During your Initial Enrollment Period (IEP)

Each individual has a different IEP or initial enrollment period that will last for 7 months. The 4th month would be the month of your 65th birthday and so if your birthday will be in June, then the IEP for you would start March 1 and then end on September 30. However, if your birthday is the on the 1st of the month, then the entire IEP would be shifted forward 1 month, so if your birth date is June 1st, then you would have an IEP starting on February 1st and ending August 31st.

You should make sure that in order to avoid delayed covered or late penalties you are signing up for Medicare while your IEP is open with the right circumstances, such as:

  • You have no other health insurance
  • You have health insurance that you bought yourself (not provided by an employer)
  • You have retiree benefits from a former employer (your own or your spouse’s)
  • You have COBRA coverage that extends the insurance you or your spouse received from an employer while working
  • You have veterans’ benefits from the Department of Veterans Affairs (VA) health system (but no insurance provided by a current employer)
  • You’re in a nonmarital domestic relationship with someone of the same or opposite sex and you are covered by his or her employer insurance

For those who do enroll in the initial 3 months of the IEP, then the coverage from Medicare will start on the 1st of the month when you turn 65. If you have your birthday on the 1st of any month, then it will start on the 1st date of the month before and if you sign up during the 4th month of your IEP, then your coverage would start on the 1st of the next month. However, for those who leave it for the 5th, 6th or even the 7th month, then coverage would be delayed by at least 2 to 3 months.

Also, during this IEP you will be able to enroll yourself in Part D of Medicare, which covers prescription medication. However, you might not need to do this if you already have some “creditable” coverage for your medication through other retiree benefits, including the VA or your COBRA. During this time you would also have the choice to change your coverage to your chosen Medicare Advantage plan from the Original Medicare, which includes Parts A as well as B.

During a Special Enrollment Period (SEP)

The SEP or special enrollment period will only be available to you if you already have some health insurance that goes past the IEP from an employer for which your spouse or you are actively working for. This allows you to delay your enrollment in Part B along with avoiding the monthly premiums until the coverage or employment ends, whichever happens first.

This SEP will last throughout the entire period that you have your current employment coverage and for 8 months after it stops. You would be able to enroll during this period at any point and then you Medicare coverage starts from the 1st day of the next month. Also, you aren’t going to be liable for any penalties that you might otherwise incur no matter what age you are when you sign up.

You should be aware that an SEP is always trumped by an IEP if they overlap and if your IEP ends on the same date that you retire, then you won’t have an SEP. This means that if you delay your enrollment, then you can’t enroll until the next general enrollment period, which is January 1 to March 31. Your coverage would also not start until July 1, which means you would not be covered for almost 1 year.

However, if you are going to be losing your coverage for prescription drugs, then you can easily sign up for the Part D of Medicare. You also won’t be liable for the late penalties if you sign up within 2 months of losing the coverage from your employers. There are also two other scenarios with Medicare that have different rules.

Two other Medicare enrollment scenarios have different rules.

If you live outside the United States: For those who don’t live in the United States regardless of whether or not you or your spouse are working, then there is an extremely difficult choice to make. You would be able to sign up for the Part B of Medicare without using it while still paying the premiums or sign up when you come back to the US and then dealing with delayed coverage and permanent late penalties.

However, if your spouse or you are still working and you have employer-based health insurance of or if you have coverage under the public national healthcare from the country, then you can delay enrollment in Medicare until your employment finishes. You are then going to be entitled to the previously mentioned SEP.

Another exception is if you aren’t fully insured and if you aren’t entitled to Part A without having to pay the premiums, then you can’t sign up for them while living overseas. Once you return permanently to live in the United States, then you should enroll within 3 months of returning. This would allow the coverage to start on the 1st of the month after you have enrolled and you won’t face late penalties regardless of how long you were living abroad or your age.

Otherwise, for those who want to sign up to get Medicare while residing outside of the US, then you can apply through the closest U.S. consulate or embassy.

Part D or the drug coverage section has rules that are different and once you move back to the US permanently, then there is an SEP of 3 months. This is for those who turned 65 while living abroad or 2 months for those who had their 65th birthday before moving out of the US. This will prevent you from having to pay late penalties and the coverage would start on the first day of the next month after enrollment.

If you are in prison: For those who have their 65th birthday while in any correctional institution or prison, then you can enroll for Part B during the IEP and pay the monthly premiums without using the services. You can also wait until you have been released and then face the permanent late penalties along with coverage being delayed.

Also, if you have been imprisoned after you turned 65 and were already enrolled in the Medicare coverage, then you are expected to keep paying your premiums so you can avoid any penalties when you are released.

There are also different rules for the drug coverage of Part D and you would have an SEP of 3 months for those who had their 65th birthday while in prison. If you had your 65th birthday before you went to prison, then your SEP is going to be 2 months and this will help you to avoid late penalties.

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