of your Medicare costs.

I have a video and blog on the Medicare surcharge called Income Related Monthly Adjustment Amount or IRMAA that is worth reading.  You can also find my detailed description of the benefits of Part A and B there as well.  I will leave you to explore that on your own so as to keep this video brief.

When you are ready to start your Medicare enrollment, go to the Social Security website to apply online.  Medicare law is a subset of Social Security law.  Keep in mind, you do not have to receive Social Security Income to get Medicare.  Benefits from Social Security do not impact Medicare benefits and visa versa. What I am about to go through is how to enroll in Medicare alone, without enrolling for Social Security income.

Your Initial Enrollment Period

Here is what is important about your enrollment period and the fact that Part A is already paid for; if you are eligible for Medicare Part A premium free there is no penalty for late enrollment in Part A.  Technically there is no late enrollment for Part A.  I will get more into that in a moment.

Plus, you can enroll in Part A only and, if you qualify, delay Part B indefinitely.

Generally, we encourage people to enroll in Medicare Part A even if you will delay enrolling in Part B.  Your Part A cost nothing and will work with your other health insurance to increase your insurance coverage.  You can enroll by calling the Social Security Office.  You no longer need to go into the Social Security Office to enroll in Medicare.  We will have more on that in a moment.

Medicare Part B however does have a premium and you can be penalized if you do not enroll when you are supposed to.

Unless you are disabled under 65, the earliest your Medicare can start is the first day of the month you turn 65.  Medicare always and only starts on the first day of the month.

The period of time you need to enroll in Medicare is called your Initial Enrollment Period.  It is a seven month that includes your 65th birthday month, the three calendar months prior to your birthday month and the three calendar months after your birthday month. Seven months in total. This period of time is when you should enroll in Medicare Part A, Part B, and Part D (Medicare prescription drug coverage).

The One Exception

There is one exception to that rule.  There is always an exception.  If your birthday lands on the first day of a month, then your entire enrollment period is moved forward by one month.  I have an enrollment calculator on my website that I will link here (above left shoulder) and down below.   But let’s do a quick example.

How to sign-up for Medicare

Initial Enrollment Example

For example, if your birthday is April 20th.    The first day your Medicare can start is April 01.  You can apply for Medicare as of January 1st (Three calendar months prior to the start of your Medicare).  The last day you can apply for Medicare during your Initial Enrollment Period is July 31st, the last day of third month after your birthday month.

In this example, the person applying for Medicare prior to April 01 will have a Medicare start date of April 01.  If the application was submitted in April, Medicare will start May 01.  If the application is submitted in May, Medicare will start June 01, and so on.

Medicare Changes As of 2023

This is new as of 2023.  If you saw a video or an article that referenced a time penalty for enrolling after your birthday month but still during your Initial Enrollment Period, that time penalty no longer exist as of 2023.

Referring to the one exception – If your birthday was April 01st instead of the 20th, then the entire process will move forward by one month.  Your Medicare can start no earlier than March 01.  Your Initial Enrollment Period starts the prior December 01st and ends June 30th.

No Medicare Card Required

As you start this enrollment process, please keep in mind that it takes time for Medicare to get that red, white, and blue card out to you.  In fact, it typically takes about 30-days after you apply to get your card in hand.   If your Medicare starts before you receive a card, no worries.  Your Medicare benefits exist whether you have the card or not.  Everything will simply be rebilled once you receive your card and Medicare number.

Can I Delay Medicare Part B Enrollment?

You can delay enrolling in Medicare as long as you have creditable insurance coverage.  Medicare defines the term creditable to be health insurance that at least as robust as Original Medicare.

How to sign-up for Medicare

Will I be penalized for Not Signing Up for Medicare at age 65?

If you fail to enroll in Part B during your initial enrollment period and you do not have creditable coverage, you can expect to pay a penalty equal to 10% of the Part B premium for every twelve months you went without Part B.  This penalty is to be paid with every Part B premium payment for the rest of your life and increases with the cost of Medicare.  The twelve-month count down starts the day your Medicare would have started if you enrolled when you were supposed to.

What is Medicare Creditable Coverage?

Medicare creditable coverage is health insurance that Medicare deems is generally equal to coverage you would have if you were enrolled in Medicare Parts A & B.

An employer group health plan is generally accepted as creditable coverage. If you or your spouse have employer group healthcare that you prefer over Medicare, you can delay enrolling in Medicare indefinitely without the risk of a penalty.

This table helps you determine if your current health insurance is Medicare creditable.

Your Situation Is it Creditable? Coordination of Benefits
Are you 65 or older with an employer group health plan through your or your spouse’s employer AND the employer has 20 or more employees? Your coverage is considered creditable. Your group health plan will pay first, then Medicare (if you have it) will pay as secondary.
Are you 65 or older with an employer group health plan through your or your spouse’s employer AND the employer has fewer than 20-employees Your coverage is NOT considered creditable. You must have Medicare. Medicare will pay first; employer coverage will pay as secondary.
You are no longer actively working, but your former employer is providing healthcare. Your coverage is NOT considered creditable. You must have Medicare. Medicare will pay first; former employer coverage will pay as secondary.
If you are under 65 and are eligible for Medicare due to a disability and your current employer has 100 or more employees. Your coverage is considered creditable. Your group health plan will pay first, then Medicare (if you have it) will pay as secondary.
If you are under 65 and are eligible for Medicare due to a disability and your current employer has fewer than 100 employees. Your coverage is NOT considered creditable You must have Medicare. Medicare will pay first; employer coverage will pay as secondary.
You have TriCare for Life plus Medicare Part A & B TriCare for Life is secondary to Medicare, like a supplement
You have TriCare for Life plus a Medicare Advantage Plan (Part C) That replaces Part A and B. The Advantage Plan pays first, TriCare pays as secondary. You must pay first, then submit your bills to TriCare manually.

What To Do Delay Medicare Part B Without Penalty?

So here is the situation; you are over 65.  You delayed your Medicare because you preferred your creditable employer coverage.  How do you start Part B without being penalized?

Easy, you can start your Part B any month you choose.  You will create your own Special Enrollment Period by simply choosing which month to start Medicare and submitting the application along with the Form CMS-L564 I mentioned earlier.   Simply have your employer sign the form or follow the instructions online if you cannot get your employer to sign the form.  That’s it.  It’s that simple.

How To Enroll In Medicare

You apply for Medicare coverage through the Social Security administration website. Although you can visit a local Social Security Office and enrolled in medicare coverage, it’s very easy to enroll in Medicare online and takes much less time. If you are to visit a local Social Security office, you will need to make an appointment.

Because the Social Security Administration closed their offices during the pandemic, they changed their online procedure so that people can sign up for Medicare health insurance coverage online much easier.

Keep in mind, you can sign up for Medicare without applying for Social Security benefits. but you will still need an online Social Security account through MySocialSecurity.gov to complete the Medicare application.

To enroll in Medicare go to SSA.gov/Medicare

How to sign-up for Medicare

This is what the page looks like.  It starts with a brief explanation of Medicare Parts.

In 2022 it will also have a section about “Time Penalties” when you enroll during your initial enrollment period but after your birthday month.  As of 2023 these penalties will be gone.

How to sign-up for Medicare

To sign up for Medicare Part A & B look for the bright blue button.  Click this if you are enrolling in BOTH Medicare Part A and Part B during your Initial Enrollment Period.   It’s very simple as long as you already have a MySocialSecurity.gov website where you check your estimated Social Security income.

How to sign-up for Medicare

If you delayed enrolling in Medicare until after your Initial Enrollment, scroll down just a bit more to “Already Enrolled In Medicare”.  Follow these instructions if you already have Medicare Part A or if you are applying for Part B because you are leaving employment.  Retiring. 

These instructions are very straightforward

You will have to create a My Social Security if you don’t already have one.  Again, this does not mean you are signing up to receive Social Security checks.  We are not doing that here. 

Form CMS-40B is your application.

Form CMS-L564 is for your employer to sign attesting that you had creditable employer coverage and are not subject to a late enrollment penalty. 

What If you can’t get your employer to sign form CLS-L564?

That is covered here as well.  You simply have to go through some extra hoops to show you had group health insurance. 

If you delay Part B because you have employer coverage, when can you enroll in Part B?  How do you do so and not be penalized?

If you lose your employer coverage, how long do you have to enroll in Part B before being penalized?

What about HSA accounts?   Why is your Part A start date important if you have an HSA account?

Medicare Loss of Employer Coverage

What if you lose your employer coverage or quite without first enrolling in Part B?

When you are over 65 and you lose creditable health coverage you have 8-months to enroll in Part B.  The 8-month period begins the month after your creditable health plan ends. 

Warning – the 8-month period referred to Medicare Part B.    You will have only 63-days to enroll in a new Part D prescription drug plan. 

Uh Yep, I didn’t design this system or these enrollment periods.

What about Part A?

If you started your Part A when you turned 65, then there is no big deal.  But, if you didn’t start your Part A and you are enrolling more than six months after turning 65, Part A has a slight curve ball.   Your Medicare Part A start date will be six months retroactive to when you enroll in Part B.  If this is October and you want your Part B to start in November, your Part A will start as of last May 01.  It starts six months retroactively. Any inpatient services you had in that time will be rebilled under Part A.

HSA Account and Medicare

If you have a Health Savings Account (HSA), the retroactive start date of Part A can get you into Tax trouble.  You cannot contribute to an HSA account when you have active Medicare. That is why if you are past your enrollment period you need to stop contributing to your HSA six months before you start your Medicare full time.

Deciding when to stop contributing to your HSA can be confusing.   We built the guide below to help you make the right decision with your HSA contributions.

HSA & Medicare
If You Apply for Medicare: During your Initial Enrollment Period (IEP) Your Part A will start on your initial enrollment date. Avoid tax penalties by stopping HSA contributions before your Initial Enrollment date.
If You Apply for Medicare: Two-months after your IEP has ended. Your Part A will start on your initial enrollment date. Avoid tax penalties by stopping HSA contributions before your Initial Enrollment date.
If you apply for Medicare after your Initial Enrollment Period but… Less than six-months after the month you turn 65 Avoid a tax penalty by stopping HSA contributions before your Initial Enrollment month.
If you apply for Medicare after your Initial Enrollment Period but… Six or more months after your 65th birthday month Avoid a tax penalty by stopping HSA contributions six-months before you apply for Medicare.

FAQ

Yes.  If you are turning 65 and within your Medicare Initial Enrollment Period you can apply online at https://www.ssa.gov/benefits/medicare/.  If you are over age 65 and outside of your Medicare Initial Enrollment Period, you will find all you need to enroll online at https://www.ssa.gov/benefits/medicare/.  However, some documents will need to be faxed, mailed or personally delivered to a Social Security office.

No.  While you can use the benefits of your HAS account at any time.  Once any part of Medicare has started, you may no longer contribute to an HAS account without penalty.

Extra caution should be used for those who are over 65 and applying for Medicare because Medicare Part A will start as much as six months retroactive to your application date.

Yes.  Medicare benefits are not predicated on your employment status.

If you miss your Medicare Initial Enrollment Period and did not have creditable healthcare, like employer health insurance, then you will need to apply during the General Enrollment Period.  The General Enrollment Period is from January 01 through March 31, with you Medicare then starting on July 01.

If you have creditable health insurance coverage after the age of 65 you can enroll in Medicare at any time with penalty. 

Most employer plans cost more than Medicare plus a supplement.  In addition, they will typically have higher deductibles and coinsurance than Original Medicare and a supplement.  We advise doing a simple cost benefit analysis before deciding to keep or change from your employer coverage.

If you or your spouse has already paid into Medicare payroll taxes for at least 40-quarters, then your Medicare Part A is fully paid for.  In that case, there is no late enrollment penalty for enrolling in Medicare Part A and you can enroll anytime after age 65.

If you didn’t get Part B when you’re first eligible, your monthly premium may go up 10% for each 12-month period you could’ve had Part B but didn’t. In most cases, you’ll have to pay this penalty each time you pay your premiums, for as long as you have Part B. If you are without Medicare part B for less than six months, it is possible to avoid a penalty.

You may owe a late enrollment penalty for Medicare Part D if, after your Medicare Initial enrollment Period, you go a minimum of 63 consecutive days without Medicare Part D or creditable coverage.

The financial penalty for late enrollment in Medicare Part D is 1% of the national base beneficiary premium for each full month without coverage.  You pay this penalty every month for as long as you have Medicare Part D.

The hidden penalty for not having Part D is what you may pay for your prescriptions when you don’t have Part D insurance.  Many serious medical conditions come with drug prices that can bankrupt the average consumer.  Keep in mind that after your initial enrollment period you will have to wait until the Annual Election Period to apply for Medicare Part D (October 15 – December 07) with a January 01 start date.

No.  Many top tier insurance companies will allow you to apply for a Medicare supplement before you have a Medicare number.  Depending on your state, you may submit an application up to six-months in advance.  However, your benefits cannot start until both Medicare Part A and Part B are active.

Yes, the application for Medicare Part D requires a Medicare number.

Summary
How to sign-up for Medicare
Article Name
How to Sign-Up for Medicare and When (Step by Step)
Description
How to sign up for Medicare and when. Are you required to enroll when you turn 65? What if you want to delay Medicare? Can you? How? What is creditable coverage? Can i still have my HSA account? We answer all these questions and more, so that you can make an informed decision.
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Publisher Name
Medigap Seminars
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Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.

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