When and How to Apply for Medicare

When and How to Apply for Medicare

Even though Medicare is an entitlement program, you must apply at the right time, or it's going to cost you!

The initial enrollment period (IEP) is a set period of time during which you are first eligible to apply for Medicare benefits. If you fail to apply during this eligibility window and do not fit into an exception category, be prepared to pay a lifetime penalty of 10 percent of the cost of your premium for every 12 months you could have had Medicare and didn't.

Whenever you have an entitlement to Medicare, you must apply and purchase during your enrollment period or be prepared to pay a penalty and potentially be without coverage. The IEP for most to apply for Medicare Part A (premium-free hospital insurance) and purchase Medicare Part B (medical insurance) is the three months before the month you turn 65, the month you turn 65, and the three months following. For coverage to start the beginning of your birth month, apply any time during the three months prior to your birthdate. If you apply during any of the remaining four months, your Part B coverage will start later.

For those under age 65 who reach their 25th month of receiving Social Security Disability Insurance (SSDI). Similar to those reaching age 65, the IEP is three months before reaching the 25th month of SSDI, the 25th month, and three months following.

The following exceptions apply:

  • if you or your spouse are on active duty and you reach your 25th month of SSDI; or
  • if you are over age 65 and have health care coverage under a group health plan (GHP) under current employment for you or your spouse, you can apply without a late enrollment penalty during a special enrollment period (SEP).

The SEP allows you to apply for Medicare penalty-free within eight months of losing GHP coverage or employment, whichever occurs first.

What happens if you fail to sign up during your IEP, despite being warned? Your option is to enroll during the general enrollment period (GEP), which runs Jan. 1 through March 31 of each year. However, your Medicare Part B coverage will not begin until July 1 of that year. Under the Affordable Care Act, you would need to procure coverage elsewhere until your Medicare entitlement went into effect.

How does this work with TRICARE For Life (TFL)? With the exception of active duty military families, who have an option for TRICARE Prime continuation with SSDI, all others who are approaching their 65th birthday must apply for Medicare Part A and purchase Medicare Part B in order to automatically be enrolled in TFL - commonly referred to as Medicare wrap-around coverage. Because TFL acts as your Medicare supplement, you can ignore solicitations for other Medicare supplement insurance plans. Roughly three months prior to your 65th birthday, you should receive a postcard from the Defense Manpower Data Center reminding you to apply for Medicare. Once you are enrolled and receive your red, white, and blue Medicare card, you must visit your local military installation and update your military ID card to indicate you are covered under Medicare.

The final element is signing up for Medicare. You have three options: online, in person at your local Social Security office (check www.ssa.gov for an office near you), or by calling Social Security at (800) 772-1213.

For additional information, visit www.medicare.gov or www.tricare4u.com.