Medicare is available to beneficiaries once they reach the age of 65 or, if they are under the age of 65, after their 24th month of receiving Social Security Disability Insurance (SSI) due to disability. Certain factors can impact when enrollment can begin and what a beneficiary’s options are when they’re approaching eligibility.
Medicare Enrollment for Seniors
Determining when coverage begins depends on when a beneficiary enrolls in Medicare. Eligibility due to age presents a recipient with three enrollment opportunities:
Initial Enrollment Period
This is a 7-month period of time that begins three months before a recipient turns 65, lasts throughout the month they turn 65 and, finally, ends three months after the recipient turns 65. Recipients who sign up within the first 3 months of their Initial Enrollment Period will be covered by Medicare starting the first day of the month in which they turn 65. If the recipient’s birthday is the first of the month, then coverage begins the first day of the month before that.
Waiting to enroll after those first three months results in a delay for Part B coverage. Recipients who wait to enroll in the month of their 65th birthday will be covered one month after enrollment. The delay is two months for recipients who enroll the month after they turn 65. Recipients who enroll two or three months after turning 65 will have their coverage delayed by three months.
Recipients eligible for premium-free Part A enrollment are not subject to the same delays during and after the Initial Enrollment Period. Recipients who enroll in Part A within 6 months of the day they turn 65 will be retroactively covered for up to 6 months (but not beyond the first day of the month before they turn 65).
General Enrollment Period
Medicare recipients who are receiving health care coverage through a private insurer, such as one provided to them by an employer, may delay their enrollment with Medicare. Once they are outside of their Initial Enrollment Period, they can only enroll in Medicare during the General Enrollment Period or a Special Enrollment Period.
General Enrollment begins January 1st and ends March 31st every year. Whether a recipient signs up for Part A, Part B or both, their coverage will begin on July 1st of their enrollment year.
Special Enrollment Periods
Loss of creditable coverage, such as a group or retiree plan offered by an employer, opens up a Special Enrollment Period for Medicare recipients. Recipients can choose to enroll in Medicare any time while they are still covered or within the 8 months after loss of employment or coverage. Some circumstances can cause the start of coverage to vary for Special Enrollment Period applications, but most coverage begins the first day of the month after enrollment is completed.
Medicare Enrollment for Disability Recipients
Benefits for disabled beneficiaries work differently than those for age-related Medicare. The type of disability and the length of time the recipient has been waiting or receiving Social Security Disability Insurance (SSDI) payments can impact when their Medicare coverage begins.
End-stage renal disease (ESRD). Medicare coverage begins three months after dialysis starts if the recipient with kidney failure requires a kidney transplant or ongoing dialysis.
Amyotrophic lateral sclerosis (ALS). Once disability benefit payments begin for recipients with ALS, their Medicare coverage kicks in.
All other SSDI recipients. Generally, SSDI recipients can expect their Medicare coverage to begin after they have received SSDI payments for two years. This means coverage starts the first day of the 25th month they receive SSDI benefits. In some cases, the date of the onset of a disability factors into the delay in coverage and the recipient may be eligible to receive Medicare sooner than that. This is determined on a case-by-case basis, so recipients interested in learning more should contact a Medicare agency representative to understand what may be applicable to their circumstances.