Most Medicare beneficiaries will start Medicare at or after age 65. But as we age and approach retirement, we have many questions and concerns. The most important are healthcare coverage, costs, and social security benefits. After all, we don’t get healthier as we age. Today we’ll discuss when Medicare starts and what you should do as you approach your 65th birthday.
Medicare age and eligibility
The official age of Medicare eligibility is 65, but that doesn’t necessarily mean that that’s when yours will or should start. Everyone’s situation is unique. Therefore, your start date may differ from your neighbor or spouse.
To become eligible for Medicare, you must meet a few requirements. Typically you need to be 65 or older and a US citizen to qualify for Medicare. However, there are situations in which you can enroll in Medicare if you’re under 65.
You can qualify for Medicare early if you have been on disability benefits for 24 months. Suppose you have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis) or have end-stage renal disease. In that case, you can also get Medicare benefits early.
When does Medicare start?
As mentioned above, everyone’s situation is different. Some will start Medicare enrollment on their 65 birthday, others will qualify early, and some will continue working and delay their Medicare coverage.
When you enroll, it will determine the enrollment period you’ll use. If you start Medicare automatically, you’ll receive your Medicare Card about three months before you turn 65. This Medicare will have the start dates for your Part A and Part B coverage.
Initial Enrollment Period (IEP)
For most people, Medicare will begin the first day of the month that they turn 65. This Initial Enrollment Period lasts for seven months. It begins three months before birth and continues for three months after.
If you plan to start Medicare at 65, completing the enrollment process a few months before you begin receiving benefits is wise. This 7-month window allows time to fix errors or if the Social Security Administration requires more information.
Suppose you enroll before your 65th birth month or are set to start Medicare the month you turn 65 automatically. In that case, your Medicare health coverage will begin the first of your birth month.
If you don’t enroll before your birth month, you will have a delay in your coverage beginning. For example, if you don’t enroll before you turn 65, your coverage won’t begin until the first of the month after your birthday.
Likewise, suppose you enroll the month after you turn 65. In that case, your coverage will begin two months after you sign up, or if you wait until the second or third month, it will take three months before your coverage starts.
The Initial Enrollment Period is also used if you receive Medicare before age 65. However, in most of those cases, your enrollment will be automatic.
General Enrollment Period (GEP)
Suppose you missed your Initial Enrollment Period, didn’t maintain creditable coverage, and don’t qualify for a Special Enrollment Period. In that case, this is when you will enroll.
The GEP begins on January 1 and continues through March 31. If you need to enroll in the GEP, your Medicare Coverage won’t start until July 1 of the year you enroll.
Special Enrollment Period (SEP)
The SEP to enroll in Original Medicare begins when you leave or lose your employer or group health plan or other creditable coverage. You’ll have eight months to enroll in Medicare, and coverage will begin the month after you enroll.
Suppose you don’t enroll in Medicare when you’re the first eligible and don’t maintain creditable coverage. In that case, you could be subject to a late enrollment penalty. This penalty accrues 10% for every 12-month period in which you’re eligible but didn’t take coverage.
Creditable coverage is considered good or better than the coverage provided by Original Medicare. Some examples are Tricare, Retiree coverage, or coverage from a current employer.
When Can I enroll in a Medicare Plan?
Another essential factor when enrolling in Medicare is the additional coverage to protect you from the out-of-pocket costs left over by Original Medicare. There are two routes you can take for supplemental Medicare coverage. You enroll in Medicare Supplement health insurance with a Medicare Part D or Medicare Advantage plan.
Medicare Supplement plans help pay your portion of the Medicare cost-share. These plans help cover costs such as Medicare Part A and Medicare Part B deductibles, coinsurance, and copays.
These plans have an additional monthly premium and are secondary coverage to Original Medicare. Since they only pick up Medicare Part A and B costs, they don’t include prescription drug coverage.
You’ll need to purchase a separate prescription drug plan to cover medications from the pharmacy. You can enroll in a Medicare Supplement or Medigap plan anytime if you can medically qualify. You can also qualify without medical underwriting if you’re in your Open Enrollment or a guarantee issue period.
Medicare Advantage plans are another way to get your Medicare benefits and combine your Medicare Part A, B, and in most cases, Part D into one plan. They are Medicare Part C and cover additional benefits not included by your Medicare coverage.
Medicare Advantage plans have an Initial Enrollment Period that runs along with your IEP from the original Medicare.
They also have two times a year that you can enroll or change Medicare Advantage plans. The Annual Enrollment Period and the Medicare Advantage Open Enrollment Period. If you qualify for specific life events, a Special Enrollment Period is used to make changes in coverage.
Do I automatically get Medicare when I turn 65?
Yes and No. It depends on your situation. Enrollment in Medicare medical insurance is automatic if you receive retirement benefits from the railroad retirement board or social security benefits before turning 65. Automatic enrollment also occurs on your 25th month of disability benefits or if you’re diagnosed with ALS.
When are you eligible for Medicare?
Unless you have a qualifying medical condition, Medicare can’t start before age 65. Individuals on disability for 24 months or with specific healthcare conditions, such as ESRD, may qualify for Medicare earlier.
Do I automatically get Medicare at age 62?
No, you’re not eligible for Medicare coverage before age 65 unless you have qualifying health conditions.
What age do we collect Medicare?
Most people will begin their Medicare coverage at age 65.
Getting help with a Medicare insurance plan
Now you have an idea of when your Medicare insurance coverage will be. Now it’s time to think about supplemental insurance to help cover the cost left over by Original Medicare.
Our licensed insurance agents can help assist with every aspect of Medicare. From teaching you to understand Medicare hospital insurance to how the Medicare Part B premiums work.
We can help review the insurance companies in your area that offer Medicare Supplement and Medicare Advantage plans and help you find the coverage you need. Simply give us a call or fill out our online request form.