Dear Marci,

I just realized I missed my Initial Enrollment Period to enroll in Medicare. What happens if I enroll in Medicare late?

-Dan (Herman, MN)

Dear Dan,

If you missed your Initial Enrollment Period (IEP) and need to enroll in Medicare, you will have to enroll during either a Special Enrollment Period (SEP) or the General Enrollment Period (GEP) to enroll in Part B or Premium Part A unless you have limited income and savings and are eligible for a Buy In. If you are eligible for Premium-Free Part A, you can enroll at any time.

Special Enrollment Period

If you are eligible for the Part B SEP, you can enroll in Medicare without penalty at any time while you have job-based insurance and for eight months after you lose your job-based insurance or you (or your spouse) stop working, whichever comes first.
If you are under 65, are Medicare-eligible due to disability, and have job-based insurance through a family member’s current work, you may also be entitled to the SEP if there are at least 100 employees at your family member’s place of work.

General Enrollment Period
The GEP takes place January 1 through March 31 of each year. During this period, you can enroll in Medicare Part B or Part A if you have to pay a premium for it.
Enrolling during the GEP in 2022 means your coverage will start on July 1, 2022. Until that time, you will not be covered by Part B, although your Part A may start sooner if you qualify for premium-free Part A.
You may have to pay a Part B premium penalty depending on the amount of time between your IEP and your enrollment.

Let’s talk about the Part B premium penalty. For each 12-month period you delay Medicare Part B enrollment, you will have to pay a 10% Part B premium penalty (unless you are eligible for a SEP through job-based insurance or are eligible for a Medicare Savings Program). In most cases, you will have to pay that penalty every month for as long as you have Medicare. If you are enrolled in Medicare because of a disability and currently pay premium penalties, once you turn 65 you will no longer have to pay that premium penalty.

If you have limited income and savings, you may be eligible for additional help. the Medicare Savings Program (MSP) or Buy-in Program. MSPs help pay your Medicare Part B premium costs and may also pay Medicare cost sharing and Part A premiums. Additional benefits of enrolling in an MSP include:
Allowing you to enroll in Medicare Part B outside of usual enrollment periods (like the GEP)
Eliminating your Part B late enrollment penalty if you have one
Allowing you to enroll in Premium Part A outside of usual enrollment periods in some circumstances

So, if you have missed your IEP, but have limited income and assets and qualify for an MSP, you will be able to enroll in Part B at any time without incurring a late enrollment penalty. I recommend contacting your State Health Insurance Assistance Program (SHIP) to check if you qualify for an MSP in your state.

I hope this helps you learn what to expect as you enroll in Medicare late. Best of luck!

-Marci

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Dear Marci,

My husband still works, and I am covered by his employer’s insurance. I am turning 65 in a few months and wondering if I should enroll in Medicare?

-Mariko (Sallisaw, OK)

Dear Mariko,

It is great that you are looking into this ahead of time and making a plan!

Job-based insurance allows you to delay Medicare enrollment in many cases. There are two questions to consider:

Will I have an opportunity to enroll in Medicare Part B later without a penalty and without waiting for a specific time of year?
Will my job-based insurance pay primary on my health care claims?
In other words, before you delay enrollment, you should determine whether you will have a Part B Special Enrollment Period (SEP) and whether your job-based insurance pays primary or secondary.

In most cases, you should only delay Part B if you will have an SEP and your job-based insurance is the primary payer (meaning it pays first for your medical bills) and Medicare is secondary.

Part B Special Enrollment Period
Because you will be eligible for Medicare due to age (meaning you will be 65+) and are covered by your spouse’s job-based insurance, you will have a Special Enrollment Period (SEP) to enroll in Part B while you have that coverage from current work up to eight months after the coverage or the work ends (whichever is first). This means that you can enroll in Part B after your Initial Enrollment Period (IEP) ends without facing a penalty and without having to wait for the General Enrollment Period (GEP).

Primary or secondary job-based insurance
Next, consider whether your job-based insurance will be the primary payer.
Job-based insurance is primary if it is from an employer with 20+ employees. Medicare is secondary in this case, and some people choose not to enroll in Part B because of the additional monthly premium.
Job-based insurance is secondary if it is from an employer with fewer than 20 employees. Medicare is primary in this case, and if you delay Medicare enrollment, your job-based insurance may provide little or no payment. You should enroll in Part B for coverage when you are first eligible.
Note: There are different rules about the SEP and which insurance is primary if you are Medicare-eligible due to disability or because you have ESRD.

To find out if your job-based insurance is primary or secondary, contact your or your spouse’s human resources department for information about your employer’s size. If you plan to delay enrollment into Part B and use the SEP later, keep records of your health insurance coverage. You will be required to submit proof of your enrollment in job-based insurance when using the SEP to enroll in Part B later. Proof of enrollment in job-based insurance includes:
Written notice from your employer or plan
Documents that show health insurance premiums paid, including W-2s, pay stubs, tax returns, and/or receipts
Health insurance cards with the appropriate effective date
Note: If you have insurance from an employer that is not because of current work, like COBRA or retiree insurance, there are different rules for the SEP and which insurance is primary.

In summary, you should find out if your husband’s insurance will be primary to Medicare. If it is primary, then you can delay Medicare enrollment if you’d like, since you would already have primary insurance from your husband’s current work.

I hope this helps you decide whether or not to enroll in Medicare during your Initial Enrollment Period!

-Marci

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Dear Marci,

I mistakenly enrolled in the wrong Medicare Advantage Plan and did not realize until the plan became effective in 2022. When can I change my coverage now?

-Susan (New York, NY)


Dear Susan,

I’m sorry to hear that! Depending on your circumstances, you may be able to change your coverage. Let’s discuss a few possibilities:

You can make certain changes during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 through March 31. Those enrolled in a Medicare Advantage Plan (like yourself) can switch to a different Medicare Advantage Plan or to Original Medicare with or without a stand-alone Part D plan. Changes made during his period are effective the first of the month after you make the change. You can use Medicare’s Plan Finder tool to compare plans and call 1-800-MEDICARE to request the change.

If you enrolled in a Medicare Advantage Plan or Part D plan by mistake or after receiving misleading information, you may be able to disenroll and change plans. Typically, you have the right to change plans if you:

Joined unintentionally: You may have enrolled believing you were joining a Medigap plan to supplement Original Medicare. Or, you meant to sign up for a stand-alone Part D plan and accidentally joined a Medicare Advantage Plan.
Joined based on incorrect or misleading information: For example, if a plan representative told you that your doctors are in the plan’s network but they are not, or you were promised benefits that the plan does not really cover.
Through no fault of your own, ended up or were kept in a plan you do not want: If you tried to switch plans during an enrollment period but were kept in your old plan. You can also make a change if you were enrolled in a plan because of an administrative or computer error.
Depending on the circumstances, this change may be retroactively effective.

You may be eligible for a Special Enrollment Period (SEP) in which to change your coverage. SEPs allow you to change your health and/or drug coverage outside normal enrollment periods. For example, if your Medicare Advantage Plan left your area or if you moved out of your plan’s service area, you would have an SEP to switch to another MA Plan or to Original Medicare. Those enrolled in certain cost assistance programs, such as Extra Help or the Medicare Savings Program, are eligible for other SEPs. Read about other circumstances that might trigger an SEP on Medicare Interactive.

And of course, you can wait for Fall Open Enrollment Period to make changes to your coverage for next year. Fall Open Enrollment Period occurs each year from October 15 through December 7, with your new coverage starting January 1.

I hope this helps you correct your coverage for 2022. Best of luck!

-Marci