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  • Overview
  • When can I enroll?
  • When will my coverage begin?
  • What if I enroll late?
  • When can I change coverage?

Enrolling in Medicare

You can first sign up for Medicare Parts A and B when you become 64 years and 9 months old. You will need to contact the Social Security Administration to begin enrolling.

You may automatically become enrolled in Medicare if you are already receiving benefits from Social Security or the Railroad Retirement Board (RRB). If you are automatically enrolled, you will receive your Medicare card three months before your 65th birthday.

If you're under 65 and disabled, you'll automatically get Part A and Part B after you get disability benefits from Social Security or the RRB for 24 months.

How to enroll in Medicare

If you're not automatically enrolled, contact the Social Security Administration:

  1. Online—ssa.gov (This link takes you away from the Fallon Health website.)
  2. Phone—1-800-772-1213 (TTY: 1-800-325-0778)
  3. In person—visit your local Social Security Office

If you get RRB benefits, you can contact the Railroad Retirement Board to enroll:

  1. Online—rrb.gov (This link takes you away from the Fallon Health website.)
  2. Phone—1-877-772-5772 (TTY: 1-312-757-4701)

When can I enroll in Medicare?

Initial Enrollment Period (IEP)

  • Begins 3 months prior to the month of your 65th birthday
  • Includes the month of your 65th birthday
  • Ends 3 months after the month of your 65th birthday

Types of coverage you can sign up for:

  • Original Medicare (Part A and/or Part B)
  • Medicare Advantage Plans (Part C)
  • Medicare Prescription Drug Plans (Part D)
  • Medicare Supplement (Medigap) Insurance Plans

Special Enrollment Period*

For those who have special circumstances including:

  • Lost health plan coverage provided by an employer/union group
  • Moved out of current plan service area
  • Current health plan no longer offers coverage in your area

Types of coverage you can sign up for:

  • Original Medicare (Part A and/or Part B)
  • Medicare Advantage Plans (Part C)
  • Medicare Prescription Drug Plans (Part D)
  • Medicare Supplement (Medigap) Insurance Plans

General Enrollment Period

  • January 1 to March 31, every year
  • Only open to those who did not sign up during their IEP or who do not qualify for a Special Enrollment Period

Types of coverage you can sign up for:

  • Original Medicare (Part A and/or Part B)

* This is not a complete list of Special Enrollment Periods that are available. For a complete list, visit medicare.gov. (This link takes you away from the Fallon Health website.)


Enrolling in a Part C (Medicare Advantage), Part D (Medicare Prescription Drug Plan) or Medicare Supplement (Medigap) Plan

To enroll in a Part C, Part D or Medicare Supplement Plan, you will have to contact a private health plan that offers the coverage you are interested in. To compare your options, you can visit medicare.gov (this link takes you away from the Fallon Health website) or speak with a counselor from The Serving the Health Insurance Needs of Everyone (SHINE) Program. Contact information for these programs is in the "Learn more" section of this site.

Want to join a Medicare Special Needs Plan?

Medicare Dual-Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan only available to individuals who qualify for both Medicare and Medicaid. Plan benefits and drug formularies are created to meet the specific needs of members.

There are other Special Needs Plan options for individuals who qualify, like Institutional and Chronic Care Plans. To learn more, visit medicare.gov. (This link takes you away from the Fallon Health website.)

Plan to work after 65?

If you or your spouse will continue to work after the age of 65 and you will receive coverage through an employer or union group, you may be eligible to join Medicare during a special enrollment period.

When will my Medicare coverage begin?

Whether you are working or retired, Medicare Part A coverage will typically begin on your 65th birthday. The start date of other Medicare coverage will be determined by the type of plan you choose and by the date you enroll.

If you sign up for Medicare during your Initial Enrollment Period

You enrolled…

Your coverage begins…

During the 3 months before your 65th birthday

The first day of your birthday month*

The month you turn 65

1 month after you sign up

1 month after you turn 65

2 months after you sign up

2 months after you turn 65

3 months after you sign up

3 months after you turn 65

3 months after you sign up

* If your birthday is on the first day of the month, your coverage starts the first day of the month prior to your birthday.
Example: If your birthday in on July 1, and you sign up for Medicare in March, April, or May, your coverage will begin on June 1.

If you sign up for Medicare outside of your Initial Enrollment Period

You signed up for Medicare during …

You are able to enroll in this type of coverage

Your coverage begins

Medicare’s Annual Enrollment Period

Anytime from October 15 to December 7

Part A
Part B
Part C
Part D
Medicare Supplement (Medigap) Insurance Plan

January 1

Special Enrollment Period*

  • the time you are still covered by an employer or union group health plan—through you or your spouse
  • the 8 months following the month that the employer/union group coverage ends, or when the employment ends—whichever happens first**
  • 63 days after the loss of employer/union group healthcare coverage or when employment ends (whichever is first)***

Part A
Part B
Part C
Part D
Medicare Supplement (Medigap) Insurance Plan

The first day of the month following your enrollment

General Enrollment Period

  • January
  • February
  • March

Part A
Part B

July 1

* This is not a complete list of Special Enrollment Periods that are available. For a complete list, visit medicare.gov. (This link takes you away from the Fallon Health website.)
** You can only enroll in Part A and/or B during this time.
*** You can only enroll in Part C (Medicare Advantage) or Part D during this time
.


Enrolling in Part C or D?

If you join a Medicare Advantage (Part C) or a Medicare Prescription Drug Plan (Part D) in the three months before you turn 65, your coverage begins the first day of the month in which you turn 65. Otherwise, your coverage—in either plan—begins the first day of the month following your enrollment.

What if I enroll late?

I enrolled late in …

Will I have to pay a penalty?

How much is the penalty?

How long will I have to pay the penalty?

Part A

Yes

10% of the current Part A premium

Twice the number of years you were eligible for Part A but did not pay.
Example: You enrolled in Part A three years after you became eligible, therefore, you will pay the penalty for six years.

Part B

Yes*

10% of the current Part B premium for each full 12-month period you wait to enroll

You will pay this penalty for as long as you have Part B coverage.

Part D

Yes**

1% of the average monthly prescription drug plan premium, multiplied by the number of months you were late enrolling, rounded to the nearest 10 cents.

You will pay this penalty for as long as you have Part D coverage

*  If you enroll in Part B during a special enrollment period, you will not have to pay a penalty.
** Those who are enrolled in Medicare's
Extra Help with the costs of Medicare Part D prescription drugs will not have to pay a late enrollment penalty.

Example: I’m enrolling in a Part D Plan, but I’m late. How much will I pay?

The average monthly premium for a Part D Plan is $35.63 in 2017. If you enrolled in a Part D Plan 14 months late, in 2017, the calculation would look like:

$35.63
(average monthly prescription drug plan premium)

Multiplied by

.14
(one percent for each month you were late enrolling)

=

$4.98
This amount is rounded to the nearest 10 cents, which is $5.00. This is the amount that would be added to the 2017 monthly plan premium for someone with a Part D late enrollment penalty.

This cost may go up each year you’re enrolled in a Part D Plan.

When can I change my current Medicare coverage?

If you have Medicare coverage but want to switch the way you get Medicare, you can do so during the following times:

When you can switch your coverage What you can do

Annual Enrollment Period

October 15-December 7

Your coverage will begin on January 1 of the following year.

  • Join a Medicare Advantage Plan or switch to a new one
  • Join a Medicare Supplement (Medigap) Plan or switch to a new one.
  • Join a Medicare Prescription Drug Plan (Part D) or switch to a new one.

Medicare Advantage Disenrollment Period

January 1-February 14

Change will be effective on the first day of the month following the receipt of your enrollment or disenrollment request.

  • Leave your current Medicare Advantage Plan to return to Original Medicare (Medicare Parts A and B) coverage only.
  • Join a Medicare Supplement Plan.
  • Join a Medicare Prescription Drug Plan (Part D).

Special Enrollment Period

If you are eligible for a Special Enrollment Period, you may also be able to switch the way you receive your coverage at additional times during the year. Please see the "When can I enroll in Medicare?" tab for more information.

Fallon Health is an HMO/HMO-POS plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Senior Plan and NaviCare depends on contract renewal.

NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.


H9001_F_2017_21_r3 Pending
H9001_N_2017_16_r2 Pending
The information on this page was last updated on 3/24/2017