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People who qualify for Medicare benefits are automatically enrolled in Part B when they first become entitled to Medicare Part A.
People who qualify for Medicare, but do not want to be enrolled in Part B, are given an opportunity to reject this coverage.
Medicare enrollment can occur at various times as described below:
· Initial enrollment;
· General enrollment;
· Special enrollment; and
· Conditional enrollment.
Most people who get Medicare are automatically enrolled. When enrollment is not automatic, certain time frames apply. The following chart shows which groups of people are automatically enrolled in Medicare and which are not. The chart also gives information about situations where the Part A coverage is not free.
Coverage Groups |
Automatic Enrollment |
Free Part A |
Age 65 or Over |
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· Receives SSA/RR retirement benefits including spouses and widow/widowers |
Yes |
Yes |
· Insured government worker for Medicare |
No |
Yes |
· Nor receiving SSA/RR benefits |
No |
Yes |
· Eligible for SSA and still working |
No |
Yes |
· Uninsured and no SSA or RR benefits (premium – up) |
No |
No |
Under Age 65 and Disabled for 25 months |
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· Receives SSA/RR disability benefits based on disability as a worker, widow/widower, age 50 – 59, adult child of any age disabled prior to age 22. |
Yes |
Yes |
· Disabled widow/widower, age 60 – 64 or widow receiving SSA benefits. |
No |
Yes |
· Insured government worker |
No |
Yes |
Any Age with Kidney Failure |
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· Insured or receives SSA or RR benefits |
No |
Yes |
· Dependent spouse or child of a worker who is insured or receives monthly benefits. |
No |
Yes |
The initial enrollment period is based on when a person is first eligible to enroll.
There is a 7-month Initial Enrollment Period to sign up for Part A or Part B. If the person is eligible for Medicare when they turn 65, they can sign up during the 7-month period that:
· Begins 3 months before the month the customer turns 65;
· Includes the month the customer turns 65; and
· Ends 3 months after the month the customer turns 65.
A person may only enroll during a later general enrollment period if:
· The person fails to enroll during the initial enrollment period; or
· The person terminates enrollment.
The general enrollment period occurs each year from January 1st through March 31st. The coverage period of a person who enrolls during a general enrollment period begins on the following July 1st.
The person may be required to pay a late enrollment penalty if they did not have creditable coverage during the time they declined to enroll in Part B.
There are two special enrollment periods:
If a person is... |
And is... |
Then the special enrollment period is... |
Age 65 or older |
Covered under an employer group health plan from an employer of any size |
Seven full calendar months beginning with the first day of the first month in which the person is no longer enrolled in an employer group health plan based on current employment. |
A disabled person under age 65 |
Covered under a large employer group health plan (100 or more employees) |
Seven full calendar months beginning with the first day of the first month in which the person is no longer enrolled as an active individual in a large group health plan. |
The coverage period of a person who enrolls during a special enrollment period begins on either of the following:
· The first day of the first month of the special enrollment period if enrollment occurs in that month; or
· The first day of the month following the month of enrollment if enrollment occurs in a month after the first month of the special enrollment period.
A person is eligible for the Part B special enrollment period if:
· The person or their spouse is currently working and the beneficiary is covered by a group health plan based on that work; or
· The person is disabled and the person is covered by a group health plan based on employment.
The person can enroll in Part B anytime while the person 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.
If the person has COBRA coverage, they must enroll during the 8-month period that begins the month after the employment ends. This Special Enrollment Period does not apply to people with End Stage Renal Disease.
If the person waited to enroll in Part B because they had health insurance while volunteering outside of the U.S. for a tax exempt organization for at least a year, the person can enroll during the 6-month period that begins the first month that any one of the following happens:
· The person is no longer volunteering outside the US;
· The sponsoring organization is no longer tax exempt; or
· The person no longer has health insurance coverage outside the US.
Enrollment for Conditional Part A under QMB may occur at any time. When a monthly premium is required, some Part A applicants apply for Part A on the condition that their applications are deemed valid only if QMB eligibility is later approved.
After filing a conditional Part A application with SSA, the person must apply for the Medicare Savings Program with the SSI MAO Office.
Conditional Part A enrollment and entitlement does not apply to any Medicare Savings Program other than QMB. The Buy-In of Part A is not a benefit for the other Medicare Savings Programs. After QMB approval, the Part A premium is paid by the State (AHCCCS) through the Buy-In process.
Conditional Part A enrollment for a QMB applicant can be verified by a letter or interface from the Social Security Administration. This information is also found on the WTPY, in the Medicare ENTITLED Field; as code Z99.
If a person does not enroll in Medicare when they are first entitled, an enrollment penalty is applied when the person applies for Medicare at a later date.
Medicare |
Penalty |
Medicare Part A With a Premium |
A penalty is assessed for the person who enrolls late in Premium Part A. This penalty is a premium surcharge. The premium surcharge for late enrollment will never be more than ten percent. This ten percent surcharge will be payable for twice the number of months in full 12-month periods during which the beneficiary could have, but did not enroll in Premium Part A. At the end of the penalty period, the premium amount reverts to the non-penalty rate. |
Medicare Part B |
A penalty is assessed for late enrollment in Part B. The penalty is an increase in the monthly premium by 10 percent for each 12-month period after the time the beneficiary was first eligible to enroll. Once the penalty amount is established, it is ongoing for as long as the beneficiary is enrolled in Part B. The penalty may be waived if the person has creditable coverage. |
Medicare Part D |
The person will be charged a late enrollment penalty (higher premiums) if they choose to enroll later when: · The person decides not to join a Medicare drug plan when they are first eligible; and · The person does not have other creditable prescription drug coverage. The penalty assessed for late enrollment in Medicare Part D is currently one percent for each full month that the person did not have creditable coverage after the person was eligible to join a Medicare drug plan. Part D penalties are waived for people enrolled in the Part D Extra Help program. |
Term |
Definition |
Conditional enrollment for Medicare Part A |
The person who must pay a monthly Part A premium applies for Medicare Part A on the condition that they only want Part A if they are approved for QMB. |
Creditable Coverage |
Health insurance coverage as defined under the Health Insurance Portability and Accountability Act (HIPAA). Examples of creditable coverage include: · Group health plans including Qualified Health Plans; · Health insurance coverage through a hospital or medical service policy, certificate or plan contract; or · Armed forces insurance (i.e. Tricare). |
Medicare Enrollment |
For Medicare purposes, enrollment is the process where people who meet Medicare eligibility criteria sign up for Medicare Part A and B. |
Medicare Part D |
Medicare Part D is a voluntary program that provides prescription drug coverage. Part D covers most prescription drugs. |
| Medicare Part D Extra Help Program | The Extra Help program provides assistance with Medicare Part D prescription costs for people with limited income and resources. |