Enrolling in Medicare might sound like the most routine of tasks. You shouldn’t treat it that way. What you do when you sign up sets the table for your future health care.

“Everybody comes from very unique family and personal situations. It’s really important that you think about those unique situations, talk to your employer, and understand what you need to do to avoid gaps in coverage for you and your family,” says Lina Walker, PhD, vice president of health security for the AARP’s Public Policy Institute.

Enrolling in Original Medicare

Together, Medicare’s core hospital insurance (Part A) and medical insurance (Part B) are known as Original Medicare. Some people are lucky enough to be automatically enrolled in Original Medicare. These are Americans who get benefit payments from Social Security or the federal Railroad Retirement Board (RRB) for at least 4 months before their 65th birthday.

Starting the first day of your birthday month (for example, March 1 for a March 15 birthday), you're covered by hospital and medical insurance. You'll get a Medicare card in the mail.

Everyone else must enroll in Original Medicare. Most people use the online application from the Social Security Administration (SSA). It should take 10-30 minutes. The website gives you a checklist of what information you need.

You can also enroll these ways:

  • Visit or phone your nearest Social Security office.
  • Call the SSA national office at 800-772-1213.
  • Send the SSA a signed, dated letter that includes your Social Security number and the date you’d like Medicare enrollment to start.
  • Visit your nearest RRB office or call the agency.

Signing up isn't a difficult process, experts say.

“I haven’t really seen any complications around the Medicare enrollment process, ever,” says Casey Schwarz, JD, senior counsel for education & federal policy at the Medicare Rights Center. “The only issue is timing.”

In other words, when you decide to enroll in Medicare matters. Bad timing could create costly headaches for you. Under the law, you have just three choices:

  1. Your initial enrollment period. For most people, this is the 7-month period that starts 3 months before the month of your 65th birthday and ends 3 months after. If you qualify to enroll early because you're disabled, it starts 3 months before your 25th month of Social Security disability payments. It ends 3 months after.

This may sound like you've got plenty of time to make up your mind. But there are catches. Suppose you hold off to enroll until near the end of those 7 months. “Then, you may have to wait 1, 2, or 3 months before your Part B coverage kicks in,” Walker says. “That could mean a gap in your coverage.

“Also, if you wait on enrolling just in Part B, you’ll have to pay a late enrollment penalty that will remain with you the entire time you’re in Medicare. It could increase your premiums for the rest of your life.”

  1. The general enrollment period. You can wait to enroll until sometime between Jan. 1 and March 1 of each year. But your coverage won’t start until the following July 1. And you may get hit with a late enrollment penalty that bumps up your premiums.

“Suppose someone keeps working after age 65, delays Social Security until age 70, and blows off Medicare,” says Tatiana Fassieux, a training specialist with California Health Advocates. “Then, they have a heart attack at age 69. They will have to wait until the general enrollment period and deal with a 4-year late enrollment penalty.”

  1. A special enrollment period. This is only for people who waited to enroll because they had private health insurance through their job or a spouse’s. Your Medicare coverage usually starts in the month after you enroll. But sometimes, you may have to wait as long as 3 months. You don't pay a late enrollment penalty, though.

People who wait to sign up for Medicare because they still get insurance through an employer “often are making some bad assumptions,” Schwarz says. “If you’ve enrolled in Medicare and get sick, Medicare could pay primary and your job insurance secondary, which could save you money.”

Enrolling in Medicare Advantage or Drug Coverage

After studying your options, you may decide you’d rather get your hospital and medical coverage through a Medicare Advantage (Part C) plan. Unlike Original Medicare, most Medicare Advantage plans also offer drug coverage. If you like the flexibility of Original Medicare, you can enroll in a Part D plan to help pay for your medications. 

You can opt for Part C or D plans during your initial enrollment period for Original Medicare. Or you can sign up at Medicare.gov during the open enrollment period for these plans. Open enrollment for both Part C and Part D runs Oct. 15-Dec. 7 each year, with coverage starting the next Jan. 1.

If you wait 63 days or longer after your Medicare initial enrollment ends to pick a drug plan, you face a late enrollment penalty.

If you’re already enrolled in a Medicare Advantage plan, you can switch plans during the fall open enrollment period and Jan. 1-March 31 of each year.

Enrolling in Medigap

The Medicare program also uses a letter system to identify its Medigap plans. These help cover your costs for deductibles and coinsurance in Original Medicare. There are 10 of them: Plans A, B, C, D, F, G, K, L, M, and N. How many you can choose from depends on what state you live in.

A 6-month open enrollment period for Medigap starts on the first day of the first month when you’re both age 65 and enrolled in Original Medicare Part B. Some states also have their own open enrollment periods for Medigap. If you don’t sign up during open enrollment, you may wind up with fewer, more expensive options.

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