What to Do If You Don’t Sign Up for Medicare in Time

Most people are first eligible for Medicare Part B when they turn 65. But what happens if you miss your Medicare enrollment window – or deliberately decide not to enroll in Medicare when you’re first eligible?

Here’s what happens – and what to do – if you don’t sign up for Medicare in time.

When to First Sign Up for Medicare Coverage

Most people become eligible for Medicare at age 65. Your Initial Enrollment Period (IEP) starts three months before the month of your 65^th birthday and extends until three months after the month of your 65^th birthday.

The date your Medicare coverage starts depends on which month you sign up for Medicare during your IEP. However, coverage always begins on the first day of the month.

If you qualify for premium-free Part A, which is the case for most people, your Part A coverage will start the month you turn 65. If your birthday is on the first, your coverage will start the month before you turn 65.

Part B coverage starts based on the month you sign up. For example, if you sign up the month before you turn 65, your Part B coverage will begin the month you turn 65.

If You Miss Your Initial Enrollment Period (IEP)

If you miss your Initial Enrollment Period, that 7-month window surrounding your 65^th birthday, your options are very limited.

You can only sign up for Medicare Part B during another enrollment period – a Special Enrollment Period or the General Enrollment Period.

If you don’t qualify for a Special Enrollment Period, you’ll have to wait for the General Enrollment Period, which is from January 1-March 31 every year. You can sign up for Medicare during this time, and your coverage would begin on July 1^st.

Note: Starting in 2023, coverage will begin the first of the month following the month you enrolled during the General Enrollment Period.

In this case, you will be entirely without health insurance coverage until July 1^st, and you may have to pay a late enrollment penalty.

Qualifying for a Special Enrollment Period (SEP)

If you miss your Initial Enrollment Period surrounding your 65^th birthday, you should find out if you qualify for a Special Enrollment Period (SEP) before panicking!

These special situations allow you to sign up for Medicare Part B without paying the late enrollment penalty, which is a 10% surcharge on your Part B premiums.  

However, SEPs are only available for a limited time, and if you miss the enrollment window, you may have to pay a late enrollment penalty after all.

Here are some examples of Special Enrollment Periods:

• You have health insurance through your job and are still working
• You’re a volunteer, serving in a foreign country
• Certain situations for people with TRICARE

The most common SEP we run across is those who have group health plan coverage through their employer or their spouse’s employer. In this case, you have 8 months to sign up for Medicare after you or your spouse stops working or you lose group health plan coverage (whichever comes first).

If you’re stuck, we recommend going to the list of SEPs on the Medicare website and see if there’s any chance your situation is listed there. We have been able to help some people in rare circumstances by combing through this list.

Penalties and Lack of Coverage When There Are No Other Options

If you missed your Initial Enrollment Period and do not qualify for a Special Enrollment Period, there are no other options but to accept the possible penalty and go without health insurance coverage for a while.

You can sign up for Medicare during the General Enrollment Period (GEP), which lasts from January 1-March 31. But your coverage will not begin until July 1. In this case, you could go many months without any health insurance coverage.

Note: Starting in 2023, coverage will begin the first of the month following the month you enrolled during the General Enrollment Period.

In addition, the Part B late enrollment penalty will apply. Here’s what you should know about the penalty:

• You’ll pay an extra 10% for each year you could have signed up for Part B but didn’t.
• This penalty is added to your monthly Part B premium. (You may also pay a higher premium depending on your income.)
• It’s not a one-time late fee — you’ll pay the penalty for as long as you have Part B.

Conclusion

Enrolling in Medicare during the proper enrollment windows is crucial to ensure you don’t face penalties and lapses in coverage.  

If you’re about to turn 65, please reach out to our office for help navigating your enrollment windows and comparing coverage options.  

And if you’ve already missed your enrollment period, we can help there, too. We’ll help you with late enrollments and can coach you through what to expect.