THINKING RETIREMENT – ANDY LANDIS-Applying for Medicare can be a tricky business. You can be penalized for enrolling too late…or even too early. Here’s how to do it right.
First, Medicare age is still 65. It hasn’t been raised to 66 or 67, like Social Security.
Most of us will enroll at 65. There are two exceptions to get Medicare before 65. You’re eligible if you’re on Social Security disability for 24 months. Or you can get special ESRD Medicare (for End Stage Renal Disease) if you need kidney transplant or dialysis.
Another big exception: you can postpone Medicare until after 65 if you have health insurance from current work. Details appear under “Special Enrollment Period” below.
You have three opportunities to enroll in Medicare: Your Initial Enrollment Period at 65. To enroll at 65, you must file at a medicare insurance agency within 7 specific months: the month you attain 65, the 3 months before, and the 3 months after. Example: if you turn 65 in April, you can file anytime from January 1 to July 31. If you filed in the first 3 months—January-March in our example—you would have Medicare coverage starting April 1.
But beware. Later filing delays Medicare coverage:
- If you enroll in your birth month—April—your coverage begins one month later, in May.
- If you enroll in month 5—May—coverage is delayed for two months, until July.
- And if you enroll in months 6 or 7—June or July—coverage doesn’t start until the third month after enrollment. That could be as late as October in our example.
Any of these could cause a gap in coverage, and you don’t want to be uninsured. You must file in the three months before your birth month to get coverage starting in your birth month.
Your Special Enrollment Period, after 65. This applies if you are over 65, but you are covered by an employer’s health insurance. Your work insurance must be based on your own work or your spouse’s. The work must be current work, and the insurance must be for active employees, not COBRA or retiree insurance.
If you meet those requirements, you can delay Medicare enrollment without penalties for late filing:
- You may enroll at any time while covered by the employer’s health plan.
- You may enroll during the 8 month period starting with the month employment ends, or the month your work insurance ends, whichever comes first.
- If you enroll in month 1, the month of termination, your Medicare coverage starts the first day of that month
- If you enroll after the month of termination, in months 2-8, your Medicare coverage is delayed until the month after you enroll. This could cause a gap in coverage.
- You must prove your employer coverage with a letter from your employer.
The General Enrollment Period, for late enrollment. The “GEP” is for late enrollees who missed the Initial and Special Enrollment Periods. It’s basically an annual “open enrollment” period. Three strict penalties apply for late enrollment: Enrollment dates are limited to January, February, and March each year.
- Coverage is postponed until July of the enrollment year. This can cause a gap in coverage.
- Finally, you will be charged a 10% late fee on your Medicare premiums for every year you were eligible but not enrolled. The penalty will apply for the rest of your life.
Here’s a worst case scenario: let’s say you file for Medicare on April 1, 2013, and you’re not eligible for an Initial or Special Enrollment Period. You just missed the January-March General Enrollment Period, so you can’t even apply until January 2014. Your Medicare would not begin until July 1, 2014, so you’ll be uninsured for 15 months. And you’ll pay late enrollment fees from then on.
The bottom line is that you should file timely. Don’t miss your Initial or Special Enrollment Periods. There are many more rules on timely filing, but here are two valuable tips: always contact SSA at (800) SSA-1213 a few months before your 65th birthday to make sure your Medicare is on track, whether you’re working or retired. And if you have health insurance from work or military service, also contact your work insurance provider to ask about Medicare enrollment. Some employers end work insurance for everyone turning 65, and some work insurance does not qualify you for a Special Enrollment Period.
How to enroll. You enroll in Medicare at Social Security. If you’re already getting Social Security before 65, you don’t need to file a Medicare application; you’ll automatically receive your Medicare card 2 months before your 65th birthday. It will include instructions to return it if you have work coverage that qualifies you for late enrollment.
If you’re not on Social Security, you must apply for Medicare at (800) SSA-1213, www.ssa.gov, or any SSA office. Resources. For more details about eligibility and enrolling, see SSA’s “Medicare” publication at http://ssa.gov/pubs/10043.html. To learn about Medicare coverage and gaps, browse www.medicare.gov, especially their comprehensive “Medicare and You” publication at http://www.medicare.gov/pubs/pdf/10050.pdf. All this is covered in some detail in my book, Social Security, The Inside Story.
One last tip: everyone is expected to obtain additional insurance to supplement Medicare. Watch for a future blog about your options. Until then, keep on planning.