What Happens if You’re Late Enrolling in Medicare?

Once you turn 65, it’s time to enroll in Medicare. But did you know that if you miss your original enrollment window, you can be subject to a penalty for late enrollment? It depends on the situation, but you could end up with higher premiums for life.

First, let’s review the typical course of action. At age 65, you become eligible for Medicare  Parts A and B, or you can choose a Medicare Advantage plan which rolls both parts together. Medicare Part A covers hospitalization, and most of us qualify for free coverage due to work history. But Part B charges a premium each month (or you pay Medicare Advantage premiums). If you don’t enroll during your original enrollment window at age 65, you will face a 10 percent higher premium for each year that you waited. That could add up to a significantly higher premium.

However, there is one exception to this rule. If you’re covered by an employer’s group healthcare plan, and that employer has more than 20 employees, then you can stick with the employer-provided plan until you leave that employment situation in the future. The same is true if you’re married and covered by your spouse’s employer-provided plan. In either of these situation you can delay your Medicare enrollment until you retire or otherwise leave that company, and then enroll in Medicare without a penalty. Then you will have an 8-month Special Enrollment window in which you can choose a Medicare plan.

The only other situation in which you wouldn’t pay a penalty would be if you qualify for the Medicare Savings Program. This program is designed for very low-income people who cannot afford their Medicare premiums. If you qualify, you will also qualify for the Extra Help program which offers you a Part D (prescription) plan.

Since the penalties for late enrollment can add up, it’s very important not to miss your original enrollment window. But remember, you’re entitled to free help. Just give us a call and we will help you identify all of your Medicare plan options so that you can enroll in a plan that suits your needs.


Posted by PGIA
1 year ago / April 25, 2023

Filed Under: Medicare Info