The Medicare Deadline Most People Don't Know They're Racing

Most people think Medicare is something they will sort out in the fall. That is when they hear about open enrollment, so that is when they plan to deal with it.

They are right, if they already have Medicare. They are in the wrong month entirely if they are about to turn 65.

Your first window is a different thing. It runs for seven months, it is built around your birthday, and nobody sends you a letter when it opens.

Two windows, and only one of them is yours

Your first window covers seven months. That is the three months before your birthday month, your birthday month itself, and the three months after. This is your one chance to sign up on normal terms.

The fall window, October 15 to December 7, belongs to people who already have Medicare. It is when they switch plans or change their drug coverage for next year.

The mix-up nearly always goes the same way. People turning 65 have heard of the fall window, so they wait for it. Their own window has been open since three months before their birthday, whatever month that falls in.

What it costs to miss it

Part B is the piece of Medicare that pays for doctor visits. Sign up late and you pay a penalty of about 10% more for every full year you waited.

That penalty never comes off. You pay it every month, for as long as you have Medicare.

Part D, the piece that pays for prescriptions, has its own version of the same penalty.

There is one common exception, and it is worth knowing before it worries you. If you are still working past 65 and your employer's health plan covers you, you can usually wait without any penalty. When that coverage ends, a fresh window opens for you. The catch is that it depends on how many people your employer has. Check your own situation rather than assuming it applies.

A checklist, in the order it needs doing

1. Put a note in your calendar three months before your birthday month. Not your birthday itself. Three months before is when your window opens.
2. Check whether your employer plan really lets you wait. Find out for certain before you count on it.
3. Choose between Original Medicare and Medicare Advantage. This is the biggest decision of the lot, and not one to make from a leaflet that arrives in the mail.
4. If you want a Medigap plan, apply within your first six months on Part B. After that, insurers can ask about your health, charge you more, or turn you down.
5. Sign up for Part D even if you take no medicine today. The penalty counts the months you went without it, not whether you needed it.

Last October I signed up a client who had been waiting for the fall window. His birthday was in March. He had never heard of the birthday window, and he had no employer plan to fall back on. By the time we sat down, his window had been shut for months. It cost him a penalty on Part B and Part D for the rest of his life. He also had to answer health questions to get a supplement plan, because he had missed that window too.

Why it pays to start early

All of this is easier to think about in month one of your window than in month seven. The people who come out of it well are the ones who started early. Knowing the most going in matters far less than having time to ask.

If you know someone turning 65 this year, tell them about the seven-month window before the mail starts arriving.

If you would like help choosing between Original Medicare and Advantage, or working out when your window opens, reach out and I'll walk through it with you.