Times and how to apply for MediCare

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People report the online information on when & how to sign up for MediCare is confusing! 


I am pleased to help with - what to do & proper steps when you want to sign up for the federal MediCare program:

First – what happens when you reach 65!

  Rules say - "eligible" first of the month you turn 65.  - Do not have to sign up! 

      Note: Person under 65, qualified for Social Security disability, also eligible after receiving benefits for 24 months. 

Want to sign up at 65!

 Social Security (SS) not MediCare is responsible for the eligibility and sign up rules. I recommend going to your Local SS office. 

Note: When your application is complete - Rules say "entitled"and you are covered by:

    -> Part A for inpatient hospital services.

    -> Part B for medically necessary outpatient services.

Your ID card will show entitled above Part A and B.

Rules to sign for MediCare Part A & Part B are set at the federal level! Eligibility periods are:

Initial Eligibility Period (IEP)

It's a seven month period around the month eligible.  

A person can sign up during:  

● The three months before eligible. Part A & B coverage will be effective the first of eligible month.
    Note: If birthday is the 1st day of a month then eligible the previous month. 


● The month eligible and in any remaining month of the IEP. Then: 

   -> Part A is always effective the first of eligible month.

 

   -> Part B's date however uses the date applied and is the first of the:

        + Next month if sign up month when 65

        + Second month after if sign up the month after 65. 

        + Third month after if sign up in second or third month after 65. 


     Note: If sign up in third month after 65 Part B is six months after Part A.

A Special Enrollment Period: (SEP)

A special time to sign up for Medicare's Part B when leaving employer coverage after age 65: 


First the rules: 

● A person covered by an employer medical plan and over 65 can apply anytime.

● Leaving creates an eight-month SEP to start Part B beginning, whichever is first, the month after: 

    -> employment ends or 

    -> employer coverage ends


● If apply while still covered you can have Part B start the:

   -> First of [your choice] any of the following three months


● If apply the first month after you can have Part B start the:

   -> First of the month they sign up – thus no days without coverage.


● If apply in any remaining month of their SEP: 

     -> Part B will start the first of the next month.


Second - how to make sign up happen: - Call the Local Social Security office Retirement person to meet about starting Part B. When there: 

● Review options to pay for your share of the monthly cost of Part B

● Ask for Form CMS-L564 to take to your employer to fill in dates covered by the medical benefit plan and get it signed. 

● When signed and taken back to the SS office the form:

      -> qualifies a person for the SEP to sign up for B.  

      -> eliminates the late enrollment penalty. 

     Note: If proof of prior coverage was not available - an additional 10% is added to Part B's cost for each 12 months of not signing up. 

 
FYI - SS sets Part A retroactive six months from the date assigned for Part B. 

     Alert - if enrolled in an employer's HSA your contributions must stop six months before the date assigned to Part B. 


The General Enrollment Period: (GEP)

A special time to sign up for Part B when a person did not apply in their IEP nor qualify for a SEP. 


The rules to sign up and get Part B in a GEP are special:

  The application can only be submitted between Jan 1st and March 31st.

  Part B will not be effective until July 1st! 


When a GEP is used what medical treatment coverage does a person have ? They can: 

   Activate Part A  [done anytime ] and have hospital coverage. 

   Sign up for a Medicare Prescription Drug Plan. The date for medication coverage may also have to wait to July 1st, depending on when Part A was activated.


What about MD or outpatient treatment? The person would have to pay for any until July 1st. 


Any questions on how or when to sign up for MediCare or on adding a Medicare Health Plan?


Feel free to send a note - Learn@JohnCParker.agency