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MEDICARE ELIGIBILITY & ENROLLMENT

MEDICARE ENROLLMENT PERIODS

Are you 65 or older? Are you eligible for Medicare because of disability? Are you losing your health care coverage from your employer?  Depending on your circumstances, you have a certain amount of time to enroll in Medicare. Learn more by reading Understanding Medicare Enrollment Periods.

I. INITIAL ENROLLMENT PERIOD (IEP)

In most cases, you become eligible for Medicare when you turn 65. You may enroll in Medicare Parts A and B up to three months before the month of your birthday, and up to three months after the month of your birthday. If you enroll prior to the month of your birthday, your Medicare start date will be on the first day of your birth month.*  *If your birthday is on the first day of the month, your enrollment period is slightly different, read Understanding Medicare Enrollment Periods above.

Enroll in Medicare on the Social Security Website 

(You will need to create an account if you don't already have one.)

If you enroll in this month of your initial enrollment period:Your coverage starts on the first day of:
Up to 3 months before your birth monthYour birth month
The month you turn 65The month following enrollment
1 month after you turn 652 months after enrollment
2 months after you turn 653 months after enrollment
3 months after you turn 654 months after enrollment

Do I have to enroll? Doesn't Social Security know I am turning 65? If you are already receiving Social Security Payments, either due to applying for early retirement or SSDI, you do not need to contact Social Security to enroll. You will be auto-enrolled and your card will be mailed to you prior to your start date. Otherwise, you must initiate contact with Social Security.

Is the Initial Enrollment Period the only time I can apply?  Other than the IEP, there are other situations when you can enroll in Medicare.  The most common are:

II. SPECIAL ENROLLMENT PERIOD: Retirement or Loss of Employer Group Coverage

Perhaps you, or your spouse, continued to work after turning 65 and received coverage from an employer (with greater than 20 employees). Once you decide to retire or lose that coverage for any reason, you will have a SPECIAL ENROLLMENT PERIOD of 8 months following with loss of coverage to enroll in Medicare without a penalty. (Please note that COBRA is not considered to be CREDITABLE COVERAGE by Medicare. If you opt to take COBRA coverage, it is advisable to enroll in Medicare well within the 8-month period to avoid a penalty.

Beneficiaries who have stopped working and are seeking immediate enrollment into Medicare Part B should call their local Social Security Office to initiate the Part B enrollment process. (You cannot enroll online if you delayed Part B enrollment.) You will need to complete  Application for Enrollment in Medicare Part B, SS Form 40B, and the Request for Employment Verification, Form CMS-L564, and send them to the local Social Security Office. (If you have difficulty getting the Request for Employment Verification Form completed you may attach copies of other documents such as; Pay stubs showing health insurance deductions,  W2’s reflecting pre-tax medical contributions, Health Insurance Cards with an effective date, Explanation of Benefits paid by the Health Plan.) NEW FROM SOCIAL SECURITY: You may also fax the information to 1-833-914-2016

If you have general questions about enrollment or specific questions about your situation, SHINE (Serving the Health Insurance Needs of Everyone on Medicare) counselors can explain the process and the forms that need to be submitted to Social Security. They can also review what your medical and prescription coverage options are beyond Medicare Part A and Part B.

III. UNDER 65 AND DISABLED FOR 24 MONTHS

If you are under 65 and have applied for SSDI (Social Security Disability Insurance) you will automatically become eligible for Medicare after 24 months have passed from your effective start date of benefits. If this situation applies to you, you do not need to enroll for Medicare with Social Security. Social Security will send you your Medicare Card several months prior to your 24th month of SSDI Benefits.

IV. GENERAL ENROLLMENT PERIOD

If you do not fit any of the circumstances listed above, more than likely your only other option is to apply during the General Enrollment Period. This takes place between January 1 and March 31 each year. Enrollment during this period becomes effective on July 1st of that same year.


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