Newest Medicare Eligibility Rules

You don’t get Medicare because you want it. You must be eligible for Medicare. Medicare eligibility doesn’t mean you can enroll in Medicare whenever you wish. You can only enroll in Medicare during specific periods under particular circumstances. 

These special times are called election periods, each governed by criteria and circumstances. You must meet specific criteria to be eligible for Medicare and can enroll in Medicare during a specific time period or circumstance.  

Congress passed the Consolidated Appropriations Act of 2021 (CAA), which expanded, streamlined, and made Medicare eligibility and enrollment easier. 

Two areas of change are very relevant to newbies going on Medicare in 2023.  

The Last 3 Months of Medicare Initial Enrollment 

You have probably heard you have seven months to enroll in Medicare—3 months before your 65th birthday, the month of your 65th birthday, and 3 months after your 65th birthday. This is referred to as your Initial Enrollment Period. The problem for years was a bizarre rule when you enroll during the last 3 months of this period that affected your Medicare eligibility. 

The old rule was if you enrolled during the 3 months before your 65th birthday, Medicare started the month you turned 65. That remains the same.  For example, your 65th birthday is in July.  Your Medicare will start in July if you enroll in April, May, or June.    

If you enrolled during the 3 months after your 65th birthday, Medicare did not start until 2 months later for month 5, 3 months later for month 6, and 3 months later for month 7.  For example, if you enroll in August, Medicare starts in October.  You enroll in October, Medicare starts in January.  Crazy.   

Now when you enroll during the last 3 months, Medicare starts immediately the following month. For example, if your 65th birthday is in July and you enroll in Medicare in August, Medicare starts September 1st instead of October 1st.  

Or if your 65th birthday is in July and you enroll in Medicare in September, Medicare starts October 1st instead of December 1st.  

This makes way more sense. It shortens the waiting time and prevents lapses in coverage from employer health plans ending on an immovable date. Not sure why this Medicare eligibility wasn’t fixed years ago.  

Medicare General Enrollment Period Eligibility

Over the years, a few people came to me who missed enrolling in Medicare when they were first eligible. Consequently, they were assessed the famous Medicare 10% penalty compounded for each year without Medicare, but more importantly, their Medicare eligibility was affected.  They could not start their Medicare health coverage until months later. 

Quite often, they have no health coverage for months. They are entirely on their own, paying for any medical services out of their own pocket. 

 Imagine you are 67 and decide it’s time to get on Medicare. You retired a few years back but never signed up for Medicare or had any other health insurance. You cannot just show up at the Social Security office, sign up for Medicare and have it start the next month. You must wait until the General Enrollment Period from January 1st—March 31st. This is just for enrollment. Medicare then did not start until July 1st, and you could only purchase a Part D drug plan and/or Medicare Supplement. No Medicare Part C/Medicare Advantage until January 1st. Not sure about the confused thinking behind such a bad rule.  

In 2023, when a Medicare beneficiary signs up for Medicare during the General Enrollment Period, Medicare coverage starts on the 1st of the following month. For example, if you sign up in February, Medicare starts March 1st. You don’t need to wait anymore until July 1st for Medicare to start.  

People constantly complain about how confusing Medicare is. Medicare rules, however—believe it or not—remain very constant over time. These two rule changes from the Consolidated Appropriations Act of 2021 (CAA) are unusual because Medicare does not change much. These new rules about Medicare eligibility and enrollment periods are a welcome adjustment to how Medicare operates. 

The Bottom Line On Medicare Eligibility & Enrollment

When you do not deal with Medicare rules daily, they feel overwhelming.  I understand and sympathize.  Also, understand Medicare eligibility and the ability to enroll in Medicare is critical.  There is no room for mistakes. 

You want to know how Medicare works, the rules, and the intricacies so that you have the best possible Medicare health coverage.

You can also just call us rather than trying to remember the Medicare eligibility and enrollment rules. We listen to your situation and provide the most up-to-date and relevant Medicare information.

Call 402-614-3389 to speak with an experienced insurance professional and licensed agent.