New to Medicare?

When Do You Qualify for Medicare?

If you meet one of the following criteria, then you are eligible to enroll in Medicare.

• U.S. citizen age 65 years old or older
• Permanent legal resident in the U.S. for 5 continuous years & 65 years or older

Special Enrollment Situations¹

• U.S. citizen or legal resident under 65 years old but have a qualifying disability (e.g. blindness) or a qualifying medical condition (e.g. End Stage Renal Disease or ALS)
• A disabled widow or widower between age 50 & age 65, but have not applied for disability benefits because you’re already getting another kind of Social Security benefit
• You, your spouse, or your dependent child has permanent kidney failure

Initial Enrollment Period (IEP)
The Initial Enrollment Period (IEP) consists of the three months before the month of your 65th birthday, the month of your birthday, and the three months after the month of your 65th birthday. This seven month period surrounding one’s 65th birthday is crucial in order to avoid the Part B and Part D penalties for enrolling late.

If you are age 65 and currently receiving Social Security or railroad retirement benefits you will be automatically enrolled in Medicare Part A and Part B. However, because Part B has a premium, you have the option of declining Part B coverage. However, Part B does require payment of a monthly premium of $110.50, barring certain exceptions. If you are not currently receiving Social Security or railroad retirement benefits, you may visit your local Social Security office and request to be enrolled in Medicare Part A and Part B.

Facing the Consequences if You Miss the IEP

If you miss the IEP deadline for enrolling in a Part D plan, then you will have to wait until Annual Enrollment Period (AEP) which runs from November 15th to December 31st, unless you qualify for a Special Enrollment Period (SEP). However, you must be receiving Part D coverage before the end of the SEP  in order to avoid a late penalty. A penalty of 1% of the average premium for each month of delayed enrollment will then remain in effect for as long as you are enrolled in any Part D plan, and the amount of the penalty will adjust since premiums change each year. To ensure that you avoid this penalty, contact a PlanPrescriber representative three months before your birthday. They can help you do a plan comparison of the Medicare Part D options available in your area, and they will also be able to answer additional questions you may have.

If you miss this seven month period for enrolling in Medicare Part B and do not have qualified alternative coverage such as retirement benefits or insurance from you or your spouse’s current employer, you might face penalties such as delayed coverage or higher premiums for enrolling in Part B. Your monthly premium may increase by up to 10 percent for each 12-month period for which you qualified for the coverage but did not enroll in Medicare Part B. Additionally, you will have to pay this penalty for as long as you have Medicare.²

If you miss the IEP, you do have another chance each year to sign up during the General Enrollment Period from January 1 - March 31, but you will still be subject to the premium penalty.

Navigating Through the IEP

Navigating through the private insurance options associated with Medicare during this IEP can be daunting. This is why PlanPrescriber is here to help. Representatives are available Monday-Friday to help you find the right Medicare Advantage, Medigap, or Prescription Drug Plan. Since there are many components to Medicare, it is important to know all your options before making your enrollment decision. If you have more questions about Medicare Parts A, B, C, & D, click here.

1. If you are eligible for Medicare based on disability or permanent kidney failure, your initial enrollment period depends on the date your disability or treatment began.

2. You may not have to pay the penalty if you have low income and are accepted into a Medicare Savings Program (MSP) that helps pay for Medicare's out-of-pocket costs.