When Should I Sign Up for Medicare? Avoiding Penalties

Last updated 3 months ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

Medicare is the United States’ federal health insurance program primarily for individuals aged 65 or older, but also for certain younger people with disabilities and individuals with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).

Signing up at the right time ensures access to necessary healthcare services and prevents costly mistakes. This guide provides information on Medicare enrollment periods and how to avoid late enrollment penalties.

Understanding the Parts of Medicare

Medicare is structured into different parts, each covering specific services. Choosing the right combination depends on individual healthcare needs and financial situations.

Medicare Part A: Hospital Insurance

Medicare Part A primarily helps cover inpatient care costs. This includes:

• Inpatient hospital stays (including critical access hospitals)
• Care in a skilled nursing facility (SNF), following a qualifying hospital stay, but not long-term custodial care
• Hospice care for individuals certified as terminally ill
• Some home health care services

Most individuals do not pay a monthly premium for Part A, often referred to as “premium-free Part A”. Eligibility for premium-free Part A at age 65 typically requires the individual or their spouse to have worked and paid Medicare taxes for at least 40 quarters (10 years).

Individuals receiving Social Security or Railroad Retirement Board (RRB) benefits for at least 4 months before turning 65 are usually automatically enrolled in premium-free Part A.

However, not everyone qualifies for premium-free Part A. Those who haven’t met the work history requirement may need to purchase Part A. In 2025, the monthly premium for Part A is $285 for those with 30-39 quarters of coverage and $518 for those with fewer than 30 quarters.

To purchase Part A, an individual must also enroll in Part B and meet U.S. citizenship and residency requirements. Delaying enrollment in premium Part A when first eligible can lead to a late enrollment penalty.

Medicare Part B: Medical Insurance

Medicare Part B covers medically necessary outpatient services and preventive care. Key covered services include:

• Doctor’s visits and services from other healthcare providers
• Outpatient care (hospital or clinic)
• Durable medical equipment (DME) like wheelchairs and walkers
• Many preventive services, such as screenings, vaccines, and annual “Wellness” visits
• Ambulance services, clinical research, mental health services, and limited outpatient prescription drugs

Unlike Part A, most people pay a monthly premium for Part B. The standard Part B premium for 2025 is $185 per month, but this amount can be higher depending on income reported on tax returns from two years prior.

This income-related adjustment means higher earners pay more. Premiums are often deducted automatically from Social Security, RRB, or Civil Service Retirement payments. If not automatically deducted, Medicare will send a bill.

Failure to enroll in Part B when first eligible can result in a significant, lifelong late enrollment penalty.

Medicare Part C: Medicare Advantage

Medicare Advantage, also known as Part C, offers an alternative way to receive Medicare benefits. These plans are offered by private insurance companies approved by Medicare.

Bundled Coverage: Medicare Advantage plans bundle Part A and Part B coverage and usually include Part D prescription drug coverage.

Extra Benefits: Plans may offer additional benefits not covered by Original Medicare, such as routine vision, hearing, dental care, and fitness programs.

Network Restrictions: Most Medicare Advantage plans have provider networks (like HMOs or PPOs). Enrollees generally need to use doctors and hospitals within the plan’s network for non-emergency care to receive the lowest costs or any coverage at all. Some plans require referrals to see specialists.

Costs: Enrollees continue to pay the monthly Part B premium, and may also pay an additional premium to the Medicare Advantage plan, although some plans have a $0 premium. Plans have varying deductibles, copayments, and coinsurance for services.

A key feature is the annual out-of-pocket maximum limit for Part A and Part B services; once this limit is reached, the plan pays 100% for covered services for the rest of the year. Original Medicare does not have an out-of-pocket limit unless paired with supplemental coverage.

Medicare Part D: Prescription Drug Coverage

Medicare Part D provides coverage for outpatient prescription drugs. This coverage is offered through private insurance companies approved by Medicare.

How to Get Part D: Individuals can enroll in a standalone Part D plan (PDP) alongside Original Medicare, or choose a Medicare Advantage plan that includes drug coverage (MA-PD). Eligibility for a standalone PDP requires having either Part A or Part B. Enrolling in an MA-PD typically requires having both Part A and Part B.

Costs: Costs vary by plan but generally include a monthly premium (in addition to the Part B premium), potentially an annual deductible, and copayments or coinsurance for prescriptions. Similar to Part B, higher-income individuals may pay an income-related monthly adjustment amount (IRMAA) for their Part D premium.

Late Enrollment Penalty: Delaying enrollment in Part D (or going without other creditable prescription drug coverage for 63 consecutive days or more after initial eligibility) can result in a lifelong late enrollment penalty added to the monthly premium.

Medicare Supplement Insurance (Medigap)

Medigap policies are supplemental insurance sold by private companies to help pay some of the out-of-pocket costs not covered by Original Medicare (Parts A and B), such as deductibles, coinsurance, and copayments.

Compatibility: Medigap policies only work with Original Medicare; they cannot be used with Medicare Advantage plans.

Coverage: Policies are standardized (e.g., Plan G, Plan K) across most states, meaning plans with the same letter offer the same basic benefits regardless of the insurer. Some plans offer additional benefits like coverage for foreign travel emergencies. Medigap generally does not cover long-term care, vision, dental, or prescription drugs.

Enrollment: The best time to buy a Medigap policy is during the 6-month Medigap Open Enrollment Period, which starts the first month an individual is 65 or older and enrolled in Part B. During this period, insurance companies cannot deny coverage or charge more due to health conditions. Outside this window, enrollment may be subject to medical underwriting.

Eligibility: Who Can Get Medicare?

Eligibility for Medicare primarily hinges on age, disability status, or specific medical conditions.

Age 65 and Older

Individuals aged 65 or older are eligible for Medicare if they are U.S. citizens or have been legal permanent residents for at least five continuous years.

Premium-Free Part A: Eligibility for premium-free Part A at age 65 usually requires the individual or their spouse to have at least 10 years (40 quarters) of Medicare-covered employment. Those eligible for Social Security or RRB retirement benefits generally qualify.

Buying Part A/B: Those not eligible for premium-free Part A can buy it if they are 65+, meet citizenship/residency rules, and also enroll in Part B. Part B eligibility requires being 65+, a U.S. resident, and either a citizen or a legal permanent resident for 5+ years.

Under 65 with Disabilities

Certain individuals under age 65 can qualify for Medicare based on disability.

Social Security Disability Insurance (SSDI) / RRB Disability: Individuals become eligible for Medicare after receiving SSDI or certain RRB disability benefits for 24 months. Enrollment in Parts A and B is typically automatic at the start of the 25th month.

Amyotrophic Lateral Sclerosis (ALS): Individuals diagnosed with ALS (Lou Gehrig’s disease) are eligible for Medicare the first month they become entitled to Social Security or RRB disability cash benefits, with no 24-month waiting period. Enrollment is automatic.

End-Stage Renal Disease (ESRD)

Individuals of any age with ESRD (permanent kidney failure requiring dialysis or a kidney transplant) can qualify for Medicare. Eligibility generally requires filing an application and meeting certain conditions related to work history (self, spouse, or parent) or eligibility for Social Security/RRB benefits.

Coverage typically starts later than for age or disability, often beginning the third month after starting regular dialysis or upon receiving a transplant. Unlike other groups, enrollment for ESRD is typically not automatic and requires contacting Social Security.

The Initial Enrollment Period (IEP): Your First Chance to Sign Up

The Initial Enrollment Period (IEP) is the primary window for enrolling in Medicare Parts A and B when first becoming eligible, typically around age 65. Enrolling during the IEP is crucial to avoid potential late enrollment penalties and gaps in coverage.

When the IEP Occurs

Based on Age: For those eligible based on turning 65, the IEP is a 7-month period. It begins 3 months before the month of the 65th birthday, includes the birth month, and ends 3 months after the birth month. For example, if an individual turns 65 in July, their IEP runs from April 1st to October 31st.

Based on Disability: For those eligible due to disability (after the 24-month waiting period), the IEP also lasts 7 months. It starts 3 months before the 25th month of receiving disability benefits, includes the 25th month, and ends 3 months after that month.

Coverage Start Date During IEP

When Medicare coverage begins depends on when enrollment occurs within the IEP:

Enrollment Before Birth Month: If enrolling in Part B (or premium Part A) in the 3 months before the 65th birthday month, coverage starts on the first day of the birth month. (Note: Premium-free Part A generally starts the month of the 65th birthday regardless of when enrollment occurs, or the month before if the birthday is on the 1st).

Enrollment During or After Birth Month: If enrolling in Part B (or premium Part A) during the birth month or the 3 months after, coverage starts on the first day of the month following enrollment. This recent change means coverage starts sooner than under previous rules, reducing potential gaps for those enrolling later in their IEP.

Why Enrolling During the IEP Matters

The IEP is the optimal time to enroll in Medicare Parts A and B to secure coverage without penalties. Missing this window without qualifying for a Special Enrollment Period (discussed later) typically means waiting for the General Enrollment Period and facing lifelong premium penalties for Part B, and potentially for Part A if required to pay premiums.

It also provides the initial opportunity to enroll in Medicare Advantage (Part C) or Part D plans.

Late Enrollment Penalties: A Costly Mistake

Failing to enroll in Medicare when first eligible, without having other qualifying coverage or qualifying for an exception, can lead to significant and often permanent financial penalties added to monthly premiums. These penalties are not one-time fees but ongoing additions to premiums.

Part B Late Enrollment Penalty

The Part B penalty is particularly common and impactful because many people must actively enroll in Part B, and the penalty typically lasts for as long as the individual has Part B coverage – essentially, for life.

Calculation: The penalty is 10% of the standard Part B premium for each full 12-month period the individual could have had Part B but did not enroll and did not qualify for a Special Enrollment Period (SEP).

Example: If someone waited 2 full years (24 months) after their IEP ended to sign up for Part B and didn’t have qualifying employer coverage, their penalty would be 20% (10% x 2 years). This 20% is calculated based on the standard Part B premium for the current year (even if their actual premium is higher due to income) and added to their monthly premium.

Using the 2025 standard premium of $185, the penalty would be $37 ($185 x 0.20), making the total monthly premium $222 ($185 + $37). Since the standard premium can change yearly, the penalty amount can also change.

Disability Exception: An important nuance exists for those qualifying for Medicare due to disability before age 65. If they incur a Part B penalty, that penalty is removed once they turn 65. This waiver does not apply to penalties accrued due to delayed enrollment after age 65.

Part D Late Enrollment Penalty

The Part D penalty applies to those who go without Medicare Part D or other “creditable” prescription drug coverage for 63 consecutive days or more after their IEP ends. “Creditable coverage” means the coverage is expected to pay, on average, at least as much as standard Medicare Part D coverage.

Like the Part B penalty, the Part D penalty is typically paid for as long as the individual has Medicare drug coverage.

Calculation: The penalty is calculated as 1% of the national base beneficiary premium ($36.78 in 2025) for each full month the individual was eligible for Part D but didn’t have it or other creditable coverage. This amount is rounded to the nearest $0.10 and added to the monthly Part D plan premium.

Example: If someone went 14 months without creditable drug coverage after their IEP, their penalty would be 14% (1% x 14 months). The monthly penalty amount for 2025 would be 1% of $36.78 multiplied by 14, then rounded: ($36.78 x 0.01 x 14) = $5.1492, rounded to $5.10 per month added to their plan premium.

Because the national base beneficiary premium can change each year, the penalty amount can also fluctuate annually.

Avoiding the Penalty: The easiest way to avoid the Part D penalty is to enroll in a Medicare drug plan (either standalone or within a Medicare Advantage plan) during the IEP, or ensure continuous creditable drug coverage from another source (like an employer plan, VA, or TRICARE).

Individuals receiving Extra Help (a program for people with limited income and resources) do not pay the Part D penalty.

Part A Late Enrollment Penalty

While most people get Part A premium-free, those who have to buy it and delay enrollment past their IEP may face a penalty.

Calculation: The monthly premium may increase by 10%.

Duration: Unlike the Part B and D penalties, the Part A penalty is time-limited. It must be paid for twice the number of years the individual could have had Part A but didn’t enroll. For example, delaying Part A enrollment for 2 years results in paying the 10% higher premium for 4 years.

Avoiding the Penalty: Enrolling in premium Part A during the IEP or qualifying for an SEP avoids this penalty. There is no penalty for delaying enrollment in premium-free Part A.

The existence of these penalties underscores the importance of understanding enrollment rules. Delaying enrollment without a valid reason or qualifying coverage can lead to significantly higher healthcare costs over the long term.

Special Enrollment Periods (SEPs): Your Second Chance

Life events can change healthcare needs and coverage. Medicare provides Special Enrollment Periods (SEPs) that allow individuals to enroll in Medicare Parts A and B, or make changes to Medicare Advantage (Part C) and Part D plans, outside of the standard enrollment periods, often without penalty.

Understanding these SEPs is vital for maintaining continuous coverage and avoiding penalties.

Common Qualifying Events for SEPs

SEPs are triggered by specific life circumstances. Some common events that grant an SEP for enrolling in Part A and/or Part B include:

• Losing Job-Based Coverage: Losing health coverage from current employment (yours or your spouse’s)
• Losing Medicaid Coverage: Effective January 1, 2023
• Impacted by Emergency/Disaster: Living in an area affected by a declared emergency or disaster
• Employer/Plan Misrepresentation: Receiving incorrect information from an employer or health plan about enrollment
• Release from Incarceration: Being released from jail/prison
• Returning to the U.S.: Moving back after living abroad
• Volunteering Overseas: Ending international volunteer service with qualifying health coverage
• Other Exceptional Conditions: Unique circumstances preventing timely enrollment, reviewed case-by-case by Social Security

Additional SEPs exist for making changes to Medicare Advantage (Part C) and Part D plans, such as moving within or out of a plan’s service area, qualifying for Extra Help, or a plan changing its contract or star rating.

It is critical to understand that not all coverage loss triggers an SEP for Part B. Specifically, losing COBRA continuation coverage or retiree health insurance does not grant an SEP to enroll in Part B.

This is because these coverages are not based on current employment, which is the requirement for the main Part B SEP related to job-based coverage. Relying on COBRA or retiree plans to delay Part B enrollment beyond the initial 8-month window after active employment ends can lead to penalties.

Key SEP Timelines and How to Use Them

SEP timelines vary depending on the event. Acting within the specific window is crucial, as SEPs are not automatic and often require proactive application and sometimes proof. Missing the SEP window usually means waiting for the GEP and facing penalties.

Loss of Job-Based Coverage (Part B SEP): This crucial SEP lasts for 8 months. It begins the month after the employment ends OR the month after the group health plan coverage based on that current employment ends, whichever happens first. Enrolling during this SEP allows penalty-free Part B enrollment. Coverage generally starts the first day of the month after enrollment. Individuals may need Form CMS-L564 completed by the employer to prove coverage.

Loss of Creditable Drug Coverage (Part D SEP): This SEP allows enrollment in a Part D plan and lasts for 2 full months after the month the creditable coverage ends or the individual is notified it’s no longer creditable, whichever is later.

Moving (Part C/D SEP): If moving out of a plan’s service area, the SEP generally starts the month before the move and continues for 2 full months after the move.

Medicaid/Extra Help (Part C/D SEP): Individuals with Medicaid or Extra Help generally have an ongoing SEP allowing them to change their Medicare Advantage or Part D plan once per calendar month (or quarter, depending on the specific SEP rules, which may change).

Coverage Start: For most SEPs, coverage begins the first day of the month after the enrollment request is received. However, specific rules can apply, such as retroactive coverage options for SEPs related to incarceration or Medicaid loss.

SEPs: Your Shield Against Penalties

Successfully utilizing an SEP when eligible is the primary way to enroll in Medicare Part B (or premium Part A) after the IEP without facing late enrollment penalties. It provides flexibility for those who maintain qualifying coverage (like job-based insurance) past age 65 or experience other specific life changes.

Missed Your Chance? The General Enrollment Period (GEP)

For individuals who miss both their Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period (SEP), the General Enrollment Period (GEP) offers another chance to sign up for Medicare Part A (if required to pay a premium) and/or Part B. However, enrolling during the GEP often comes with consequences.

GEP Dates: January 1 – March 31 Annually

The GEP occurs each year from January 1st through March 31st. This is the designated window for those who didn’t enroll when first eligible and lack SEP qualifications.

Coverage Start Date

Under current rules, if an individual enrolls in Part A or Part B during the GEP (January 1 – March 31), coverage begins on the first day of the month after enrollment. For example, enrolling in February means coverage starts March 1st.

This is an improvement over older rules where coverage didn’t start until July 1st, but it doesn’t eliminate the potential for significant gaps in coverage. If someone loses coverage mid-year and missed their prior enrollment windows, they still must wait until the next GEP starting January 1st to enroll, potentially facing many months without coverage before enrollment is even possible.

Warning: Penalties Likely Apply

Enrolling during the GEP almost always means incurring late enrollment penalties for Part B and/or premium Part A. The GEP exists specifically for those who missed their penalty-free windows (IEP and SEP). Relying on the GEP should be avoided whenever possible by enrolling during the IEP or a qualifying SEP.

Medicare & Other Insurance: Navigating the Maze

Many people have other health insurance when they become eligible for Medicare. Understanding how Medicare works with other coverage – known as Coordination of Benefits (COB) – is essential for making informed enrollment decisions and ensuring bills are paid correctly.

Who Pays First? Primary vs. Secondary Payer Basics

When an individual has Medicare and another form of health coverage, each is called a “payer”. COB rules determine the order of payment.

Primary Payer: Pays first on health claims, up to the limits of its coverage.

Secondary Payer: Pays second on any remaining costs that the primary payer didn’t cover, but only if the service is covered by the secondary plan and only up to its limits. The individual may still be responsible for some costs.

The specific rules determining whether Medicare or the other insurance pays first depend on the type of other insurance and the individual’s circumstances (e.g., employment status, employer size). It’s crucial to inform all doctors and healthcare providers about all health coverage to ensure proper billing.

If coverage changes, Medicare’s Benefits Coordination & Recovery Center (BCRC) should be notified at 1-855-798-2627 (TTY: 1-855-797-2627). More information is available at Medicare.gov.

The payer status isn’t static; it can change based on life events like retirement. Understanding the current coordination rules is vital.

Working Past 65 with Employer Coverage (EGHP)

For individuals working past age 65 (or covered by a working spouse’s plan), the coordination rules depend heavily on the employer’s size. More details can be found at Medicare.gov.

Employer with 20 or More Employees: The Employer Group Health Plan (EGHP) pays primary, and Medicare pays secondary. In this situation, individuals can often delay enrolling in Medicare Part B without penalty as long as they are covered by the EGHP based on current employment. They will qualify for an 8-month SEP to enroll in Part B when the employment or coverage ends.

Employer with Fewer than 20 Employees: Medicare pays primary, and the EGHP pays secondary. In this scenario, enrolling in both Part A and Part B during the IEP is generally necessary. The small employer’s plan may not pay claims first if Medicare is not enrolled, potentially leaving the individual with large bills even if they have the employer plan. Delaying Part B in this case usually leads to penalties and coverage gaps.

Disability Under 65: For those covered by an EGHP due to their own or a family member’s current employment while under 65 and disabled, the employer size threshold shifts. The EGHP is primary only if the employer has 100 or more employees; otherwise, Medicare is primary.

Health Savings Account (HSA) Conflict: A critical point for those working past 65 with high-deductible health plans is that contributions to an HSA are not permitted once any part of Medicare (Part A or Part B) begins. Since premium-free Part A coverage can be retroactive up to 6 months from the application date, individuals should stop HSA contributions at least 6 months before applying for Medicare or Social Security benefits to avoid tax penalties.

COBRA Considerations

COBRA allows temporary continuation of EGHP coverage after employment ends. However, its interaction with Medicare is often misunderstood. See Medicare.gov and DOL.gov for details.

SEP Timing: COBRA coverage does not count as coverage based on current employment. The 8-month SEP for enrolling in Part B starts when the active employment or the EGHP coverage ends, whichever is first – not when COBRA coverage ends. Delaying Part B enrollment solely because of having COBRA will result in missing the SEP and facing penalties.

Payer Order: If an individual is eligible for Medicare (usually meaning age 65+ or eligible due to disability), Medicare pays primary, and COBRA pays secondary. If someone has COBRA first and then becomes eligible for Medicare, the COBRA coverage may end. If someone has Medicare first and then elects COBRA, they can generally keep both, with Medicare paying first.

Coverage Risk: Because Medicare pays first for eligible individuals, failing to enroll in Part B when required (e.g., after employment ends) can leave the person effectively uninsured for Part B services, as COBRA may not cover costs that Medicare would have paid.

Drug Coverage: COBRA prescription drug coverage might be creditable for Part D purposes, but this must be verified with the plan administrator. If it is creditable, Part D enrollment can be delayed without penalty until the COBRA coverage ends (enrollment must occur within 63 days of losing creditable coverage). If it’s not creditable, delaying Part D enrollment will lead to penalties.

Retiree Health Plan Coordination

Retiree health plans are offered by former employers or unions. See Medicare.gov.

Payer Order: For retirees, Medicare pays primary, and the retiree plan pays secondary.

Part A & B Enrollment: Enrolling in both Medicare Part A and Part B when first eligible (usually at retirement or age 65) is generally required to receive full benefits from the retiree plan. The retiree plan may not pay for services that Medicare would have covered if Part B was not enrolled.

Plan Variability: Retiree plans differ significantly. Benefits can change or even be eliminated. Individuals must check with their former employer or union benefits administrator to understand how their specific plan works with Medicare.

Drug Coverage: Retiree prescription drug coverage must be creditable to avoid the Part D late enrollment penalty. Plans must notify retirees annually if their coverage is creditable. Enrolling in a separate Medicare Part D plan could cause the individual (and potentially dependents) to lose their retiree health coverage entirely, including medical benefits. It’s crucial to verify this before joining a Part D plan.

VA Benefits and Medicare

Veterans Affairs (VA) benefits and Medicare operate largely independently.

No Coordination: Medicare does not pay for services received at VA facilities, and the VA generally does not pay for services received at non-VA facilities unless pre-authorized by the VA. They do not coordinate benefits; the individual chooses which system to use for care. VA benefits do not cover Medicare deductibles or coinsurance.

Enrollment Recommendation: The VA encourages veterans to enroll in Medicare Parts A and B when eligible. Having Medicare provides flexibility to receive care outside the VA system. Enrolling in Part A is usually free, and while Part B has a premium, it ensures access to non-VA doctors and hospitals. Delaying Part B enrollment can lead to penalties and gaps if non-VA care is needed later.

Drug Coverage: VA prescription drug coverage is considered creditable coverage for Medicare Part D. This means veterans can delay enrolling in a Medicare Part D plan without penalty as long as they maintain VA drug coverage. However, VA coverage only applies to prescriptions filled through VA pharmacies or mail order, while Part D covers drugs from a wider network of pharmacies.

Resources: Veterans can find more information at VA.gov and Medicare.gov.

TRICARE / TRICARE For Life (TFL)

TRICARE is the health program for uniformed service members, retirees, and their families. Its interaction with Medicare is specific and requires action from beneficiaries. Find details at TRICARE.mil/medicare and TRICARE.mil/tfl.

Part A & B Required: For most TRICARE beneficiaries who become eligible for Medicare (e.g., military retirees turning 65), enrollment in both Medicare Part A and Part B is mandatory to retain TRICARE coverage. Failure to enroll in Part B when required will result in loss of TRICARE benefits. Exceptions exist for active duty service members and their families, and those enrolled in certain TRICARE plans like TRICARE Reserve Select or Young Adult.

TRICARE For Life (TFL): Once enrolled in Medicare Parts A and B, eligible beneficiaries are automatically covered by TRICARE For Life (TFL). There are no separate enrollment forms or fees for TFL, but Part B premiums must be paid.

Coordination (Wraparound Coverage): TFL works as “wraparound” coverage with Medicare. In the U.S. and its territories, Medicare pays primary, and TFL pays secondary on claims for services covered by both programs. TFL typically covers Medicare’s deductibles and coinsurance, often resulting in zero out-of-pocket costs for beneficiaries for covered services. Overseas (except U.S. territories), TFL generally pays primary.

Drug Coverage: TFL includes comprehensive, creditable prescription drug coverage. Therefore, enrolling in a separate Medicare Part D plan is usually unnecessary and provides little additional value for TFL beneficiaries. Because TFL coverage is creditable, beneficiaries can enroll in Part D later without penalty if desired.

SEP for TRICARE: TRICARE beneficiaries have a specific SEP related to Medicare enrollment.

The failure to enroll in Part B when required can jeopardize not only access to Medicare benefits but also the continuation or effectiveness of other valuable coverage like TRICARE or retiree plans. Understanding these coordination rules is paramount.

Medicare Coordination Rules Summary

Specific Situations: Disability & Living Abroad

Enrollment rules can have unique aspects for individuals qualifying for Medicare due to disability before age 65, or for U.S. citizens living outside the country.

Getting Medicare Before 65 Due to Disability

Individuals under 65 typically qualify for Medicare after receiving Social Security Disability Insurance (SSDI) or certain Railroad Retirement Board (RRB) disability benefits for 24 months.

Automatic Enrollment & IEP: Enrollment in Parts A and B is usually automatic starting the 25th month of disability benefits. The 7-month IEP is centered around this 25th month (3 months before, the 25th month, 3 months after). Individuals with ALS have no waiting period and get Medicare the first month disability benefits begin.

Penalty Waiver at 65: If an individual under 65 incurs a Part B late enrollment penalty due to delaying enrollment after their disability-based IEP, this penalty is waived when they turn 65. This provides significant financial relief compared to age-based penalties.

Working with a Disability: Medicare coverage can continue for at least 8.5 years after returning to work, as long as the individual still meets disability requirements. If premium-free Part A coverage eventually stops due to work, individuals may be eligible to buy Part A and Part B. Coordination with employer health plans follows specific rules based on employer size (100+ employees for EGHP primary).

Resources: Information is available from the Social Security Administration at SSA.gov and Medicare at Medicare.gov.

Medicare Enrollment While Living Outside the U.S.

Medicare coverage generally does not extend to healthcare services received outside the United States (defined as the 50 states, DC, Puerto Rico, US Virgin Islands, Guam, American Samoa, and Northern Mariana Islands), except in very limited, specific situations (e.g., medical emergency near a foreign border, travel through Canada between Alaska and another state). This creates unique challenges for U.S. citizens living abroad. See SSA.gov/foreign and Medicare.gov.

Enrollment Options:

• U.S. citizens living abroad who are receiving Social Security benefits may be automatically enrolled in premium-free Part A but not Part B when they turn 65.
• Individuals can choose to enroll in Part B during their IEP (even while abroad, by contacting the nearest U.S. Embassy or Consulate) or delay enrollment. Enrolling ensures coverage is available upon return visits to the U.S.
• Delaying or dropping Part B while living abroad is possible but carries risks. Upon returning permanently to the U.S., enrollment may be restricted to the GEP (January 1 – March 31), potentially causing coverage gaps, and lifelong Part B penalties will likely apply.

Coverage Limitations: Medicare Advantage plans, Part D plans, and Medigap policies generally cannot be purchased or used by individuals living outside the U.S., as enrollment requires residing within the plan’s service area.

Returning to the U.S.: Moving back permanently triggers a Special Enrollment Period to join a Part D plan (lasting 2 months after the month of return). The 6-month Medigap Open Enrollment Period begins once Part B is effective.

The decision of whether to enroll in and pay for Part B while living abroad requires careful consideration of potential future returns to the U.S. versus the cost of premiums for coverage that offers limited utility overseas.

Key Resources for More Information

Making the right Medicare enrollment decisions is vital. Fortunately, reliable information and personalized assistance are available:

• Medicare.gov: The official U.S. government site for Medicare, offering comprehensive details on eligibility, coverage, costs, enrollment, and plan comparison tools.
• Social Security Administration (SSA): Handles Medicare enrollment (Parts A and B) and eligibility questions. Apply online or find contact information at SSA.gov. SSA also manages applications for Extra Help with prescription drug costs.
• 1-800-MEDICARE: Call Medicare directly for questions about coverage and enrollment at 1-800-633-4227 (TTY: 1-877-486-2048).
• State Health Insurance Assistance Program (SHIP): Provides free, unbiased, local counseling on Medicare decisions. Find local SHIP contact information at SHIPHELP.org.
• Benefits Coordination & Recovery Center (BCRC): For questions about how Medicare works with other insurance, call 1-855-798-2627 (TTY: 1-855-797-2627).

Utilizing these official resources can help individuals navigate Medicare enrollment confidently and avoid costly penalties.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.