Medicare late enrollment exemptions

Medicare features substantial penalties for late enrollment. The Part A (hospital coverage) late enrollment penalty is 10% of your monthly premium, and it must be paid for twice the number of months that you failed to sign up for eligible coverage. The Part B (general medical) late enrollment penalty is an increasing percentage, and it must be paid on a monthly basis for as long as you keep your Part B benefits. The Part D (prescription drug) late enrollment penalty is also a percentage, but one that Medicare updates on an annual basis.

If you have missed the initial Medicare enrollment periods and you wish to avoid paying the above penalties, you should try to determine whether or not you qualify for Special Enrollment Periods. If you qualify, you may enroll in Medicare Part A or Part B during the Special Enrollment Period without having to pay the normal penalty.

As an example, if you are covered by pre-existing health insurance because you or your spouse is currently employed, your Special Enrollment Period will usually be during the eight months beginning after the end of employment. If your employment or your spouse’s employment ends on January 15 and your associated health plan terminates on January 30, for instance, you have until September 15 to enroll in Medicare Part A and/or Part B without paying a late enrollment penalty as described above.

Par C and Part D have different enrollment periods

If you are interested in Medicare Advantage (also called Medicare Part C) or Medicare Part D, which is Medicare’s prescription drug plan, the enrollment periods are a bit different. You may enroll in Part C or Part D during the period when you first qualify for Medicare. During the first 45 days of each year, you can leave your Medicare Advantage Plan and switch to original Medicare Part A or Part B with or without selecting a Part D drug plan. This is known as the Medicare Advantage Disenrollment Period, or MADP. There is also a Fall open enrollment period from October 15 through December 7. During this time you may change your Medicare coverage and enroll in, change, or drop your Medicare drug coverage. Outside of these periods, you may only change your coverage without penalties if you qualify for a Special Enrollment Period.

If you do not enroll in Medicare during the eight month Special Enrollment Period or the initial enrollment period around your 65th birthday, you will have to wait until the following general enrollment period. This begins on January 1st. You may also have to pay higher Part B monthly premiums and a late-enrollment penalty for Part A if you don’t qualify for free Part A as a result of previous employment.

If you receive Social Security disability benefits and are covered under a private health plan, you may qualify for a Medicare Special Enrollment Period. Contact Medicare directly at 1-800-633-4227 to speak with a representative.

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