It’s important to apply for Medicare at the correct time to ensure you’re optimizing your coverage and not missing out. The following page covers the topic of when to apply for Medicare, in particular how soon before you turn 65 that you should apply for Medicare.

If you or someone you love is getting close to their 65th birthday, here’s what you or they need to know. If there are still a few years to go, you should still keep this information in mind. Mark your calendars, set an alarm on your phone, whatever you’ve got to do!

Applying for Medicare at Age 65

If you are eligible for Medicare, there is a 7-month enrolment period to sign up for Part A and/or Part B. You’ll qualify for Medicare at age 65 if:

  • You are a citizen of the United States or a legal resident living in the United States for a minimum of 5 years at the time of the window of this 7 year period.
  • You or your spouse has worked long enough to qualify for Social Security or Railroad Retirement Board benefits (This translates to around 10 years of full time employment).
  • You or your spouse is a government employee or retiree who has not paid into Social Security but paid Medicare payroll taxes while employed in that position.

The Initial Enrolment Period begins 3 months before you turn 65, includes your birthday month, and ends 3 months after the month you turn 65. 

For example, if you turn 65 on May 1, your IEP will begin on February 1 with an end date of May 31 for a total of 7 months. The total window is 7 months long, but that doesn’t mean you should apply 7 months before your 65th birthday! Remember, take your birth month and could that as one month, and then the window is 3 months before that birth month, and 3 months after that birth month.

Coverage may be delayed up to three months if you sign up towards the end of your IEP, so it’s recommended to enroll as soon as possible. If you do not sign up for Medicare within your IEP, you may face lifetime penalties and/or lapse in medical coverage so it’s very important to be on top of this. Even if you’re late, though, it’s still worth following through with because getting your Medicare coverage late is better than not having it at all.

Note: If you are already receiving benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Medicare Part A and Part B. You should receive your Original Medicare package and Medicare card around 30 days before your 65th birthday. Make sure that your address and everything on file is up to date!

If you live in Puerto Rico and receive Social Security or Railroad Retirement Board benefits, you will only be automatically enrolled in Medicare Part A. If you would like Medicare Part B, you will need to enroll on your own. 

Medicare Part A is typically free for eligible seniors. However, if you or your spouse has paid Medicare taxes for less than 10 years of work, you will need to purchase Medicare Part A. Your monthly premium will depend on how long you have worked, but the maximum amount as of 2020 is $458. Medicare Part B always includes a premium, as of 2020 it is $144.60. 

Special Enrolment Period (SEP)

A Special Enrolment Period is available for qualifying seniors. To qualify, you must have health insurance (beyond the length of your IEP) from an employer, whether it is your own or through your spouse. 

Your SEP lasts for 8 months and begins the month after employment ends or the month after your employment-based health insurance ends (whichever comes first). 

During this time, you may sign up for Medicare Part and/or Part B without facing a late enrolment penalty. 

General Enrolment Period for Seniors for Medicare

General Enrolment Period for Seniors for Medicare

If you miss your Initial Enrolment Period, Medicare offers a General Enrolment Period where new clients can sign up for Medicare Part A and/or Part B or existing clients can make changes to their plan without facing a penalty. The General Enrolment Period runs from January 1 to March 31 of every year. 

You may be eligible to sign up for Medicare during this period if:

  • You do not qualify for a Special Enrolment Period (SEP) 
  • You did not sign up for Medicare during your Initial Enrolment Period 

If you sign up during the General Enrolment Period, you will be responsible for paying a premium for Medicare Part A and/or Part B. Coverage will begin around July 1 and there may be a higher premium for signing up during this time.

What’s Next?

If you need help determining the best route to take, we’re here to guide you. We’ve created extensive resources to assist seniors and their families in choosing the correct coverage, getting it setup in time, and getting the most out of the Medicare coverage that they are entitled to. The next step is to learn ore about how to apply for Medicare, ensure that you’re applying during the correct window of timing, and make sure you reach out to us if you have any questions or if you need any help.