Medicare Enrollment

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Medicare Part B Enrollment

Enrolling in Part B

Medicare Part B covers medically necessary outpatient services for people with Medicare. That’s a broad description, but it basically means that Part B is going to cover many of the things that come to mind when you think about health insurance. That includes routine trips to the doctor, annual screenings (e.g., mammograms and colonoscopies), flu shots and other vaccines, checkups, ambulance rides and more.

Whereas Medicare Part A usually doesn’t have a premium, Part B does. This makes it important to enroll in this portion of Medicare when you’re first eligible. Otherwise, you might have to pay a penalty fee if you decide to get it later. Plus, delaying Part B enrollment could impact your coverage.

Unsure about when to enroll? Let’s talk about what you need to know when it comes to enrolling in Medicare Part B.

Initial Enrollment Period for Part B

For some people, enrollment into Original Medicare is automatic. This means that when you’re close to eligibility, based on either age or disability, you’ll be enrolled in the program without having to do it yourself. This applies to:

  • People already drawing retirement benefits from Social Security or the Railroad Retirement Board, or
  • People with disabilities who qualify for Medicare before turning 65.

If you’re already drawing retirement benefits by the time you qualify for Medicare, then you’ll be enrolled in both Part A and Part B. You have to be drawing benefits for at last 4 months before you turn 65 to get enrolled. And while enrollment is automatic, you can decline Part B coverage, though this is probably not a good choice for most people.

For people with disabilities, automatic enrollment happens once you’ve been receiving disability benefits for 24 months. You’ll be enrolled into Parts A and B on the 25th month of disability. The only exception is for people with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), who get enrolled into Original Medicare the same month their disability benefits start.

If you’re not drawing retirement benefits and you don’t qualify for Medicare based on disability, then you’ll need to sign up for Part B (and Part A) yourself once you’re eligible. This also applies to people with end-stage renal disease (ESRD). People with ESRD can qualify for Medicare at any age, but they don’t get enrolled into the program automatically.

For those who have to enroll themselves, the best time to do it is the Initial Enrollment Period (IEP), which is unique to each person. Your IEP runs for a total of 7 months: 3 months before the month you turn 65, the month you turn 65 and the 3 months after.

So, for example, if your birthday is April 11th, your IEP would run from January 1st through July 31st the year you turn 65.

Outside of this initial enrollment window, there’s only one other guaranteed chance to enroll in Part B, and it’s called the General Enrollment Period. But this isn’t an ideal time to enroll in Part B, as we’ll explain below.

Medicare General Enrollment Period

If you miss your initial enrollment period for Part B, either because you didn’t get around to it or thought you didn’t need the coverage, then you won’t be able to sign up until the General Enrollment Period, unless you qualify for a special signup period (discussed later).

The general enrollment period runs from January 1st through March 31st each year. You can use this 3-month window to enroll in Parts A and/or B if you missed your IEP. That’s what it’s for.

However, if you use this window to enroll, your coverage won’t start until July 1st. And there’s a penalty for late enrollment.

Penalty for Late Enrollment

Because Part B comes with a monthly premium, there’s a penalty fee for signing up late, meaning outside of your initial enrollment window. There’s actually a penalty for enrolling late in Part A, too, but it only applies if you’re in the small minority of people who have a premium for Part A. Most people don’t.

But most people do have a premium for Part B. So there’s a penalty fee for enrolling late.

This penalty is based on how long you waited to sign up for Part B. It’s 10% for each full, 12-month period that you could have had Part B but didn’t, added to whatever your Part B premium would be already. And, important to note, it lasts as long as you have Part B coverage — i.e., forever.

Let’s look at an example:

  • Your initial enrollment period for Part B ended on July 31, 2017.
  • You didn’t get coverage during this time, and you don’t have current work-based health insurance through your job or your spouse’s job.
  • In the summer of 2019, you decide you do need Part B coverage. But you have to wait until the next general enrollment period, which starts January 1st.
  • You enroll in Part B on January 1, 2020.
  • July 31, 2017 to January 1, 2020 is 29 months. Your Part B late enrollment penalty (10%) is based on the number of full, 12-month periods when you could have had Part B but didn’t. This means you’ll pay the late enrollment penalty based on 24 months — i.e., 20%.

This 20% penalty gets applied on top of your Part B premium. For most people, that’s the standard amount, which is $170.10 a month in 2022. Adding 20% to that brings the Part B premium up to about $204 a month.

For others, that might include an income-related monthly adjustment amount (IRMAA), which can increase what you pay each month for Part B. An extra 20% on top of that could make Part B pretty expensive.

The point here is that if you wait to enroll in Part B, you may have a penalty fee added to your premium, and that penalty never goes away.

And since your Part B coverage doesn’t start until July 1st if you enroll during general enrollment, you’ll also face having to pay for your medical care yourself in the interim.

We’ve said it before and we’ll say it again: the best time to sign up for Part B is when you’re first eligible.

Special Enrollment Situations

Of course, there are exceptions to that rule. For some people, it might make sense to wait to enroll in Part B. But these are special and very specific circumstances. You can delay enrollment in Part B without facing a penalty if you’re in one of the following scenarios:

  • You’ve got health insurance through work (or your spouse’s work) when you turn 65 and become eligible for Medicare.
  • You’re serving as a volunteer in a foreign country when you first become eligible for Medicare.
  • You have TRICARE.

For people serving as volunteers in a foreign country or those who are members of TRICARE, there may be more specific scenarios that you have to meet in order to get a special enrollment period for Medicare Part B. Contact Social Security or TRICARE directly for more information.

If you’re working when you turn 65 and you’ve got job-based health insurance, then you can, generally speaking, stay in your job-based coverage instead of enrolling in Part B. You won’t have a penalty fee for late enrollment if you enroll later as long as you or your spouse continues to work for the company that’s providing health insurance.

But be aware that certain other stipulations might apply. For example, if you work at a company with fewer than 20 employees, your job-based plan might not continue covering your claims if you don’t have both Part A and Part B. Talk to your company’s health plan administrator or Medicare directly to figure out if you need to enroll if you’re still working at age 65.

Once your employment ends or the job-based coverage ends (whichever happens first), you have 8 months from that date to enroll in Medicare Part B without a penalty. This is called the Part B Special Enrollment Period.

You can also enroll in Part B at any time while you’re still working if you’re eligible. But if you don’t, you have 8 months from the date your job-based coverage ends (or the job ends) to enroll in Part B.

If you miss the Part B special enrollment window, you’ll have to wait until the next general enrollment period to sign up for Part B. And at that point, you would face a penalty for late enrollment.

  • Note: the special enrollment window only applies if you’re working past your initial enrollment window at age 65. If you lose your job-based coverage or the job it’s based on and that happens during your initial enrollment period, you don’t qualify for a special enrollment period. You would use your IEP to enroll in Medicare in that case.

Medicare Open Enrollment

Each fall, current Medicare enrollees have a chance to change their coverage for the coming year. This period is known as the Medicare Open Enrollment Period (or annual election period), and it runs from October 15th through December 7th.

During this period, anyone who already has Original Medicare or Medicare Advantage can make changes to their coverage. That includes switching from Original to Medicare Advantage, going from one Advantage plan to another and changing Part D drug plans, among other things.

But the open enrollment period cannot be used to sign up for Medicare Part B if you don’t have it, unless it just happens to coincide with your initial enrollment window.

If you missed your IEP and need Part B coverage, the only way to get it after the fact is to use the general enrollment period or see if you qualify for a special enrollment period.

Medigap Enrollment

We talk about Medicare supplement plans, also known as Medigap, elsewhere. But we wanted to mention them here, too, because enrolling in Part B at age 65 triggers your initial eligibility window for Medigap. And that’s important.

Medicare supplement plans are medically underwritten. This means they can consider your health history in accepting your application and setting rates.

But this only applies outside of the Medigap open enrollment period, a window that starts on the first month you have Medicare Part B and you’re 65 years old and ends 6 months later. Once the window closes, it can’t be repeated. It’s triggered automatically when you’re 65 and you enroll in Part B for the first time.

During the Medigap open enrollment period, you can enroll in any Medigap policy that’s legally sold in your state, and the insurance company can’t charge you higher rates or deny your application based on medical history.

Outside of the open enrollment period for Medigap, you may not find a Medigap policy at all. And if you do, it may cost more depending on your health history.

Some states have different rules about this, and you may be able to enroll in Medigap outside the initial window. But the best time to enroll in Medigap (if you want or need it) is to do it during that 6-month open enrollment period when you’re 65 and have Part B for the first time.