When Does Medicare Coverage Start?

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medicare enrollment form — *_{Image Credit, Shutterstock}*

Medicare confuses many people and for a good reason—the rules aren’t always clear! Understanding when your Medicare coverage starts can save you from enrollment penalties and a huge headache. If you’re a senior looking for answers about Medicare, you’re in the right place. Here’s everything you need to know about Medicare coverage.

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Initial Enrollment Period

For most people, their Initial Enrollment Period (IEP) for Medicare begins three months before they turn 65 and ends three months after the month they turn 65. This seven-month window is the best time to enroll in Medicare to avoid any late enrollment penalties.

How to Avoid the Dreaded Medicare Part D Penalty!

stressed senior woman wearing a yellow dress and sitting on a couch with head in hands — *_{Image Credit: Shutterstock}*

The LEP (Late Enrollment Period) penalty for Medicare Part D can be charged to you because:

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1. You waited 63 days without creditable prescription drug coverage upon leaving company benefits and are older than 65 years and 90 days.

Do NOT wait past 63 days to get Medicare Part D upon leaving company health insurance!

2. Your company’s prescription drug benefits (not health insurance) were not “creditable” as Medicare declares.

Click HERE to find out more about “creditable” prescription drugs.

3. You never enrolled in Medicare Part D at the time you enrolled in Medicare Part A and Part B when you turned 65, and now you want to enroll.

Samuel, you were denied Medicare Part D prescription coverage because you met Medicare’s LEP (late enrollment penalty) rule. Unfortunately, you will receive the Part D penalty when you enroll during Medicare’s Annual Enrollment period. This penalty will last a lifetime.

Americans who plan to retire after 65, who are leaving their employer’s health plans and applying for Medicare Parts A and B, must also prove they have “creditable coverage” when applying for a Medicare Part D prescription drug plan. This is a Medicare rule. Don’t delay your Part D enrollment!

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General Enrollment Period

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If you missed your IEP, you can sign up for Medicare Part A and Part B during the General Enrollment Period between January 1 and March 31 each year. However, coverage doesn’t start immediately after you sign up during this period. For example, if your birthday is on June 1st, your Initial Enrollment Period is February through August. If you sign up in February, March, or April, your coverage will begin on May 1st (according to Medicare.gov). It’s important to note that coverage always starts on the first of the month.

Special Enrollment Periods

There are also Special Enrollment Periods (SEPs) that allow you to enroll in Medicare outside the IEP or General Enrollment Period under certain conditions. For example, if you’re still working and covered by an employer’s health plan at age 65, you can delay your Medicare enrollment without penalty until eight months after your employment ends or the coverage stops, whichever happens first. Medicare expert Toni King has some excellent advice on this subject.

Steps to Enrolling in Medicare

Turning 65 and Receiving Your Social Security Check:

You should receive your “Welcome to Medicare” Kit with your Medicare card 90 days prior to turning 65.
If you aren’t working full-time with employer benefits or covered by your spouse’s employer benefits when turning 65, please do not return your Medicare card. You do NOT want to pay for Medicare Part B. This can cause you to receive the “famous Part B penalty.”

Turning 65 and NOT Receiving Your Social Security Check:

You will NOT automatically receive your “Welcome to Medicare” kit when turning 65 with your Medicare card.
You must enroll in Medicare Parts “A, B, and D” to keep from receiving a “late enrollment penalty (LEP).
You must enroll in Medicare online at www.ssa.gov/medicare at least 90 days prior to turning 65 for your Medicare Parts A and B to begin the 1^st day of the month you turn 65. Go to Medicare.gov to enroll in your Medicare Part D plan.
Do NOT wait until right before you turn 65 to enroll in Medicare. It will take time to receive your Medicare card before the 1^st day of the month you turn 65.

Turning 65 and Still Working Full-Time

Do you have Individual Health Insurance?

Working full-time or contract labor with individual health insurance should enroll in Medicare Parts A, B, and D when turning 65 to avoid a Medicare Part B and D penalty.
Note: Medicare does NOT recognize individual health plans as “creditable coverage.”

Do you have Qualified Employer Benefits and Work Full-Time?

Medicare allows you to delay your Medicare Parts A and/or B if you or your spouse are working full-time with employer benefits, not retirement benefits, and you are covered by that specific employer benefits.
IMPORTANT! “Is still working” are Medicare’s buzzwords for delaying your Medicare Part B. Please take note of that, John and others who may be in his shoes!
To enroll in Medicare after turning 65 and having delayed Medicare Part B due to working full-time with employer benefits, complete Social Security forms CMS-L564 “Request for Employment Information” (signed by the employer or HR) and CMS-40B “Application for Enrollment in Medicare Part B.” Under “Remarks #12,” state which month you want your Medicare Part B to start. Take your forms to your specific Social Security office either in person, by fax, or by priority mail to enroll in Medicare Part B. Remember to write the words “Special Enrollment Period” across the top of each form to keep from receiving the famous Medicare Part B penalty.

More on Special Enrollment Periods

Medicare enrollment paper with glasses and pen — *_{Image Credit, Shutterstock}*

According to Medicare.gov, other extenuating circumstances that may allow an individual to make changes to their Medicare Advantage and Medicare drug coverage plans include:

Changing where you live.
- Moving to a new address that isn’t in your current plan’s service area.
- Moving to a new address that isn’t in your current plan’s service area but having new plan options in your new location.
- Moving back to the U.S. after living outside the country.
- Moving into or out of a nursing home or rehab facility.
- Getting out of jail.
Losing your current coverage.
- Losing Medicaid eligibility.
- Leaving employer, union, or COBRA coverage.
- Leaving a Medicare Cost Plan through which you had drug coverage.
- Dropping your coverage in a Program of All-inclusive Care for the Elderly (CARE) plan.

More Medicare Resources

Understanding when Medicare coverage starts can help you avoid gaps in coverage and late penalties. It’s important to plan and enroll as soon as you’re eligible. If you still need help understanding Medicare, then we’ve got you covered! Check out these great videos before you go!

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