For most people, your Medicare effective date can be as soon as the first day of the month you turn 65. But situations vary and some people are eligible to have coverage start much sooner.
Your Medicare effective date is the first day that you are covered under Medicare benefits, though the effective date may be different for Parts A and B. Your Medicare start date is influenced by when you are initially eligible for Medicare and when you enroll.
When Are You Eligible for Medicare?
For most people, Medicare enrollment eligibility starts at age 65. If you are under 65, there are instances in which you would be eligible for Medicare. Age is not the only factor in determining Medicare eligibility. To qualify for Medicare, you must also:
- Be a U.S. citizen or permanent legal resident
- Have lived in the U.S. for at least five years
When does your Medicare coverage start if you are turning 65?
Medicare coverage start dates depend on when you enroll. The Initial Enrollment Period (IEP) is a seven-month period to enroll in Medicare. You first become eligible to enroll in Medicare three months before you turn 65 and it ends three months after you turn 65.
The coverage start date is heavily dependent on when you enroll during this time frame.
|When you sign up for Part A and/or B||When coverage starts|
|Months 1 to 3 before turning 65||The first day of the month you turn 65|
|The month you turn 65 to 3 months after||The first day of the month after you sign up|
When are you eligible for Medicare before the age of 65?
If you are collecting Social Security Administration (SSA) Disability, you are eligible for Medicare 25 months after you qualify for benefits.
Other conditions have shorter time frames. For example, for amyotrophic lateral sclerosis (ALS) you are immediately eligible for Medicare when approved for SSA. For end-stage renal disease (ESRD) the time period is three months after receiving dialysis or having a kidney transplant.
When Should You Enroll in Medicare if You Are Turning 65 Soon?
You should start Medicare enrollment before you turn 65, but there’s a window of opportunity for your Initial Enrollment Period. And if you’re collecting SSA benefits, your enrollment is automatic.
How do you enroll if you are going to start collecting SSA benefits?
You will automatically be enrolled in Medicare Parts A and B if you are collecting SSA benefits prior to age 65.
How do you enroll if you are not going to collect SSA benefits yet?
If you are not currently enrolled in SSA benefits prior to your Initial Enrollment Period (IEP), you will need to apply for Medicare yourself.
Most people do not pay a premium for Part A because they or their spouse) have paid enough in Medicare taxes during their employment history. Part B will always have a premium that has to be paid. You can sign up for Parts A and/or B by doing the following:
- Apply online
- Call 1 (800) 772-1213 or 1 (877) 772-5772 for the Railroad Retirement Board
- Contact your local SSA office
When Are the Medicare Enrollment Dates?
Medicare enrollment dates vary based on the type of enrollment you are participating in. Below is a chart of the most common types of enrollments, how you can qualify for a specific enrollment, and the enrollment period.
|Type of Enrollment Period||Description||Enrollment Dates|
|Initial Enrollment Period (IEP)||This IEP applies to when you first turn 65.||This period lasts for seven months. It starts three months before you turn 65 and lasts three months after you turn 65.|
|Open Enrollment Period (OEP)||This is an Annual Enrollment Period in which you can make changes to your overall Medicare plan. These changes include:
|Oct. 15-Dec. 7. Plan changes go into effect on Jan. 1 of the next year.|
|General Enrollment Period (GEP)||If you are eligible for Medicare and did not enroll during your IEP, you can enroll during the GEP.||Takes place Jan. 1-March 31 every year and the Medicare Effective Date is July 1 of the same year.|
|Special Enrollment Period (SEP)||A Medicare SEP allows you to switch plans or sign up outside of the standard Medicare enrollment periods.
|Enrollment time frames vary depending on the reason for the SEP.|
|Medicare Advantage OEP||The Medicare Advantage OEP allows you to switch to a different Medicare Advantage plan or go back to your Original Medicare after your Annual OEP.||Jan. 1-March 31 with an effective date of the first day of the month after you make a change.|
What Happens if You Enroll in Medicare Late?
Enrolling in Medicare after you are eligible to do so without an SEP may cause you to suffer a penalty, which applies to Part B and D only.
For every 12-month period you could have had Part B but didn’t sign up, you incur a 10% penalty for as long as you have Part B. This penalty doesn’t apply if you had creditable health coverage.
When there’s a period of 63 days in a row in which you were eligible for Part D but did not enroll, you add 1% of the premium for every full month without creditable coverage.
It’s important to enroll in Medicare when you are eligible if you do not have health insurance or drug coverage.
Do You Have To Enroll in Medicare at Age 65?
No. Medicare does not force you to enroll at age 65. In most cases, if you have premium-free Part A and are not contributing to a health savings account (HSA), there is no downside to enrolling in Part A if you continue to work and have creditable health insurance.
When you, or your employer, are contributing to an HSA, you should not enroll in Medicare Parts A or B. High Deductible Health Plans do not allow you to have secondary insurance in order to receive the tax benefits of an HSA.
For Part B, you may decide to not enroll if you have health insurance because you would pay a monthly premium and receive no benefit. If you are not collecting SSA benefits, you don’t have to do anything.
But if you are collecting SSA benefits, Medicare will automatically enroll you. You are able to disenroll by submitting form CMS-1763 and completing an interview in person or by phone with the SSA either at your local office or by calling 1 (800) 772-1213.
Learn More From Our Sources
- Medicare.gov | Special Circumstances (Special Enrollment Periods) | Last accessed August 2022
- Medicare.gov | When Can I Sign up for Medicare? | Last accessed August 2022
- SSA.gov | How Do I Terminate My Medicare Part B (Medical Insurance)? | Last accessed August 2022