Enrollment

Navigating Medicare enrollment can feel overwhelming, but understanding your options and deadlines is key to avoiding penalties and ensuring the coverage you need. This guide explains when and how to enroll, what penalties to watch for, and how different life situations can affect your Medicare plan.

Delaying Medicare

If you’re still working at 65 in New Mexico and have employer coverage, you may not need to enroll in Medicare immediately. Delaying enrollment incorrectly, however, can lead to costly penalties or gaps in coverage.

When You Can Delay
You may delay Part B (and sometimes Part A) if:

• You or your spouse are still working
• You have active, creditable employer coverage
• Your employer has 20+ employees

This allows you to keep employer insurance, skip Part B’s monthly premium, and enroll later during an 8-month Special Enrollment Period (SEP). Part A enrollment is usually free unless you have an HSA.

When You Shouldn’t Delay

• No job-based insurance (COBRA, retiree, and Marketplace plans don’t count)
• Employers with fewer than 20 employees
• Relying on VA coverage (Medicare suggests enrolling in Parts A & B)

Important: Delaying Part B without proper coverage results in a 10% lifetime penalty for each year you wait.

Tip for HSA Users: Enrolling in Medicare stops your ability to contribute to an HSA. Stop contributions at least six months before enrolling to avoid IRS issues.

Understanding Medicare Enrollment Penalties

Medicare has specific enrollment periods. Missing them can increase your costs permanently.

Part B Late Enrollment Penalty

• 10% of the standard Part B premium for each full 12-month period without coverage
• Example: 2-year delay → 20% added to your monthly premium permanently
• Avoid it: Enroll during your Initial Enrollment Period (IEP) or delay with active, creditable coverage and use the SEP later

Part D Late Enrollment Penalty

• Applies if you go 63+ days without creditable drug coverage after first eligible
• 1% of the national base premium per month without coverage
• Avoid it: Enroll during IEP or maintain other creditable drug coverage

Medicare Enrollment Periods

Initial Enrollment Period (IEP)

• 7-month window around your 65th birthday (3 months before, month of, 3 months after)
• Automatic enrollment if receiving Social Security; otherwise, you can sign up manually

General Enrollment Period (GEP)

• For those who miss IEP
• January 1 – March 31, with coverage beginning July 1
• Late enrollment penalties may apply

Special Enrollment Period (SEP)

• For qualifying life events, such as losing employer coverage or moving
• 8 months to enroll without penalty after losing coverage

Medicare Advantage Open Enrollment (MA OEP)

• January 1 – March 31
• Switch MA plans or return to Original Medicare
• Add Medigap or PDP coverage if applicable

Annual Enrollment Period (AEP)

• October 15 – December 7
• Make changes to Medicare Advantage, Part D, or switch plans
• Coverage changes effective January 1 of the following year

If You Have Coverage Through a Spouse

• Employer size matters:Fewer than 20 employees → Medicare becomes primary; enroll in Parts A & B immediately
  20+ employees → Employer coverage stays primary; you may delay Part B
  
• After determining which plan pays first, decide whether to enroll now or wait for SEP
• Guaranteed right to buy Medigap within six months after enrolling in Part B

Annual Notice of Change (ANOC)

Each fall, Medicare plans send an ANOC, summarizing plan changes for the coming year. Review it carefully.

Check for:

• Cost changes: premiums, deductibles, copays
• Prescription updates: medications covered, cost tiers, rules
• Network changes: doctors and pharmacies
• Plan changes: any new restrictions or benefits

Why it matters: Reviewing your ANOC ensures your plan still fits your healthcare needs and helps avoid unexpected expenses.

Next Steps

Understanding enrollment rules and deadlines is critical to protecting your health and finances. Health Wealth Protect LLC offers personalized guidance to ensure you make the right decisions.

Call (505) 417-6565 to schedule a free consultation and get expert help navigating your Medicare enrollment options.