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Does Medicare Automatically Start at Age 65?

For most people, Medicare won't automatically start at age 65. It's time to check if you'll need to sign up for Medicare Part A or B.

September 29, 2017 - By Hal Levy - read

So, you’re ready to get Medicare. Will Medicare just start at 65 without your input? There’s a simple way to find out.

Whether or not you have to register for Medicare on your own depends on whether or not you get retirement benefits. For most Americans, it usually means that you’ll have to manually sign up for Medicare.

Cases When Medicare Automatically Starts for You

Medicare will automatically start when you turn 65 if you’ve received Social Security Benefits or Railroad Retirement Benefits for at least 4 months prior to your 65th birthday.

You’ll automatically be enrolled in both Medicare Part A and Part B at 65 if you get benefit checks. According to the Social Security Administration, approximately 30 percent of seniors claim Social Security benefits early. For that 30 percent, Medicare Part and Part B will automatically start when they reach the age of 65.

Your Medicare Card: You can expect to receive your Medicare card in the mail three months before your birthday. Your Medicare card will come with a complete enrollment package that includes basic information about your coverage. Your card won’t be usable until you turn 65, even though you’ll receive the card before that time.

Your Costs: Keep in mind that you’ll still have to pay the usual costs of Medicare, even though you’re automatically enrolled. Once your Medicare is active, the cost of your Part B premium will be deducted from your Social Security or RRB benefits.

If you already have Original Medicare (Part A and B) when you’re 65, everything will continue as normal. There will be no change in your Medicare coverage if you turn 65 while you’re already on Medicare. Fortunately, you won’t have to worry about qualifying for coverage in the future. As long as you want to be enrolled, you’ll stay eligible.

You’ll also be able to purchase Medigap or Medicare Part C coverage if it wasn’t offered to beneficiaries under the age of 65 in your area. Even if you already had one of these supplementary plans, you’ll be eligible to change or renew your coverage without penalty. You’ll receive a one-time open enrollment period for Medigap on the first day of the month that you turn 65, and a one-time initial enrollment period for Part C that begins begins 3 months before the month that you turn 65 and lasts for 7 months.

If you already have Medicare Part A when you’re 65, then you’ll be enrolled in Part B automatically. You’ll receive a replacement Medicare card in the mail three months before your birthday. The replacement card with Part B coverage cannot be used until you turn 65.

You’ll also be able to purchase Medicare Supplement coverage, since Medicare Supplement requires Part B.

Cases When Medicare Does NOT Automatically Start for You

Medicare will NOT automatically start when you turn 65 if you’re not receiving Social Security Benefits or Railroad Retirement Benefits for at least 4 months prior to your 65th birthday. You’ll need to apply for Medicare coverage.

There’s no such thing as a Medicare office – enrollment in the program is handled by the Social Security Administration (or the Railroad Retirement Board, if the RRB manages your retirement benefits). If you have to enroll in Medicare Part A and/or B on your own, you can visit your local Social Security office.

You can also sign up for Medicare online by following the instructions at https://www.ssa.gov/medicare. In most cases, signing up online will take ten minutes.

What Do You Do if You’re Expecting a Medicare Card but Haven’t Received Anything?

If you’re expecting to receive a Medicare card but haven’t yet received one three months before your 65th birthday, the first thing to do is to not worry. Medicare sends out hundreds of thousands of cards per year without issue. It’s possible for the card to be delayed or for there to be an error. To confirm whether a Medicare card is heading your way,  check with your local Social Security office to make sure that you’re enrolled.

Should You Wait Until You Turn 65 to Sign Up for Medicare?

If you wait to sign up right before your 65th birthday (or wait until after you turn 65), you may go for months without coverage.

Initial Enrollment Period (signing up ASAP): Your Initial Enrollment Period will last for 7 months. This Initial Enrollment Period begins 3 months before the month of your 65th birthday, and ends 3 months after your birthday month. If you fail to enroll before your birthday month, your coverage will be delayed.

General Enrollment Period (waiting to enroll, with a penalty): You’ll have to sign up during the General Enrollment Period – which falls between January 1 and March 30 every year – if you didn’t sign up during the Initial Enrollment Period. At this point, you’ll be charged a late enrollment penalty. Your premiums for Part B will be permanently increased by 10% for each year that you neglected to sign up for Part B and your monthly premiums for Part A will temporarily increase by 10 percent. Your coverage will start 3 months after the General Enrollment Period ends.

You may be able to avoid the General Enrollment Period penalties if you qualify for a Special Enrollment period.

Special Enrollment Period (waiting to enroll, without a penalty): If you have health insurance through your job, you can sign up for Medicare without penalty during a Special Enrollment Period. This Special Enrollment Period will last for 8 months after you leave your employer. It’s a good idea to sign up 2 months before leaving work, so that your Medicare coverage will be ready once your employer-sponsored healthcare ends.

If you’re covered by a group health plan via your spouse or a family member, you’ll also qualify for a Special Enrollment Period to enroll in Original Medicare for 8 months after their insurance ends. You won’t have to pay a late enrollment penalty if your employer-linked coverage meets a minimum set of qualifications. It’s important to check with your insurer or HR department to make sure that your coverage is sufficient to postpone Medicare enrollment.

If you’re still working at 65 and receiving health insurance through your employer, you may still need to sign up for Medicare. If your company offers health insurance and has fewer than 20 employees, your health insurer will refuse to pay for costs that Medicare would have covered. Signing up for Medicare will ensure that those costs are paid for.

If your company has more than 20 employees, it’s still a good idea to enroll in free Part A coverage right away. Your coverage will be free since you already paid Medicare taxes. However, if you have a Health Savings Account, you won’t be able to contribute to it once you enroll in Medicare.

Can You Be Rejected for Medicare?

As long as you meet the eligibility requirements for Medicare, then no, you can’t be rejected for Medicare. Medicare is available to everyone turning 65, even if you have pre-existing health conditions.

Special Circumstances if You’ve Worked for 10 Years or Less in the United States

Most people will qualify for coverage by paying Medicare and Social Security taxes for 10 years through any combination of employers. You’ll need to have spent 10 years doing taxable work to enroll in Medicare Part A for free. If you’ve worked for less than 10 years in the US, you’ll need to pay monthly premiums for Medicare Part A.

However, if your spouse who is 62 or older has enough quarterly credits or receives Social Security benefits, then you’ll still qualify. You may also be able to qualify based on your spouse’s work record if you’re widowed or divorced.

What Should I Do Once I Get Medicare?

Although you can rely on Original Medicare alone, 86 percent of Medicare enrollees also join a privately-run supplementary plan. Original Medicare pays for a great deal of healthcare, but still leaves you with potentially costly gaps in healthcare coverage. Supplementary plans can cover these gaps – including deductibles and copayments – at a fraction of the out-of-pocket rate.

HealthCare.com’s plan selector is designed to intelligently bring you the best Medicare Supplement plans. These plans, also known as Medigap insurance, that fill the “gaps” in coverage that you would otherwise be charged by Original Medicare.

Am I Legally Required to Sign Up for Medicare?

The law doesn’t require you to get Medicare, although all Americans who have no health insurance coverage are given a tax penalty.

Can You Get Private Insurance Instead of Medicare?

If you have Medicare Part A or Part B, insurers generally aren’t allowed to sell you a traditional individual health insurance plan (these are sometimes called Obamacare or marketplace plans).

You can purchase individual health insurance if you’ve never enrolled in Medicare because you think the overall costs are too high. If you’re in the unusual situation of paying for Part A premiums, you can also switch to individual health insurance.

If you develop a medical condition before turning 65 that would qualify you for Medicare, such as ESRD, you can decline to purchase Medicare.

If you decide to purchase private insurance once you’re eligible for Medicare – unless you’re continuing your employer-sponsored insurance that qualifies you for a Special Enrollment Period – then you’ll have to pay the costly late enrollment penalty once you do apply.

Taking the Next Steps

If you’re nearing the age of 65, then it’s important you start considering your Medicare coverage.

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