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When you’re looking for insurance coverage as you approach retirement and the Medicare eligibility age, it’s important to keep enrollment on your radar. All Americans aged 65 and older qualify for Original Medicare coverage, which includes Part A (hospital insurance) and Part B (medical insurance). However, those with disabilities, End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) can also qualify regardless of age.

When you qualify for Medicare coverage, it’s important to be prepared for your Initial Enrollment Period (IEP) so you don’t receive late enrollment penalties. We are here to help you know what you need for enrollment by understanding when your IEP opens and what actions you need to take during that time.

Preparing for Your Initial Enrollment Period

The Medicare IEP starts three months before your 65th birthday and closes three months after. You can enroll at any time during this period. Some people are automatically enrolled in Medicare premium-free Part A because they’ve been receiving Social Security or Railroad Retirement Board benefits for at least four months before turning 65. If this doesn’t apply to you, then you’ll need to enroll in Medicare when your IEP opens.

When it’s time to sign up for your Medicare benefits, you’ll need to go through Social Security to complete the process. You can plan ahead by setting up your secure my Social Security account online before your IEP begins. Once your IEP opens, you’ll be ready to fill out your forms and sign up for Medicare.

In addition to signing up for Original Medicare, you’ll need to sign up for a Medicare Advantage or Part D (prescription drug coverage) plan. Unlike Medicare Part A and Part B, Part D isn’t a government-sponsored plan. You’ll need to work with a private insurance company like Wellcare or go through an insurance broker to find a plan that’s right for you. You can get a head start on the process by shopping plans before your IEP opens.

Late Enrollment Penalties and How to Avoid Them

If you miss the six-month IEP, you could be subject to late enrollment penalties. Medicare late penalties are different from other types of late fees you might have from a credit card or your utility bills. The biggest difference is that Medicare late fees are not a one-time fee. Rather than paying a specific dollar amount with enrollment, your late penalties will be attached to your monthly premium and could continue for the lifetime of your plan. Each part of Medicare comes with its own late enrollment penalties:

  • Part A: Those who don’t qualify for premium-free Part A and miss the IEP will have to pay a penalty double the number of years you didn’t sign up. For example, if you didn’t sign up for Medicare Part A until you turned 66 (one year after the eligible age), you’ll have to pay a penalty for the next two years.
  • Part B: If you missed the IEP when you turned 65 and didn’t sign up for Part B, you’ll have to pay an extra 10% on your premium for each year you could’ve signed up but didn’t. For example, if you didn’t sign up for Medicare Part B until you turned 66, then you’ll have to pay an extra 10% on your premium for the next year. •
  • Part D: Not everyone needs to sign up for a Medicare Part D plan. Those who have credible drug coverage (coverage that’s equal to or better than what’s offered with Part D plans) are exempt from enrolling. However, if you don’t have such coverage, you’ll need to enroll at 65. If you miss your IEP, then you’ll have to pay an extra 1% every month.

Qualifications for Early Medicare Enrollment

While most people don’t reach the Medicare eligibility age until they turn 65, there are a few exceptions to the rule for those who qualify early. Those who are over 18 years old and have one or more of the following conditions will qualify for Medicare:

  • You have a disability and have received Social Security Disability benefits for at least 24 months.
  • You have been diagnosed with End-Stage Renal Disease (ESRD).
  • You have been diagnosed with ALS (Lou Gehrig’s disease).

Knowing what age you’re eligible for Medicare is important so you don’t miss the enrollment window. Remember, you can sign up for Medicare as early as three months before your 65 birthday and as late as three months after. Be prepared when the time comes, so you don’t accrue any late enrollment penalties. Get in touch with a member of our team to learn more about Medicare eligibility.

Medicare Eligibility Questions

How do I check my Medicare eligibility? has a calculator that makes it easy to check your Medicare eligibility. Answer a few questions and it’ll tell you the year you qualify for enrollment and whether you qualify for disability Medicare.

What are the other eligibility requirements for Medicare?

Some people can qualify for Medicare under the age of 65. You can qualify for Medicare if you’re over 18, have a disability and have been receiving Social Security Disability Benefits for 24 months. Other conditions that qualify patients for Medicare are End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease).


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Sources - 5 things you need to know about signing up for Medicare - When Does Medicare Coverage Start - Avoid Penalties

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