If you are turning 65, your first Medicare enrollment window usually lasts seven months. It starts three months before your birth month and ends three months after it. This is your Initial Enrollment Period (IEP). These Medicare enrollment rules apply in Colorado and across the country. Some people are enrolled automatically, and coverage through current work can change when you need to sign up.
Your Seven-Month Enrollment Window
For most people, the IEP includes the three months before they turn 65, their birth month, and the three months after it.
If you sign up for Part B during any of the three months before your birth month, coverage usually starts on the first day of your birth month. If you sign up during your birth month or one of the next three months, Part B usually starts on the first day of the month after you sign up.
For example, if your birthday is June 15, your IEP runs from March through September. Signing up in March, April, or May gives you a June 1 Part B start date. If you sign up in June, Part B starts July 1.
If your birthday is on the first day of a month, Medicare uses the prior month to set your initial enrollment window and usual coverage start date. Premium-free Part A can also have different start rules from Part B.
Will You Be Enrolled Automatically?
If you are already receiving Social Security retirement benefits before age 65, you are generally enrolled in both Part A and Part B automatically. If you are not receiving those benefits, you generally need to sign up yourself.
Part A covers hospital care and certain other services. Many people qualify for premium-free Part A based on their own or a spouse's work record. Part B covers doctor visits, outpatient care, and preventive services. Most people pay a monthly Part B premium.
What If You Have Coverage Through Current Work?
Some people can delay Part B without a late-enrollment penalty while they have qualifying group health coverage based on their own or a spouse's current work. The rules depend on the coverage and employment situation. Retiree coverage and coverage that continues after work ends may follow different rules.
If you have coverage through current work, check how it works with Medicare before deciding when to enroll. If you do not qualify for a later enrollment period and delay Part B, you may face a gap in coverage and a late-enrollment penalty.
Choosing How to Get Medicare Coverage
With Original Medicare, Part A covers hospital care and Part B covers medical care. You can generally use any doctor or hospital that accepts Medicare. You pay deductibles and a share of covered costs. Original Medicare has no yearly limit on what you pay out of pocket unless you have other coverage that helps with those costs.
Medicare Advantage is another way to get your Part A and Part B benefits through a plan offered by an insurance company. Most plans include prescription drug coverage, but some do not. Plans may also offer extra benefits. Provider networks, costs, and rules for getting care vary by plan. Medicare Advantage plans have a yearly out-of-pocket limit for covered Part A and Part B services.
Most people continue to pay their Part B premium whichever option they choose.
Prescription Drug Coverage
Original Medicare does not cover most prescriptions you fill at a pharmacy. If you have Original Medicare, you can choose a separate Medicare Part D drug plan or keep other drug coverage you already have.
Drug plans differ in the medicines they cover, the pharmacies they use, and what members pay. If you go 63 or more days in a row without Medicare drug coverage or other creditable prescription drug coverage after your IEP, a Part D late-enrollment penalty may apply if you join a drug plan later. Creditable drug coverage is coverage expected to pay, on average, at least as much as standard Medicare drug coverage.
If you choose Medicare Advantage, check whether the specific plan includes drug coverage.
When Can You Change a Plan?
You can generally join a Medicare Advantage or Part D plan when you first become eligible. Plan coverage may start on a different date from Part A or Part B, depending on when the plan receives your request.
Each year, the Annual Enrollment Period (AEP) runs from October 15 through December 7. People already in a Medicare Advantage plan may also make certain changes during the Medicare Advantage Open Enrollment Period, from January 1 through March 31.
If you join a Medicare Advantage plan when you first get both Part A and Part B, you may have an opportunity to change that choice during your first three months with both parts. Other Special Enrollment Periods may apply in certain situations.
Considering Medigap
Medicare Supplement Insurance, also called Medigap, can help pay some of the costs left by Original Medicare. It is optional and works with Original Medicare, not Medicare Advantage.
Your federal six-month Medigap Open Enrollment Period begins the first month you are 65 or older and have Part B. It can begin later than your 65th birthday if you enroll in Part B later. During this period, you can buy any Medigap policy sold in your state without being turned down because of your health. After it ends, your options may be more limited, though other protections can apply in certain situations.
Putting the Timeline Together
Start by finding out whether you will be enrolled in Part A and Part B automatically and whether coverage through current work changes your timing. Then compare Original Medicare and Medicare Advantage, including how each option handles your doctors, prescriptions, and costs. If you are considering Medigap, keep its separate enrollment window in mind.