Understanding Original Medicare
Laying a Solid Foundation | Lesson 6

Enrolling in Original Medicare

Now that you know what Original Medicare does and doesn’t cover, it’s time to talk about enrollment.

And just like our last lesson, this information is important because the ability to enroll your clients in Part A and/or Part B is the start of your opportunity to get them additional coverage.

The timing of when your clients can enroll in that coverage varies. More specifically, eligibility depends on age, annual enrollment windows, and special circumstances.

There’s an Initial Enrollment Period, Special Enrollment Period, and General Enrollment Period that apply to Original Medicare.

We’ll start out with the Initial Enrollment Period.

This is the first opportunity a consumer has to enroll in Original Medicare, and it’s usually related to their 65th birthday.

The initial enrollment period, or IEP for short, can happen automatically, but sometimes, a consumer must actively enroll, so we’ll walk through both of those scenarios.

Automatic enrollment in Original Medicare occurs when an individual is turning 65 and has already been receiving benefits from Social Security for four months prior to turning 65.

They would receive their Medicare card in the mail three months prior to their 65th birthday. Coverage would start on the first of their birthday month.

It’s important to note that, in cases when the 65th birthday falls on the first of a month, the month prior is treated as their birthday month.

The first of that month prior would be their enrollment date.

An individual is also automatically enrolled if they’ve been on disability for 24 months.

Their Medicare card would come in the mail during their 25th month on disability.

Coverage would also begin during that same month.

For beneficiaries who are automatically enrolled in Original Medicare, the Part B premium is automatically deducted from their Social Security check.

Deductions will continue to be withdrawn monthly, unless the beneficiary changes the payment frequency.

That covers automatic enrollment during the Initial Enrollment Period.

If the individual is not yet taking social security at age 65, they will need to take action to enroll themselves in Medicare.

Individuals have a seven-month enrollment window that is based around the month of their 65th birthday.

They have the three months prior to their birthday month, the month of, and three months after to enroll — unless their birthday is on the first of a month. In this case, their seven-month IEP starts a month earlier and ends a month earlier.

In this scenario, if they chose to enroll in Part B and do not yet receive Social Security payments, they will be billed quarterly for the Part B premium.

Auto pay is available as an option through Medicare Easy Pay.

For Medicare, the IEP is a crucial timeframe for your clients.

Missing the initial enrollment period puts an individual at risk of paying a late enrollment penalty unless they qualify for a Special Enrollment Period to enroll.

And that moves us along nicely to our next enrollment period, the SEP, or Special Enrollment Period.

Individuals have a Special Enrollment Period opportunity if they chose not to pick up Original Medicare because they or their spouse are still working, and they are covered under an employer group health plan.

This is a continuous opportunity for as long as they are employed or covered under their spouse’s coverage, but only extends out eight months after employment or coverage ends, whichever happens first.

I want to emphasize here that COBRA coverage does not extend the Special Enrollment Period.

If the individual does not enroll during their Special Enrollment Period in the circumstance I just described, they will have to wait until the annual General Enrollment Period, and they may end up having to pay a late enrollment penalty.

We can’t stress enough how important these first enrollment periods are.

Next up, the General Enrollment Period.

This is an individual’s last resort to enroll in Medicare Part A and/or B if they missed their Initial Enrollment Period and either missed or did not qualify for a Special Enrollment Period.

This General Enrollment Period occurs annually from January 1 through March 31.

The individual needs to apply for Original Medicare coverage during this time frame.

No matter when they apply during the General Enrollment Period, their coverage will begin the month after they sign up.

Because of the need to wait for that time frame of January 1 through March 31, and then wait until the month after they sign up for their coverage to go into effect, that is all time that could be spent accruing a late enrollment penalty for the individual.

Obviously, no one wants to see that happen, so that again is why we put the emphasis on these enrollment periods.

And now that we’ve talked about the enrollment periods, how do your clients enroll?

In cases where individuals are not automatically enrolled in Medicare, they can apply online, visit a local Social Security office, or call the Social Security 1-800 number.

If the individual is enrolled in Part A and just needs to sign up for Part B, they can do so by completing an application for enrollment in Part B form, and that’s coded CMS-40B.

And should you want more guidance on how your clients can enroll, you can visit our resources section for that info, we’re happy to share that.

One last note, you can assist your clients with the enrollment process and point them in the right direction, but ultimately, they will be the ones who need to enroll themselves.

Very important to remember that, but you can certainly help them along the way. Hopefully, now you have a better idea of how to do that.

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