When am I eligible to enroll in Medicare?
Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) for Medicare Plans A and B is 7 months, starting three months before the month of your Medicare eligibility and ending three months after. If you are eligible because you are turning 65 years old, your month of eligibility is usually your birthday month (exception: people born on the first of a month become eligible the month prior to their birthday). If you are eligible due to a disability, your month of eligibility generally coincides with the 25th month of receiving Social Security Disability Insurance (SSDI). If you are diagnosed with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease), however, you will be eligible for Medicare sooner. For more information, contact Social Security at www.ssa.gov or 1-800-772-1213.
General Enrollment Period (GEP)
General Enrollment Period (GEP) is for people who did not sign up for Parts A and B during their IEP (and did not defer enrollment due to creditable coverage) or who terminated their part A or B benefits and wish to re-enroll. This period is from January 1 through March 31 of each year with benefits beginning the following July 1. People enrolling at this time may be subject to late enrollment penalties.
What are the enrollment requirements for Medicare coverage?
- Medicare Part A
- There is no monthly Part A premium for people who have at least 40 quarters of Social Security credits. People who have contributed less than 40 quarters to Social Security and meet the citizenship and residency requirements may be eligible to purchase Part A for a monthly premium.
- You will be automatically enrolled in Part A the month of your 65th birthday if you are receiving retirement benefits from Social Security or the Railroad Retirement Board. If you are not receiving retirement benefits from Social Security (1-800-772-1213) or from the Railroad Retirement Board (1-877-772-5772), you will need to contact these agencies three months before you turn 65 in order to enroll in Medicare Part A.
- If you are a person with a disability, you will usually be enrolled in Part A effective the 25th month of receiving Social Security Disability Insurance (SSDI). People diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) will be eligible sooner. Contact Social Security (1-800-772-1213) for your enrollment benefits.
- Medicare Part B
- Part B has a monthly premium based on your income. Like Part A, you will automatically be enrolled in Part B at age 65 if you are already collecting Social Security or Railroad Retirement benefits. If you are not receiving Social Security (1-800-772-1213) or Railroad Retirement (1-877-772-5772), you will need to contact these agencies three months before you turn 65 in order to enroll in Medicare Part B.
- If you are a person with a disability, Part B enrollment is effective the 25th month of receiving Social Security Disability Insurance (SSDI) unless you are diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), in which case you will be eligible for Medicare sooner.
- You may be able to defer enrollment into Part B if you are covered by the group health plan of a large employer (more than 20 employees) based on your own active employment or that of your spouse. It is best you consult your employer benefits administrator for advice. Contact HICAP at 1-800-434-0222 for more information.
- Medicare Part C (Medicare Advantage)
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It is optional to enroll in a Medicare Advantage Plan or Part C. NOTE: If you have End-Stage Renal Disease you will not be able to enroll in a Medicare Advantage Plan. If you want to enroll in one of these plans, you must be entitled to both Parts A and B. Your Initial Coverage Election Period (ICEP) to join a Medicare Advantage Plan begins 3 months immediately before you first become eligible for both Medicare Parts A and B and ends on the later of:
- The last day of your Part B initial enrollment period or
- The last day of the month preceding your eligibility for both Part A and Part B
You may also enroll in a Medicare Advantage Plan during the Annual Election Period (AEP) that runs from October 15th through December 7th each year.
In addition, there is a Medicare Advantage Annual Disenrollment Period (MA ADP) between January 1st and February 14th that allows beneficiaries the chance to disenroll from Medicare Advantage and return to Original Medicare with the option of also enrolling in a standalone Part D plan. NOTE: beneficiaries may not drop Medicare prescription drug coverage if they have it, or add Medicare prescription drug coverage if they don't have it during Medicare Advantage Annual Disenrollment.
Medicare Part D
If you are newly eligible for Medicare, the Initial Enrollment Period (IEP) for Part D is the same as the IEP for Parts A and B. To enroll in Part D, you must be enrolling in either Part A or Part B or both. People who have Medicare due to a disability have another IEP for Part D when they turn 65.
If you don't enroll in Medicare Part D during this Initial Enrollment Period and you are not eligible for Low-Income Subsidy (LIS), you can only enroll at the end of each year during the Annual Election Period (AEP) that runs from October 15th through December 7th or during a Special Election Period (SEP) due to certain circumstances. Contact HICAP at 1-800-434-0222 to learn more about Special Election Periods.
- Medigap Supplemental Insurance to Medicare
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To enroll in a Medigap policy, you must have Medicare Parts A and B. If you are turning 65 or older, your 6-month Open Enrollment period for a Medigap policy begins the date your Part B becomes effective. Plans are required to sell you a policy and charge you their lowest premium for your age group irregardless of pre-existing health conditions. You may apply for a policy prior to the effective date of your Part B and request your benefits begin the same date as your Medicare to avoid a break in coverage.
In California, if you become eligible for Medicare due to a disability other than End-Stage Renal Disease (ESRD), you also have a 6-month Open Enrollment period once your Part B becomes effective. If you are notified retroactively of your Medicare eligibility, your Open Enrollment period begins the date you receive notice from Social Security of your right to receive Medicare benefits. NOTE: plans have the right to charge you a higher premium based on your health status.
If you were eligible for Medicare prior to your 65th birthday due to a disability, you are also entitled to an Open Enrollment period at age 65 irregardless of pre-existing health conditions including End-Stage Renal Disease (ESRD).
What happens if I do not enroll in Medicare when I first become eligible?
- Medicare Part A
- If you do not enroll in Part A when you are first eligible, you will have to wait until the General Enrollment Period (GEP) to do so and your benefits will not begin until the following July.
- Medicare Part B
- If you do not enroll in Part B when you are first eligible and do not qualify for a Special Election Period (SEP), you will have to wait until the General Enrollment Period (GEP) to do so and your benefits will not begin until the following July. You will be assessed a 10 percent penalty for each, full 12-month period that you qualified for coverage but did not have it. The penalty will be added to your monthly premium. Contact Social Security at 1-800-772-1213 for more detailed information.
- Medicare Part D
- If you do not join a Part D Plan when initially eligible, do not qualify for Low-Income Subsidy (LIS) or a Special Election Period (SEP), and do not have creditable prescription coverage, you will not be permitted to enroll until the Annual Election Period (AEP). You may also incur a late enrollment penalty. The late enrollment penalty is equal to 1 percent of the benchmark figure for each month you were eligible for Part D but did not have it. The benchmark figure is the average monthly Part D premium for California for a given year, and it can change from year to year.
- For more information, contact HICAP at 1-800-434-0222.
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