New to Medicare? A Guide to Enrollment

June 23, 2016

by: Margie Johnson Ware, Aging and Health Specialist.

You would think that a basic question like “When and how do I get my first Medicare card?”  would be a simple yes/no/next month kind of response.

But because there are so many different Medicare situations, the answer can be a lot more complex.  You don’t want to be automatically enrolled in Medicare at age 65 and not know it. You also don’t want to wait to apply because you think it’ll happen automatically. That’s how people end up paying costly late enrollment penalties. Read on for more key enrollment tips for first time Medicare users.

1. Figure out the exact dates of your Initial Enrollment Period, and decide which parts of Medicare to apply to.

Let’s take a look at the case of Joanna Perkins, a VP of Marketing who is turning 65 soon. Her period of Initial Eligibility for Medicare (also known as the Initial Enrollment Period) begins during the three months before the month of her 65th birthday. For Joanna, that means that she can apply for Medicare as early as August 1, because she will be 65 on November 25th. This seven month Initial Enrollment Period is the same for all Medicare users: you can enroll in Medicare during the three months before your 65th birthday, the month of your 65th birthday, and the three months after your 65th birthday.

Now that Joanna has determined her enrollment deadline, she decides to apply online at the Social Security website. She could also visit her local Social Security office, or call them at 1-800-772-1213; all three options are valid ways to enroll. Because Joanna is still covered by employer insurance, she can delay enrolling in Parts A & B until she retires (Part B would charge her a monthly premium for coverage she doesn’t need yet, due to her employer coverage). Once Joanna retires and loses her employer coverage, she can enroll in the other parts of Medicare (Part B, Part D, Medigap, or Part C/Medicare Advantage) during her Special Enrollment Period.

Are you turning 65 soon? Make sure to determine the dates of your own Initial Enrollment Period as early as possible. The dates are different for every person depending on when their 65th birthday is. And start reading up on Medicare even before that seven month window starts. Should you wait to enroll in certain parts of Medicare until you retire, like Joanna did? Or should you enroll in everything immediately?

For a complete guide to delaying any of the parts of Medicare due to your employment status, check out this “65 and Still Working” guide. And for access to free, personalized coverage advice from a licensed Medicare advisor, check out the Medicare Questionnaire.

2. Know when you are eligible for automatic enrollment in Medicare, and when you are not.

Joanna ALMOST didn’t apply for Medicare at all, because her next-door neighbor Ron got his Medicare card in the mail without doing anything. Until she learned otherwise, Joanna thought she could just wait until the card showed up in her mailbox too. So why did Joanna have to apply to Medicare herself, when Ron got his card automatically? It’s because Ron retired and took his Social Security benefit early, at age 64. If you are already getting Social Security retirement or disability benefits (or Railroad Retirement benefits) when you reach Medicare eligibility, you will be enrolled in Medicare Parts A & B (Original Medicare) automatically. Therefore, SSA automatically enrolled Ron in Original Medicare, whereas Joanna needed to apply on her own.

If you are currently on Social Security (either through early enrollment or disability), remember to look for your Medicare card in the mail. If you are within three months of your 65th birthday, or more than two years into receiving disability payments, you should already have a card. If you are concerned that you may be due for a card but have not yet received it, call the Medicare office at 1-800-Medicare.

3. If you are on Social Security disability, learn more about how that affects your Medicare enrollment options.

Finally, let’s take a look at the case of Joanna’s sister Bridget. Bridget sustained a crippling back injury in 2012 and went on Social Security disability. Once Bridget had been on disability for two years, she became eligible for Medicare and was enrolled in Original Medicare (Parts A and B) automatically. But because she didn’t know to look for it, she never opened the envelope with her new Medicare card. Bridget’s medical costs were incredibly high, and she had no idea what to do about it.

All individuals on Social Security disability are automatically enrolled in Original Medicare after two years (24 months). In some cases, you can receive Medicare in less than two years if Social Security determines that your disability started before your disability application date, or if you have Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD).

If you receive Social Security disability, check with your present insurance company to understand what your next steps are, or call your local State Health Insurance Assistance Program (SHIP) . In addition to your automatic enrollment in Original Medicare, you may want to enroll in additional parts of Medicare, i.e a Medicare Advantage plan, a Part D drug plan and/or a Medigap plan.  If you are low-income you may also be eligible for Medicare Savings Programs to pay out-of-pocket costs, depending on what the rules are in your state. To learn more about how disability benefits interact with Medicare coverage, check out this disability guide.

When in doubt, always discuss your Medicare situation with a trustworthy, unbiased professional. You can access free Medicare advice from licensed benefits advisors by taking the Medicare Questionnaire, created by the nonprofit National Council on Aging.