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Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant. Medicare has two parts - Part A which is hospital insurance, and Part B which is medical insurance.

Individuals are generally eligible for Medicare at age 65. However, eligibility can vary based on certain disabilities or specific medical conditions. 

Most people need to enroll in Medicare during their Initial Enrollment Period (IEP), which begins 3 months before you turn 65, includes your birthday month, and continues for 3 months after—a 7-month window in total.

You must enroll during this time if:

• You're turning 65 and not receiving Social Security or Railroad Retirement benefits.
• You don't have qualifying employer health coverage.

If you're already receiving Social Security before 65, you’ll be automatically enrolled in Medicare Parts A and B.

You may delay enrolling without penalty if you (or your spouse) are still working and have employer-provided coverage. When that ends, you get an 8-month Special Enrollment Period (SEP) to sign up.

Missing your enrollment window can lead to late penalties and gaps in coverage, especially for Medicare Part B and Part D (prescription drug coverage).

Check out our in depth blog Medicare Enrollment for a step-by-step guide.

A Special Enrollment Period (SEP) is a window of time outside the standard enrollment periods when you’re allowed to sign up for, switch, or drop Medicare coverage due to specific life events.

You may qualify for a SEP if:

• You lose employer or union health coverage
  (e.g., you or your spouse retires or loses job-based insurance)
• You move out of your plan’s service area
  (especially for Medicare Advantage or Part D plans)
• You’re released from jail
• You gain or lose eligibility for Medicaid
• Your plan changes its contract with Medicare
• You enroll in or leave a long-term care facility
• You get misleading info or face an enrollment error caused by a federal employee or agent

Most SEPs last 2 months (63 days) from the date of the qualifying event, but some last longer depending on the situation. During this time, you can:

• Enroll in a Medicare Advantage Plan
• Switch back to Original Medicare
• Join, drop, or change a Part D prescription drug plan

Missing your SEP window can mean waiting until the next Open Enrollment Period and possibly facing late enrollment penalties or gaps in coverage.

Reachout to us as soon as possible if you have experienced a life changing event so that we can help you determine if you qualify for a SEP and make sure you take advantage of it before time runs out.

A late enrollment penalty is an extra monthly cost added to your Medicare premium if you wait too long to enroll in certain parts of Medicare without having other qualifying coverage. These penalties can be permanent, so understanding them—and how to avoid them—is key.

Most people get Part A (hospital insurance) for free. But if you have to pay for it and don’t enroll when first eligible, your monthly premium may go up 10%.

• Penalty duration: You’ll pay the higher premium for twice the number of years you delayed enrollment.

If you delay Part B (medical insurance) and don’t have other creditable coverage (like employer health insurance), you’ll pay a 10% penalty for every 12-month period you went without it.

• Example: Wait 2 years? That’s a 20% higher Part B premium—for life.

If you don’t get Part D (prescription drug coverage) when you’re first eligible—and you don’t have creditable drug coverage—you’ll pay a penalty.

• Amount: 1% of the national base premium ($34.70 in 2024) multiplied by the number of full, uncovered months you went without coverage.
• Penalty duration: For as long as you have Part D coverage.

How to Avoid Penalties

• Enroll during your Initial Enrollment Period (IEP) when you turn 65.
• If you’re still working and covered by employer insurance, make sure it counts as creditable coverage—and enroll during a Special Enrollment Period when that ends.
• Work with a Medicare expert, at Elkin Financial, who can guide you through deadlines and plan options so you don’t miss a beat—or pay for it later.

Yes, you can change your Medicare coverage, and there are specific times each year when you’re allowed to do so. Here’s a quick breakdown:

Medicare Open Enrollment Period (Oct 15 – Dec 7)

• Switch from Original Medicare to Medicare Advantage
• Switch from Medicare Advantage to Original Medicare
• Change from one Medicare Advantage plan to another
• Join, drop, or switch a Part D prescription drug plan

Your new coverage starts January 1 of the following year.

Medicare Advantage Open Enrollment (Jan 1 – Mar 31)

• Switch from one Medicare Advantage plan to another
• Drop your Medicare Advantage plan and return to Original Medicare
• Join a Part D drug plan (if switching back to Original Medicare)

This period is only for people already enrolled in a Medicare Advantage plan.

Special Enrollment Periods (SEPs)

You may qualify for a SEP if:

• You move to a new area
• You lose employer or union coverage
• Your plan changes its contract with Medicare

Need Help Choosing a New Plan?

Changing plans can affect your coverage, your costs, and your access to doctors. That’s why it’s smart to review your plan every year—especially if your health needs or prescriptions change. Reach out to us right away if you're considering changing your plan so we can help ensure you're getting everything you need.

In most cases, no—employers do not pay your Medicare premiums once you retire. However, there are a few exceptions and scenarios where employer involvement might come into play:

If You're Still Working After 65:

• Large Employers (20+ employees): Your employer group health plan remains your primary insurance, and Medicare is secondary. The employer usually continues to contribute to your health coverage, but they don’t pay your Medicare Part B premium.
• You can delay enrolling in Part B and Part D without penalty if your employer plan is considered creditable coverage.

If You Retire and Have Employer Retiree Benefits:

• Some employers offer retiree health benefits that work alongside Medicare. These plans may cover some or all of your premiums, but this is increasingly rare.
• If provided, these benefits are often limited, and you’ll still need to enroll in Medicare Parts A and B to avoid gaps.

COBRA Coverage:

• If you’re on COBRA after retiring, Medicare becomes primary, and COBRA is secondary. You must still enroll in Medicare on time—even if COBRA seems to cover you.
• COBRA does not delay your Medicare enrollment window.

Important to Know:

• Most people pay the Part B premium themselves, either through automatic deduction from Social Security or direct payment.
• Medicare Advantage and Part D plans may have additional premiums.

If Original Medicare (Parts A & B) isn’t meeting your healthcare needs—whether due to out-of-pocket costs, lack of prescription coverage, or missing benefits like dental and vision—you have several options to fill those gaps: Medicare Supplement (Medigap), Medicare Advantage (Part C), standalone prescription drug plan (Part D), or check for Medicare savings programs.

Check out our in depth blog post What Are My Options If Original Medicare Isn’t Enough? to learn more about your options or  Schedule an Appointment.

Original Medicare typically does not cover most prescription drugs. However, it may cover certain medications in specific situations—like immunosuppressive drugs for transplant patients or oral chemotherapy drugs.

If you’re looking for broader drug coverage, you have options:

• Medicare Advantage plans (Part C) often include prescription drug coverage.
• You can enroll in a standalone Part D drug plan.
• If you qualify, Medicaid may also help cover the cost of your medications.
• Some Medigap (supplemental) plans may offer limited drug benefits, but these are no longer sold with drug coverage—so a separate Part D plan is usually best.

Still unsure what applies to you? Contact us to explore the best option for your needs.