Sign up for Medicare - Medicare Advice - Financial Writer, Financial Journalist, Financial Speaker - Financial Expert Kimberly "Ask Kim" Lankford

What You Need to Know About Signing Up for Medicare

More than 10,000 Baby Boomers turn 65 every day and they need to learn how to navigate a new system: Medicare. Even the first step – signing up – can be tricky. If you don’t know what you’re doing, you could be hit with a penalty, pay more than you need to, or end up with big gaps in coverage. Here are some key questions and answers for you when it’s time to sign up for Medicare.

Will I be enrolled in Medicare automatically when I turn 65?
If you’re already receiving early Social Security benefits, then you’re automatically enrolled in Medicare when you turn 65 and will receive your Medicare card three months before your 65th birthday. But the age for receiving full Social Security benefits is now 66 and is rising for people born in 1955 and later, making a lot of people eligible for Medicare before they enroll in Social Security. In that case, you’ll need to take steps to sign up for Medicare yourself. 

You can enroll in Medicare anytime from three months before to three months after the month you turn 65. The easiest way is to enroll online at, even if don’t want to sign up for Social Security benefits yet. See How to Apply Online for Medicare Only for more information. 

Do I have to enroll in Medicare Part A and Part B when I’m 65, even if I’m still working?
If you don’t have health insurance through your or your spouse’s current employer, then you’ll need to sign up for Medicare at age 65 – even if you have retiree health insurance or COBRA continuation coverage. Medicare is considered to be your primary coverage at 65 unless you have health insurance through a current employer.

If you or your spouse are still working and have employer coverage, then the answer depends on the size of your company:

If you work for an employer with fewer than 20 employees, then you usually have to sign up for Medicare at age 65. For most small employers, Medicare generally becomes the primary coverage at age 65 and the employer’s coverage becomes secondary. If you don’t sign up for Medicare at 65, you could have big coverage gaps.

If your company has 20 or more employees, you don’t have to sign up while you or your spouse is still working (you just need to enroll within eight months of leaving your job). Most people still sign up for Part A because it’s free, but they may decide to delay signing up for Part B while they’re covered by their employer’s health insurance. (Part B costs $144.60 or more per month for most people in 2020.)  

However, some people delay signing up for both Part A and Part B if they have a high-deductible health insurance policy and want to contribute to a health savings account, because you can’t contribute to an HSA after you enroll in Medicare. If you do delay signing up for Medicare while you’re working, you will need to enroll within eight months of losing your employer-based coverage to avoid a penalty.

How much does Medicare cost per month?
Part A, which covers hospitalization, is free for most people. Part B, which covers doctor’s visits and outpatient care, generally costs $144.60 per month in 2020. However, people with high incomes have to pay more, and the premiums are generally based on your last income-tax return on file — which is 2018 income for 2020 premiums. If you’re single and your modified adjusted gross income, plus tax-exempt interest income, was more than $87,000 in 2018, or $174,000 if married filing jointly, then you’ll generally have to pay a high-income surcharge in 2020. In that case, your premiums could be from $202.40 per month up to $491.60 per month (per person), depending on your income. 

Is there a way to get the high-income surcharge reduced?
Maybe. The surcharge is based on your last tax return on file, which for most people is the 2018 tax return for 2020 premiums. If your income has dropped since then because of certain life-changing events, such as retirement or job loss, marriage, divorce or death of a spouse, the Social Security Administration may be able to use a more-recent year’s income to determine your Medicare premiums. You’ll need to submit Form SSA-44 to the Social Security Administration with evidence of the eligible life-changing event (such as a statement from your employer that you retired). See Medicare Premiums: Rules for Higher-Income Beneficiaries for more information.

Kim Lankford

Leave a Comment