Navigating Medicare for the first time can be intimidating, but understanding your options during your initial enrollment period can make the process much smoother. Whether you're just turning 65 or are newly eligible due to a disability, knowing what steps to take will ensure you get the coverage you need.
What is the Initial Enrollment Period (IEP)?
The Initial Enrollment Period (IEP) is a seven-month window when you can first sign up for Medicare. This period begins three months before the month you turn 65, includes your birth month, and extends three months after. If you’re under 65 and eligible for Medicare due to a disability, your IEP starts three months before and ends three months after your 25th month of receiving disability benefits.
What Are Your Enrollment Options?
During your IEP, you have a few key decisions to make regarding your Medicare coverage. Here’s a breakdown of your options:
Medicare Part A (Hospital Insurance)
Most people receive Part A premium-free if they or their spouse paid Medicare taxes while working. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Even if you’re still working and have insurance through your employer, it’s a good idea to enroll in Part A because it’s usually free. Learn more about Part A eligibility and enrollment.
Medicare Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, medical supplies, and preventive services. Unlike Part A, Part B comes with a monthly premium. If you’re still working and have employer insurance, you might delay enrolling in Part B without penalty. However, make sure your employer's insurance qualifies as creditable coverage to avoid penalties later. Find out when Medicare coverage starts.
Medicare Part C (Medicare Advantage)
Medicare Advantage Plans are an alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies approved by Medicare and often include Part D (prescription drug coverage) as well as additional benefits like dental, vision, and hearing. Choosing a Medicare Advantage Plan means your coverage will be provided by a private insurer instead of Medicare.
Medicare Part D (Prescription Drug Coverage)
If you take prescription medications, enrolling in a Part D plan is essential. These plans are also offered by private insurers and can vary in cost and coverage. Even if you don’t take many medications now, it’s wise to enroll during your IEP to avoid late enrollment penalties down the line.
Medigap (Medicare Supplement Insurance)
Medigap plans help pay for some of the healthcare costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles. If you opt for Original Medicare, you might want to consider a Medigap policy to help manage your out-of-pocket costs. You have a six-month Medigap Open Enrollment Period that starts the month you turn 65 and are enrolled in Part B. During this time, you can buy any Medigap policy sold in your state, regardless of your health status. Learn more about buying a Medigap policy.
What If You Miss Your IEP?
Missing your Initial Enrollment Period can lead to late enrollment penalties and gaps in your coverage. If you don’t sign up for Part B during your IEP, you may face a late enrollment penalty, which will increase your monthly premium by 10% for each full 12-month period you could have had Part B but didn’t sign up. This penalty continues for as long as you have Part B. Part D also has penalties if you don’t enroll when you’re first eligible.
However, if you missed your IEP due to circumstances such as ongoing employment with employer-provided insurance, you might qualify for a Special Enrollment Period (SEP). The SEP allows you to enroll in Medicare without penalties once your employment or insurance coverage ends.
Making the Right Choice for You
Your first-time Medicare enrollment is a critical step in ensuring your healthcare needs are met as you age. Take the time to review your options and consider factors such as your current health, prescription needs, and whether you have other health coverage.
Understanding your Medicare options doesn’t have to be complicated. Join one of GetSetUp’s Medicare classes today to learn more about how to choose the right plan for you and ensure you have the coverage you need for a healthy future.
Reviewed By: Keith Gilbert