Medicare enrollment is automatic for some people, but not for everyone. Whether you need to sign up yourself depends on one key factor: are you already receiving Social Security or Railroad Retirement Board benefits when you turn 65? If yes, you’ll be enrolled automatically in both Part A and Part B. If no, you’ll need to apply on your own.
Who Gets Enrolled Automatically
If you’re already collecting Social Security retirement benefits before your 65th birthday, Medicare will come to you. You’ll receive a welcome package with your Medicare card about three months before your coverage starts. The package includes both Part A (hospital coverage) and Part B (medical coverage), and your enrollment happens without any paperwork on your end. The same applies if you’re receiving benefits through the Railroad Retirement Board.
People under 65 who receive Social Security Disability Insurance also get enrolled automatically, but only after a 24-month waiting period. Those first 24 months of disability benefits serve as a qualifying period before Medicare kicks in. There’s one notable exception: if you have ALS (Lou Gehrig’s disease), Medicare starts as soon as your disability benefits begin, with no waiting period.
Who Needs to Sign Up Manually
If you’re still working at 65 and haven’t started collecting Social Security, nobody is going to enroll you. You need to contact the Social Security Administration and file an application yourself. This is a common situation, since many people delay Social Security to increase their monthly benefit. It’s also the situation most likely to catch people off guard.
A few other groups also need to apply manually:
- People who must pay a premium for Part A because they don’t have enough work history to qualify for premium-free coverage. They won’t be auto-enrolled and must apply during a valid enrollment period.
- People with end-stage renal disease (permanent kidney failure) who are under 65 and not already on Social Security disability. They need to complete a specific application through Social Security.
To enroll manually, you can call Social Security at 1-800-772-1213 or visit your local Social Security office. The specific form depends on your situation, but Social Security can walk you through which one you need.
The 7-Month Window You Don’t Want to Miss
If you need to sign up yourself, your Initial Enrollment Period lasts seven months. It starts three months before the month you turn 65 and ends three months after your birthday month. Signing up during the first three months gives you the earliest possible coverage start date. Waiting until the later months of the window delays when your coverage begins.
Missing this window entirely creates real problems. If you don’t sign up during your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you’ll have to wait until the next General Enrollment Period, which runs January 1 through March 31 each year. That gap leaves you without coverage, and it comes with a financial penalty that follows you for life.
The Late Enrollment Penalty
For Part B, the penalty is an extra 10% added to your monthly premium for every full 12-month period you could have signed up but didn’t. If you waited two years past your initial window, for example, you’d pay a 20% surcharge on your Part B premium. This penalty is permanent. It stays on your bill for as long as you have Part B, which for most people means the rest of their life.
Working Past 65 With Employer Coverage
If you’re still working at 65 and covered by a group health plan through your employer (or your spouse’s employer), you have more flexibility. You can delay Medicare enrollment without penalty as long as you’re covered through that employer plan based on current employment. COBRA coverage does not count for this purpose.
Once you leave your job or lose that employer coverage, you get a Special Enrollment Period. You can enroll at any time while still covered under the employer plan, or during the eight-month period that begins the month the employment ends or the group health plan coverage ends, whichever comes first. As long as you enroll within that eight-month window, you won’t face a late penalty.
What to Do If You Were Auto-Enrolled but Don’t Want Part B
Being automatically enrolled doesn’t mean you’re locked in. If you receive your welcome packet and decide you don’t want Part B (perhaps because you have solid employer coverage and don’t want to pay the monthly premium), you can decline it. Follow the instructions in your welcome packet and send your Medicare card back. If you keep the card, you’re agreeing to keep Part B and you’ll start paying the premium.
To formally drop Part B after enrollment, you need to send a written, signed request to Social Security. Your coverage will end at the close of the month following the month you file. So if you submit the request in April, coverage ends May 31.
Think carefully before dropping Part B, though. If you change your mind later and don’t qualify for a Special Enrollment Period, you’ll have to wait for the General Enrollment Period to re-enroll. You’ll also face the 10%-per-year late penalty on your premiums going forward. The only people who can safely skip Part B without consequences are those with qualifying employer coverage through current employment.