Medicare: When to Enroll
Medicare is a health insurance program provided by the federal government, available to people:
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65 and older
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Under 65 with certain disabilities and conditions
While many aren’t eligible until they turn 65, don’t wait until that milestone birthday to start thinking about Medicare. Begin weighing your options months in advance – because there are a lot of choices, things to consider to best fit your health needs, deadlines, and questions you may have. But – your preparation timeline will look different, depending on whether you’ll be automatically enrolled in Medicare or if you have to sign up.
Who gets automatically enrolled?
According to the Centers for Medicare and Medicaid Services - if you’re already getting retirement or disability benefits from Social Security at least four months before you turn 65, you’ll automatically get Medicare Part A (hospital insurance that covers things like hospital stays and skilled nursing facility care) and Part B (medical insurance that covers things like doctor’s office visits, X-rays, and lab tests) when you turn 65.
You will be mailed a welcome package with your Medicare card three months before your Medicare Part A and Part B coverage starts. Once you have Part A and Part B, you have what is known as Original Medicare.
Who needs to sign up for Medicare?
If you’re close to turning 65 and not receiving Social Security benefits – you’ll need to take action to enroll.
You can only enroll at certain times:
Don’t miss your Original Medicare (Part A and B) enrollment window!
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Initial Enrollment Period. This enrollment period is if you’re new to Medicare. The seven-month Initial Enrollment Period (IEP) begins three months BEFORE the month you turn 65 and ends three months AFTER your birthday month. For example, if your birthday is June 15, you’ll have from March 1 until Sept. 30 to enroll.
Failing to enroll in Medicare on time could cost you – and we’re not just talking about a one- time fee. Late enrollment penalties are added to your monthly premium for as long as you have that type of coverage. For many, that’s a lifetime penalty. Avoid this by doing your homework and signing up during your IEP!
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Special Enrollment Period. You have another opportunity to enroll after age 65 without a late enrollment penalty if you’re eligible for a Special Enrollment Period (SEP). You qualify for an SEP if you or your spouse are still working past 65 and have health insurance from that employer. You can enroll in Medicare any time while you have that coverage and up to eight months after the employment or coverage ends – whichever comes first.
SEP rules expanded on Jan. 1, 2023. You may qualify for an SEP for certain “exceptional conditions,” like loss of Medicaid coverage, a missed chance to sign up while incarcerated, or an inability to enroll because of a natural disaster. Read this special enrollment form for more qualifying circumstances and information.
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General Enrollment Period. If you missed your IEP and you don’t qualify for an SEP, you get another time frame to sign up during Medicare’s General Enrollment Period (GEP) which lasts from Jan. 1 through March 31 each year. You may have to pay a late enrollment penalty if you delay until this enrollment period.
Other plans that work with Original Medicare
Original Medicare (Part A and Part B) does not cover all of your medical costs, or all the healthcare services you may need like hearing aid services, routine eye exams, and prescription drugs. You have a choice of private health plans to help pay those costs and cover other healthcare services. These private health plans are Medicare Advantage or Part C, Medicare Part D prescription drug plans, and Medicare Supplement (Medigap) plans. Keep in mind, you must first be enrolled in Original Medicare to join any of these plans.
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Medicare Supplement Open Enrollment Period. If you want to supplement your Original Medicare coverage to help with additional costs, your six-month enrollment window starts the first day of the month you turn 65, as long as you have already signed up for Original Medicare. This is often referred to as “Medigap Open Enrollment.” If you sign up outside of this enrollment period, you may have to pay more for a policy. Medigap policies help cover out-of-pocket costs associated with Original Medicare, like copays and deductibles.
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Annual Enrollment Period. The title may be a bit misleading. The Annual Enrollment Period (AEP) that goes from Oct. 15 to Dec. 7 is not the period for you to enroll in Medicare for the first time (unless this time frame coincides with your IEP). If you already have Medicare, this is the time to review your coverage and decide whether you want or need to make any changes like switching from Original Medicare to a Medicare Advantage Plan.
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Medicare Advantage Open Enrollment Period. This window from Jan. 1 to March 31 is a time to make changes to your Medicare Advantage coverage if you are already enrolled. During this timeframe, you can switch to another Medicare Advantage Plan, drop your Medicare Advantage plan and go back to Original Medicare, or join a Medicare prescription drug plan. With a Medicare Advantage plan, you may have coverage for things Original Medicare doesn’t cover like dental, vision, and hearing aid services, as well as fitness benefits and more.
Medicare can seem complicated with all the different enrollment windows, qualifiers, and information. Blue Cross Blue Shield of Arizona (AZ Blue) is here to make it easy for you. You can schedule time with our AZ Blue Medicare team if you have questions or need help navigating your options.
Blue Cross® Blue Shield® of Arizona (BCBSAZ) is contracted with Medicare to offer HMO and PPO Medicare Advantage plans and PDPs. Enrollment in BCBSAZ plans depends on contract renewal.