Turning 65 Soon? What Happens If You Don’t Enroll in Medicare?

Many people are surprised to learn that Medicare does not automatically start when you turn 65. And unfortunately, missing your Medicare enrollment window can be an expensive mistake. If you fail to sign up during your Initial Enrollment Period, you could face lifelong penalties or gaps in coverage. The good news is that there are exceptions and ways to minimize the costs if you miss your deadline.

Understanding the Medicare Enrollment Period

Your Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes your birthday month, and extends three months after. This seven-month window is your first opportunity to enroll in Medicare Parts A and B. If you are still working and covered by employer insurance, you may be able to delay enrollment without penalty, but you must meet specific criteria.

What Happens If You Miss the Window

If you do not enroll during your IEP and you are not eligible for a Special Enrollment Period, you may have to wait until the General Enrollment Period, which runs from January 1 through March 31 each year. Your coverage will then begin on July 1. This gap can leave you without health insurance for several months.

In addition, you could face late enrollment penalties that last as long as you have Medicare. The Part B penalty adds ten percent to your monthly premium for every full twelve-month period you delayed enrolling. For Part D prescription coverage, the penalty is one percent of the national base premium for each month you went without creditable drug coverage. These costs add up and continue year after year.

Exceptions and Special Enrollment Periods

There are certain situations where you can enroll later without penalty. If you or your spouse are actively working and have employer-based coverage, you can delay Medicare and enroll during a Special Enrollment Period after your job or coverage ends. You may also qualify for an exception if you were misinformed by Medicare or Social Security about your eligibility.

If you missed your window and believe you had a valid reason, you can file an appeal. Medicare allows appeals for certain situations, but it is best to have professional guidance to strengthen your case.

We Can Help

If you missed your Medicare enrollment or you’re unsure of when to sign up, don’t panic. Our licensed insurance brokers can help you understand your options, determine if you qualify for a Special Enrollment Period, and guide you through the appeal process if necessary. Call or email us for free Medicare assistance and protect yourself from costly penalties.