FAQs

When does Medicare coverage begin for someone age 65 or older?

 

Note the focus of this FAQ is on Medicare coverage for individuals age 65 or older, not those who may be Medicare-eligible due to disability. This addresses the effective dates of Part A (inpatient hospital and skilled nursing facilities) and Part B (physician’s visits, outpatient hospital services, durable medical equipment, etc.); however, it does not cover the effective date of Part D (prescription drug coverage) or Part C (also known as Medicare Advantage).

Generally, Medicare coverage begins on the first day of a given month. The actual effective date of coverage will depend on when the individual signs up relative to their 65 birthday. Part A coverage is retroactive six months from when an individual signs up but no sooner than the month in which they turn 65.

Effective January 1, 2023, the effective date of Part B coverage for individuals enrolling in coverage during either the Initial Enrollment Period (IEP) or the General Enrollment Period (GEP) changed, making coverage effective sooner than in years past. Additional information on this welcome change can be found on the SSA’s Medicare website.

There are three timeframes during which an individual might enroll in Medicare and different effective dates of coverage for each type of enrollment situation.

  1. Initial Enrollment Period (IEP): An individual’s initial Medicare effective date is the first day of the month of their 65 birthday. For coverage to begin on this date, an individual must enroll in the three-month period prior to turning 65. If an individual enrolls during the 65 birthday month or any of the three months after, coverage begins on the first day of the month following enrollment. As mentioned above, this was a recent change for 2023; in prior years, if an individual enrolled during the three months following their 65 birthday, Part B coverage may have been delayed two or three months.
  2. Special Enrollment Period (SEP): If an individual does not enroll in Medicare during the IEP – most commonly because they are continuing to work and are covered under an employer’s group health plan – they will enroll in Medicare via a SEP. The SEP spans eight months once active group health coverage is lost, although individuals likely want to enroll prior to the end of the SEP. If enrolling during the SEP, coverage will begin on the first day of the month following enrollment; however, in some situations, an individual can choose to have coverage start on the first day of any of the three following months.
  3. General Enrollment Period (GEP): If an individual does not enroll during the IEP or SEP, the last opportunity to enroll in Medicare is the GEP. The GEP runs each January 1 through March 31 with coverage beginning the first day of the month following enrollment. Like the IEP, prior to 2023, if an individual enrolled during the GEP, coverage was not effective until July 1 of that year, so this is a welcome change for individuals enrolling during the GEP.

Individuals should always work with a licensed Medicare agent when determining the effective date of coverage for their specific situation to avoid late enrollment penalties. Additional information about Medicare effective dates can be found on Medicare.gov.

PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.

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