Getting Medicare (continued)

• Special Enrollment Period—A person may decide to wait to sign up for Part A and/or Part B because he or she is covered by a group health plan based on his or her own or a spouse’s current employment (or if disabled, a family member’s current employment). Someone in this situation can sign up for Part A and/or Part B at any time while he or she has group health plan coverage based on current employment or during the 8-month period that begins the month after the employment ends, or the group health plan coverage ends, whichever happens first. Note: This Special Enrollment Period doesn’t apply to people with ESRD. 

• Special Enrollment Period for international volunteers—A person who waited to sign up for Part A and/or Part B because he or she had health insurance while volunteering in a foreign country has a special opportunity to sign up.

Medicare Part A and Part B premiums 

Most people don’t have to pay a monthly premium for Part A because they or a spouse paid Medicare taxes while they were working. This is called “premium-free Part A.” Most people do pay a premium each month for Part B.

Late enrollment penalties 

A person who doesn’t sign up for Part A when he or she is first eligible may have to pay a penalty equal to 10% of the Part A premium. The 10% premium penalty applies no matter how long someone delays Part A enrollment. The person will have to pay the premium penalty for twice the number of years he or she could have had Part A, but didn’t sign up. 

A person who doesn’t sign up for Part B when he or she is first eligible may have to pay a late enrollment penalty. The monthly premium for Part B may go up 10% for each full 12-month period that the person could have had Part B, but didn’t sign up for it. The person will have to pay the premium penalty for a long as he or she has Medicare

Usually, there’s no late enrollment penalty if someone signs up for Part A and/or Part B during a Special Enrollment Period.

When can a person with Medicare join a Medicare Advantage Plan (like an HMO or PPO) or a Medicare drug plan?  

There are specific times when a person can sign up for a Medicare Advantage Plan or a Medicare drug plan:

• When a person first becomes eligible for Medicare or turns 65, during his or her Initial Enrollment Period.

• Between October 15–December 7 each year, with coverage beginning on January 1 of the following year. 

• Under certain circumstances that qualify a person for a Special Enrollment Period (SEP), like:   

– Moving out of the plan’s service area 

– Having both Medicare and Medicaid 

– Qualifying for Extra Help to pay for prescription drugs 

– Living in an institution (like a nursing home)

It may be possible to join, switch, or drop a Medicare Advantage Plan at other times, under certain circumstances.