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Dear Marci,

I turned 65 a while ago and I didn’t enroll in Medicare Part B. I instead kept my Marketplace plan. How can I enroll in Medicare?

– Noah (Portland, OR)

Dear Noah,

In general, if you do not enroll in Medicare during your Initial Enrollment Period (IEP), you must wait for the General Enrollment Period (GEP) to sign up for Medicare. The GEP runs January 1 through March 31 of each year, and if you enroll during this period, your Medicare benefits will start on July 1. This means that you may experience gaps in coverage. You will also likely have a late enrollment penalty for not signing up for Medicare when you were first eligible.

You will likely have to use the GEP to enroll in Medicare if (a) you kept your Marketplace plan and did not enroll in Medicare when you were first eligible, or (b) you enrolled in premium-free Part A and kept your Marketplace plan when you became eligible for Medicare. You will likely have to use the GEP to enroll in Medicare Part B.

Currently, you may be able to request time-limited equitable relief to enroll in Part B outside of the GEP. Time-limited equitable relief is a process you can use to enroll in Part B and/or eliminate a Part B late enrollment penalty (LEP). You may be eligible to request time-limited equitable relief if you delayed Medicare Part B enrollment while you had a Marketplace plan.

For example, maybe you enrolled in Medicare Part A and declined Part B when you first became eligible for Medicare because your Marketplace plan with cost assistance was cheaper than Part B. You may not have realized that you were supposed to sign up for Medicare and that you would lose your cost assistance because of your Medicare eligibility. In some instances, you may have continued to receive cost assistance even after enrolling in Part A. In other situations, you may have faced Marketplace plan coverage problems once your plan realized that Medicare should be covering costs. For example, the Marketplace plan may have stopped paying primary for your health costs.

Time-limited equitable relief is a limited process that allows you to either (a) enroll in Medicare Part B without penalty, or (b) eliminate or reduce your Part B LEP if you are already enrolled in Part B but had delayed enrollment when you had a Marketplace plan.

In order to qualify for time-limited equitable relief, you must be enrolled in premium-free Part A and (a) have an Initial Enrollment Period (IEP) that began April 1, 2013 or later, or (b) have been notified of retroactive premium-free Part A on October 1, 2013, or later.

To request time-limited equitable relief you will need to contact the Social Security Administration or visit a local Social Security office and ask to use time-limited equitable relief to enroll in Part B and/or eliminate your Part B LEP. You should bring proof that you are enrolled in a Marketplace plan, like a recent premium bill. If you received a letter about being enrolled in Medicare and a Marketplace plan, you can also bring that letter as proof. The opportunity to request time-limited equitable relief lasts until September 30, 2017.

Noah, if you think you are eligible to use time-limited equitable relief, please contact the Medicare Rights Center’s national helpline at 800-333-4114 for further assistance.

– Marci

High-density lipoprotein (HDL) is often referred to as the “good” cholesterol.

Having high HDL levels helps carry cholesterol from your arteries to your liver, where it can be used or excreted.

Having high levels of HDL also has antioxidant and anti-inflammatory effects, and is linked to a reduced risk of heart disease (1, 2).

Most health experts recommend minimum blood levels of 40 mg/dl in men and 50 mg/dl in women.

While genetics definitely play a role, there are several other factors that affect HDL levels.

Here are nine healthy ways to raise your “good” HDL cholesterol.

1. Consume olive oil

olive oil being poured into a small dish

Extra virgin olive oil may be more healthful than processed olive oils.

Olive oil is one of the healthiest fats around.

A large analysis of 42 studies with more than 800,000 participants found that olive oil was the only source of monounsaturated fat that seemed to reduce heart disease risk (3).

Research has shown that one of olive oil’s heart-healthy effects is an increase in HDL cholesterol. This effect is thought to be caused by antioxidants it contains called polyphenols (4, 5, 6, 7).

Extra virgin olive oil has more polyphenols than more processed olive oils, although the amount can still vary among different types and brands.

One study gave 200 healthy young men about 2 tablespoons (25 ml) of different olive oils per day for three weeks.

The researchers found that participants’ HDL levels increased significantly more after they consumed the olive oil with the highest polyphenol content (6).

In another study, when 62 older adults consumed about 4 tablespoons (50 ml) of high-polyphenol extra virgin olive oil every day for six weeks, their HDL cholesterol increased by 6.5 mg/dl, on average (7).

In addition to raising HDL levels, olive oil has been found to boost HDL’s anti-inflammatory and antioxidant function in studies of older people and individuals with high cholesterol levels ( 7, 8, 9).

Whenever possible, select high-quality, certified extra virgin olive oils, which tend to be highest in polyphenols.

Bottom line: Extra virgin olive oil with a high polyphenol content has been shown to increase HDL levels in healthy people, the elderly and individuals with high cholesterol.

2. Follow a low-carb or ketogenic diet

Low-carb and ketogenic diets provide a number of health benefits, including weight loss and reduced blood sugar levels.

They have also been shown to increase HDL cholesterol in people who tend to have lower levels.

This includes those who are obese, insulin resistant or diabetic (10, 11, 12, 13, 14, 15, 16, 17).

In one study, people with type 2 diabetes were split into two groups.

One followed a diet consuming less than 50 grams of carbs per day. The other followed a high-carb diet.

Although both groups lost weight, the low-carb group’s HDL cholesterol increased almost twice as much as the high-carb group’s did (14).

In another study, obese people who followed a low-carb diet experienced an increase in HDL cholesterol of 5 mg/dl overall.

Meanwhile, in the same study, the participants who ate a low-fat, high-carb diet showed a decreasein HDL cholesterol (15).

This response may partially be due to the higher levels of fat people typically consume on low-carb diets.

One study in overweight women found that diets high in meat and cheese increased HDL levels by 5-8%, compared to a higher-carb diet (18).

What’s more, in addition to raising HDL cholesterol, very-low-carb diets have been shown to decrease triglycerides and improve several other risk factors for heart disease (13, 14, 16, 17).

Bottom line: Low-carb and ketogenic diets typically increase HDL cholesterol levels in people with diabetes, metabolic syndrome and obesity.

3. Exercise regularly

Being physically active is important for heart health.

Studies have shown that many different types of exercise are effective at raising HDL cholesterol, including strength training, high-intensity exercise and aerobic exercise (19, 20, 21, 22, 23, 24).

However, the biggest increases in HDL are typically seen with high-intensity exercise.

One small study followed women who were living with polycystic ovary syndrome (PCOS), which is linked to a higher risk of insulin resistance. The study required them to perform high-intensity exercise three times a week.

The exercise led to an increase in HDL cholesterol of 8 mg/dL after 10 weeks. The women also showed improvements in other health markers, including decreased insulin resistance and improved arterial function (23).

In a 12-week study, overweight men who performed high-intensity exercise experienced a 10% increase in HDL cholesterol.

In contrast, the low-intensity exercise group showed only a 2% increase and the endurance training group experienced no change (24).

However, even lower-intensity exercise seems to increase HDL’s anti-inflammatory and antioxidant capacities, whether or not HDL levels change (20, 21, 25).

Overall, high-intensity exercise such as high-intensity interval training (HIIT) and high-intensity circuit training (HICT) may boost HDL cholesterol levels the most.

Bottom line: Exercising several times per week can help raise HDL cholesterol and enhance its anti-inflammatory and antioxidant effects. High-intensity forms of exercise may be especially effective.

4. Add coconut oil to your diet

Studies have shown that coconut oil may reduce appetite, increase metabolic rate and help protect brain health, among other benefits.

Some people may be concerned about coconut oil’s effects on heart health due to its high saturated fat content.

However, it appears that coconut oil is actually quite heart healthy.

Coconut oil tends to raise HDL cholesterol more than many other types of fat.

In addition, it may improve the ratio of low-density-lipoprotein (LDL) cholesterol, the “bad” cholesterol, to HDL cholesterol. Improving this ratio reduces heart disease risk (26, 27, 28, 29).

One study examined the health effects of coconut oil on 40 women with excess belly fat. The researchers found that participants who took coconut oil daily experienced increased HDL cholesterol and a lower LDL-to-HDL ratio.

In contrast, the group who took soybean oil daily had a decrease in HDL cholesterol and an increase in the LDL-to-HDL ratio (29).

Most studies have found these health benefits occur at a dosage of about 2 tablespoons (30 ml) of coconut oil per day. It’s best to incorporate this into cooking rather than eating spoonfuls of coconut oil on their own.

Bottom line: Consuming 2 tablespoons (30 ml) of coconut oil per day may help increase HDL cholesterol levels.

5. Stop smoking

Quitting smoking can reduce the risk of heart disease and lung cancer.

Smoking increases the risk of many health problems, including heart disease and lung cancer (30).

One of its negative effects is a suppression of HDL cholesterol.

Some studies have found that quitting smokingcan increase HDL levels. Indeed, one study found no significant differences in HDL levels between former smokers and people who had never smoked (31, 32, 33, 34, 35).

In a one-year study of more than 1,500 people, those who quit smoking had twice the increase in HDL as those who resumed smoking within the year. The number of large HDL particles also increased, which further reduced heart disease risk (32).

One study followed smokers who switched from traditional cigarettes to electronic cigarettes for one year. They found that the switch was associated with an increase in HDL cholesterol of 5 mg/dl, on average (33).

When it comes to the effect of nicotine replacement patches on HDL levels, research results have been mixed.

One study found that nicotine replacement therapy led to higher HDL cholesterol. However, other research suggests that people who use nicotine patches likely won’t see increases in HDL levels until after replacement therapy is completed (34, 36).

Even in studies where HDL cholesterol levels didn’t increase after people quit smoking, HDL function improved, resulting in less inflammation and other beneficial effects on heart health (37).

Bottom line: Quitting smoking can increase HDL levels, improve HDL function and help protect heart health.

6. Lose weight

When overweight and obese people lose weight, their HDL cholesterol levels usually increase.

What’s more, this benefit seems to occur whether weight loss is achieved by calorie counting, carb restriction, intermittent fasting, weight loss surgery or a combination of diet and exercise (16, 38, 39, 40, 41, 42).

One study examined HDL levels in more than 3,000 overweight and obese Japanese adults who followed a lifestyle modification program for one year.

The researchers found that losing at least 6.6 lbs (3 kg) led to an increase in HDL cholesterol of 4 mg/dl, on average (41).

In another study, when obese people with type 2 diabetes consumed calorie-restricted diets that provided 20-30% of calories from protein, they experienced significant increases in HDL cholesterol levels (42).

The key to achieving and maintaining healthy HDL cholesterol levels is choosing the type of diet that makes it easiest for you to lose weight and keep it off.

Bottom Line: Several methods of weight loss have been shown to increase HDL cholesterol levels in people who are overweight or obese.

7. Choose purple produce

Consuming purple-colored fruits and vegetables is a delicious way to potentially increase HDL cholesterol.

Purple produce contains antioxidants known as anthocyanins.

Studies using anthocyanin extracts have shown that they help fight inflammation, protect your cells from damaging free radicals and may also raise HDL cholesterol levels (43, 44, 45, 46).

In a 24-week study of 58 people with diabetes, those who took an anthocyanin supplement twice a day experienced a 19% increase in HDL cholesterol, on average, along with other improvements in heart health markers (45).

In another study, when people with cholesterol issues took anthocyanin extract for 12 weeks, their HDL cholesterol levels increased by 13.7% (46).

Although these studies used extracts instead of foods, there are several fruits and vegetables that are very high in anthocyanins. These include eggplant, purple corn, red cabbage, blueberries, blackberries and black raspberries.

Bottom line: Consuming fruits and vegetables rich in anthocyanins may help increase HDL cholesterol levels.

8. Eat fatty fish often

The omega-3 fats in fatty fish provide major benefits to heart health, including a reduction in inflammation and better functioning of the cells that line your arteries (47, 48).

There’s some research showing that eating fatty fish or taking fish oil may also help raise low levels of HDL cholesterol (49, 50, 51, 52, 53).

In a study of 33 heart disease patients, participants that consumed fatty fish four times per week experienced an increase in HDL cholesterol levels. The particle size of their HDL also increased (52).

In another study, overweight men who consumed herring five days a week for six weeks had a 5% increase in HDL cholesterol, compared with their levels after eating lean pork and chicken five days a week (53).

However, there are a few studies that found no increase in HDL cholesterol in response to increased fish or omega-3 supplement intake (54, 55).

In addition to herring, other types of fatty fish that may help raise HDL cholesterol include salmon, sardines, mackerel and anchovies.

Bottom line: Eating fatty fish several times per week may help increase HDL cholesterol levels and provide other benefits to heart health.

9. Avoid artificial trans fats

Artificial trans fats have many negative health effects due to their inflammatory properties (56, 57).

There are two types of trans fats. One kind occurs naturally in animal products, including full-fat dairy.

In contrast, the artificial trans fats found in margarines and processed foods are created by adding hydrogen to unsaturated vegetable and seed oils. These fats are also known as industrial trans fats or partially hydrogenated fats.

Research has shown that, in addition to increasing inflammation and contributing to several health problems, these artificial trans fats may lower HDL cholesterol levels.

In one study, researchers compared how people’s HDL levels responded when they consumed different margarines.

The study found that participants’ HDL cholesterol levels were 10% lower after consuming margarine containing partially hydrogenated soybean oil, compared to their levels after consuming palm oil (58).

Another controlled study followed 40 adults who had diets high in different types of trans fats.

They found that HDL cholesterol levels in women were significantly lower after they consumed the diet high in industrial trans fats, compared to the diet containing naturally occurring trans fats (59).

To protect heart health and keep HDL cholesterol in the healthy range, it’s best to avoid artificial trans fats altogether.

Bottom line: Artificial trans fats have been shown to lower HDL levels and increase inflammation, compared to other fats.

Take home message

Although your HDL cholesterol levels are partly determined by your genetics, there are many things you can do to naturally increase your own levels.

Fortunately, the practices that raise HDL cholesterol often provide other health benefits‘