Applying for MediCare

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A lot of information about signing up for MediCare can be found online!  However, even some  information on the Social Security and Medicare sites is confusing or not up to date!


To help when applying for the federal MediCare program lets look at the proper steps: 

First – MediCare itself

  When a person reaches 65 the Medicare system considers them eligible to apply. 

      Note: An under 65 person, approved by Social Security, also becomes eligible after 24 months of  receiving disability benefits. 

      [They have until month 28 to decide what to do.]


The Social Security system is responsible to process a person's application not the MediCare system.

     Note: When a person's application is complete and they have an effective date the MediCare system considers them entitled.


A look at when you can apply? 

Federal regulations limit the when  a person can apply for Medicare Part A and Medicare Part B and established the following eligibility periods:

Initial Eligibility Period (IEP)

When a person is turning 65 they have a 7 month period to take action if they want to apply. If this is the time to apply it can be completed through the Social Security during: 


● The three months before eligible  (when 65). If an application is completed during one of these months their coverage will be effective the first day of the month when 65. 

    Note: If a persons birth day is the 1st day of a month coverage begins the first day of the previous month.


● The month turn 65.  Coverage will be effective the first day of the next month.


Any of the three months after eligible - coverage is delayed:

     + Apply one month after 65 – until first of second month after application. 

     + Apply second or third month after 65 –  until first of third month after application.  

Special Enrollment Period (SEP)

When a person worked past age 65 and then decided to sign up they have an up to 8 month period to apply. 


What are the rules? If apply while still on the employer plan or the first month after leaving coverage can start (you decide ) the first day of: 

Month you apply or 

Any of following three months.


What do you do? It is important, when leaving an employer after 65, to call the Local Social Security office for an appointment with a Retirement person. 

 

Why an appointment? A couple special things need to be done to qualify for a SEP

Ask the retirement person for Form CMS-L564

Take the form to your employer to fill in the dates you were on the company medical benefit plan. 

Take it back to the SS office when signed. 

    Why a special form? Providing proof of leaving coverage qualifies a person for the SEP. The signed form also eliminates Part B's late enrollment penalty. 

   [No proof - 10% is added to Part B's cost for each 12 months of not having enrolled.] 


     Note - Part A start gets adjusted:  When applying after 65 the SS system adjusts the effective date retroactive six months from the Part B date. 

     Alert - this means if enrolled in a HSA contributions must stop 6 months before the Part B effective date. 

General Enrollment Period (GEP)

This is a special time each year for the person who did not apply for Part B during their IEP or use a SEP. 


However, the rules for the GEP are different:

  The application for Part B can not be submitted until after the next Jan 1st and must be in before March 31st to receive Part B.

  A person in this situation would: 

       + not have coverage for any MD or outpatient treatment expenses

       + be able to apply for medication coverage in a Medicare Prescription Drug Plan since the needed Part A can be started at any time.

  

  The effective date for a person using a GEP will not be until July 1st! 


The situation of having to use a GEP can happen to a person who left an employer, elected COBRA, and stayed enrolled until it ended.] 

Send a note with any enrollment questions

Feel free to contact - Learn@JohnCParker.agency