Enrolling in Medicare is an important milestone as you approach retirement age. But what if you miss your enrollment window? Unfortunately, delaying Medicare enrollment can result in costly lifetime penalties and gaps in health coverage. In this article, we’ll cover what happens if you don’t sign up on time, the penalties you might face, and how to avoid them.

Understanding Medicare Enrollment Periods

Before exploring the consequences, it’s important to understand when you’re supposed to sign up.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is a 7-month window:

• Begins 3 months before the month you turn 65

• Includes your birthday month

• Ends 3 months after your birthday month

Missing this window can lead to late fees and coverage delays.

Special Enrollment Period (SEP)

You may qualify for a Special Enrollment Period if you have credible coverage through an employer (your own or your spouse’s). Once that coverage ends, you have 8 months to sign up for Medicare without penalty.

General Enrollment Period (GEP)

If you miss both your Initial and Special Enrollment Periods, you’ll need to wait for the General Enrollment Period, which runs January 1 to March 31 each year. Coverage begins July 1—and penalties may apply.

Penalties for Not Signing Up on Time

Delaying Medicare doesn’t just affect when your coverage starts—it can also increase your monthly premiums for life.

Part A Penalty

• Most people don’t pay a premium for Part A (hospital insurance).

• If you do need to pay (because you don’t have enough work credits), your premium may go up 10% for twice the number of years you delayed enrollment.

Part B Penalty

• Part B (medical insurance) has a standard monthly premium.

• If you miss enrollment, your premium increases by 10% for every 12-month period you were eligible but didn’t sign up.

• This penalty is permanent—you’ll pay it as long as you have Medicare.

Part D Penalty

• Part D (prescription drug coverage) penalties apply if you go 63 days or more without drug coverage.

• The penalty is 1% of the national base premium multiplied by the number of months you delayed.

• Like Part B, this penalty is lifetime.

Coverage Delays if You Miss Enrollment

Even beyond penalties, missing your enrollment period means you could be without health insurance for months. For example, if you miss your Initial Enrollment Period and apply during the General Enrollment Period in January, your coverage won’t start until July 1—leaving a dangerous gap.

How to Avoid Medicare Late Penalties

Fortunately, you can avoid these issues with proper planning.

Mark Your Calendar Early

Know your Initial Enrollment Period and set reminders months in advance.

Confirm Employer Coverage

If you’re still working at 65, make sure your employer coverage counts as credible coverage so you won’t face penalties when you eventually switch.

Seek Professional Guidance

Medicare can be complicated. Working with a licensed Medicare advisor or using official resources like Medicare.gov can help ensure you enroll correctly and on time.

Final Thoughts

Missing your Medicare enrollment deadline can be costly. Late penalties for Parts A, B, and D can follow you for life, and coverage gaps could leave you without protection when you need it most. By understanding enrollment periods and planning ahead, you can avoid unnecessary fees and make the transition to Medicare smooth and stress-free.

Need Help With Medicare? Make An Appointment Today!

One of the most common questions people ask as they approach age 65 is: “Do I need to retire to qualify for Medicare?” The answer is no. Medicare eligibility is based on age or certain health conditions—not on whether you’re retired. Let’s break down how it works, especially if you’re planning to keep working past 65.

Medicare Eligibility Basics

Age-Based Medicare Eligibility

• Most people qualify for Medicare at age 65.

• Retirement is not required to start Medicare coverage.

Medicare for People Under 65

• Individuals may qualify earlier due to certain disabilities.

• Conditions like End-Stage Renal Disease (ESRD) or ALS can also make someone eligible before 65.

Do You Have to Be Retired to Get Medicare?

Medicare and Social Security Retirement Benefits

Medicare and Social Security are often linked in people’s minds, but they are separate programs. You don’t have to begin Social Security retirement benefits to enroll in Medicare.

Working Past Age 65

• Many people continue working after turning 65.

• You can enroll in Medicare even if you remain employed.

• Since Medicare Part A (hospital insurance) is usually premium-free, many workers sign up while keeping their employer health coverage.

Medicare Enrollment When You’re Still Working

Employer Coverage vs. Medicare

• If you have health insurance through your employer (or your spouse’s employer), you may be able to delay Medicare Part B (medical insurance) without penalty.

• The key is whether your employer coverage is considered “creditable coverage.”

Avoiding Medicare Late Enrollment Penalties

• If you don’t have creditable coverage and delay enrollment, you could face permanent penalties.

• It’s important to review your options carefully before deciding whether to delay Medicare.

Key Takeaways

• You do not need to retire to qualify for Medicare.

• Eligibility typically begins at 65, regardless of employment status.

• Employer coverage may influence whether you should enroll right away.

• Delaying Medicare without creditable coverage can lead to penalties.

Bottom Line:

Medicare eligibility is based on age or qualifying health conditions—not retirement. Whether you’re still working or fully retired, understanding how Medicare coordinates with your health coverage can save you money and help you avoid penalties.

Have Questions Regarding Medicare? 

Make an appointment with one of our professionals today. 

Introduction

• Navigating Medicare can be overwhelming.

• Common question: What is Medigap and do I need it?

• This guide explains what Medigap is, how it works, and who it’s for.

What Is Medigap?

Definition

• Medigap = Medicare Supplement Insurance

• Private insurance that helps pay for costs not covered by Original Medicare (Parts A & B)

Costs Covered by Medigap

• Copayments

• Coinsurance

• Deductibles

Purpose of Medigap

• Reduces out-of-pocket costs

• Provides predictable healthcare expenses

How Does Medigap Work?

Coordination with Medicare

• Medicare pays its share of approved healthcare costs.

• Medigap pays its share based on plan coverage.

Important Notes

• Only works with Original Medicare (not Medicare Advantage).

• Must be enrolled in Medicare Part A & B.

• Policies sold by private companies but standardized federally.

What Do Medigap Plans Cover?

Standardized Plans

• Labeled A, B, C, D, F, G, K, L, M, N

• Each plan offers different levels of coverage

Typical Coverage Includes

• Part A coinsurance & hospital costs

• Part B coinsurance or copayments

• Blood (first 3 pints)

• Part A hospice care coinsurance/copayment

• Skilled nursing facility coinsurance

• Part A &/or Part B deductibles (depending on plan)

• Emergency care abroad

Availability Notes

• Not all plans available in every state

• Some plans (e.g., Plan F) only available to those eligible before 2020

What Medigap Doesn’t Cover

• Prescription drugs (need Part D)

• Long-term care

• Dental, vision, hearing

• Private-duty nursing

When Should You Enroll in Medigap?

Open Enrollment Period

• Six months starting the month you’re 65 and enrolled in Part B

Benefits of Enrolling Early

• Guaranteed acceptance regardless of pre-existing conditions

• Avoids medical underwriting later

Medigap vs. Medicare Advantage

Key Differences

• Medigap supplements Original Medicare

• Medicare Advantage replaces Original Medicare, often including extra benefits

Important Note

• Cannot have Medigap and Medicare Advantage at the same time

• Consider which option aligns best with budget and healthcare needs

Is Medigap Right for You?

Ideal Candidates

• Want predictable healthcare costs

• Travel frequently (some plans cover international care)

• Prefer flexibility in choosing doctors/hospitals

Alternatives

• Medicare Advantage if you want vision, dental, or prescription coverage bundled

Final Thoughts

• Medigap reduces surprise medical bills and ensures manageable healthcare costs

• Compare options carefully

• Consult a trusted advisor to select the best plan

Need Help With Medicare?

Make an appointment with one of our professionals!

Overview of 2025 Medicare Costs

• Brief introduction to Medicare cost changes in 2025
• Why knowing premiums and deductibles matters for retirees in the Lehigh Valley

Medicare Part B Costs for 2025

Standard Monthly Premium

• 2025 premium amount: \$185/month
• Comparison to 2024’s \$174.70/month premium
• What this increase means for most beneficiaries

Part B Deductible

• 2025 deductible amount: \$257/year
• How the deductible works and when you pay it

Coinsurance and Out-of-Pocket Costs

• 20% coinsurance rule
• Examples of common Part B services

 Medicare Part A Costs for 2025

Premium-Free Part A

• Who qualifies for \$0 monthly premium
• Work history requirements

Premiums for Those Without Enough Work Credits

• Full premium: \$518/month (fewer than 30 quarters of coverage)
• Reduced premium: \$285/month (30–39 quarters of coverage)

Other Factors That May Affect Your Medicare Premium

Higher Income Premium Adjustments (IRMAA)

• Income thresholds and how they impact Part B and Part D premiums
• 2025 IRMAA surcharge ranges

Late Enrollment Penalties

• How penalties are calculated
• Strategies to avoid these costs

Medicare Advantage (Part C) Costs in 2025

• Average premium trends (slight decrease for 2025)
• Why costs vary by plan and location

Medicare Prescription Drug Plan (Part D) Costs in 2025

• Variation by plan and income level
• How to compare plans in the Lehigh Valley for best value

How Lehigh Valley Medicare Advisors Can Help You Save

• Personalized plan comparisons
• Guidance on avoiding penalties and excess costs
• Annual plan review for cost efficiency

Final Thoughts

• Summary of key 2025 Medicare cost changes
• Encouragement to review coverage before annual enrollment

Get Personalized Medicare Guidance Today

Ready to see how these 2025 Medicare changes affect you?

Contact Lehigh Valley Medicare Advisors for a free, no-obligation consultation.

We’ll help you:

• Compare plans side-by-side
• Identify ways to lower your out-of-pocket costs
• Avoid costly penalties
  📞 Call us today at 610-973-5334 or register for a obligation Free Consultation. 

1. Independent Advisors

We provide truly independent advice, meaning we are not tied to any single insurance provider. This independence allows us to present a range of Medicare plans, focusing solely on your specific needs, budget, and preferences. With unbiased guidance, you can be confident that our recommendations are based on what works best for you—not on commissions or sales targets.

2. No Hidden Fees for Services

One of the biggest advantages of working with us is the transparency around costs. Our consultation and plan selection services are provided without hidden fees, making sure you understand every aspect of your plan without worrying about extra charges. This open approach builds trust and ensures that you’re only paying for your selected Medicare coverage—no surprises.

3. Yearly Review of Your Plan

As healthcare needs can change over time, we offer an annual review of your plan. This yearly assessment helps you stay informed about any updates to your current coverage, new plan options, or adjustments that might benefit you based on your evolving healthcare needs. With this proactive approach, we help you keep your Medicare coverage in sync with your life changes, so you’re always getting the best possible care for your situation.

By choosing LV Medicare Advisors, you’re not only securing the right Medicare plan for today but also ensuring ongoing support and guidance into the future.

Medicare Advantage, sometimes known as “Part C,” is something of a catch-all choice for those who are ready to sign up for Medicare. Medicare Advantage plans are offered by private insurers in conjunction with the Medicare program, and can provide you with additional health insurance coverage.

What’s in them?

In addition to signing up for Medicare Part A (hospital stays) and Part B (medical coverage), Medicare Advantage plans offer their subscribers extra features. This frequently, but not always, includes the Medicare Part D prescription drug plan.¹

In some cases, Medicare Advantage plans offer coverage for areas not normally offered within regular Medicare plans. This can include dental, hearing, and vision insurance.¹

What are the rules?

Medicare pays for a fixed amount of your health care to the company offering your Medicare Advantage (MA) plan. Beyond that, each MA plan requires different out-of-pocket fees. Those fees can vary from plan to plan.¹

Depending on your plan, you may have different rules you need to follow when seeking a medical referral to get treatment from a specialist or if you are seeking non-urgent care (even from health care providers within the plan).

It’s also important to remember that rules, requirements, and features may change from year to year. It will be important to make sure that those changes line up with any treatment that you need.

What about my prescriptions?

While most MA plans offer Part D coverage for prescription drugs, some don’t. One example would be for Medicare Medical Savings Account plans. In cases where the plan can’t or chooses not to offer prescription drug coverage, you may have the ability to join a separate Medicare Prescription Drug Plan, depending on the type of plan you enroll in.¹

You will likely have a number of questions and concerns as you examine your options for Medicare Advantage plans. Discuss these with a trusted financial professional who can help you make choices that may best fit your lifestyle.

1. Medicare.gov, 2022

Lehigh Valley Medicare Advantage Plans

When you turn 65, you become eligible for Medicare if you:

1. Either receive or qualify for Social Security retirement cash benefits
2. Or, currently reside in the United States and are either:
   1. A U.S. citizen
   2. Or, a permanent U.S. resident who has lived in the U.S. continuously for five years prior to applying

How you enroll at age 65 depends on whether or not you are already receiving Social Security retirement benefits or Railroad Retirement benefits. Also, there are circumstances in which someone may become Medicare-eligible at age 65 but defers Medicare enrollment without future penalties—for instance, if an individual has qualifying insurance from an employer.

How much you have to pay for your Medicare coverage depends on your work history (i.e. if and how long you have paid Medicare taxes). Everyone owes a monthly premium for their medical insurance (Part B). Most people with Medicare get their hospital insurance (Part A) premium-free.

For questions regarding Medicare eligibility, call the Medicare Rights Center’s free national helpline at 800-333-4114 or contact Lehigh Valley Medicare Advisors.

© 2022 Medicare Rights Center. Used with permission.

Bethlehem Medicare Advisors

Allentown Medicare Advisors

Easton Medicare Advisors

Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.

Medicaid is a state and federal program that provides health coverage if you have a very low income.

If you are eligible for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs.

Also know that while Medicare and Medicaid are both health insurance programs administered by the government, there are differences in covered services and cost-sharing. Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are a dual-eligible.

© 2022 Medicare Rights Center. Used with permission.

Let's break down the basics. Whether your 65th birthday is on the horizon or decades away, understanding the different parts of Medicare is critical, as this government-sponsored program may play a role in your future health care decisions. Parts A & B are the two components of Original Medicare. There are two components. In general, Part A covers inpatient hospital care, skilled nursing facility costs, hospice, lab tests, surgery, and some home health care services. One thing to keep in mind is that, while very few beneficiaries must pay Part A premiums out of pocket, annually adjusted standard deductibles still apply.^1,2 Many pre-retirees are frequently warned that Medicare will only cover a maximum of 100 days of nursing home care (provided certain conditions are met). Under the current Part A rules, you would pay $0 for days 1-20 of care in a skilled nursing facility (SNF). During days 21-100, a $203 daily coinsurance payment may be required of you.^1,2 Knowing the limitations of Part A, people need to look for other choices when it comes to managing the costs of extended care. Part B covers physicians’ fees, outpatient hospital care, certain home health services, durable medical equipment, and other offerings not covered by Medicare Part A.²

Part B does come with some costs, however, which are adjusted annually. The premiums vary, according to the Medicare recipient’s income level, but the standard monthly premium amount is $174.70 for 2024, and the current yearly deductible is $240.²

Sometimes called “Medicare Part C,” Medicare Advantage (MA) plans are often viewed as an all-in-one alternative to Original Medicare. MA plans are offered by private companies approved by the federal government. Although these plans come with standardized minimum coverage, the amount of additional protection offered can differ drastically from one person to the next. This is due to unique provider networks, premiums, copays, coinsurance, and out-of-pocket spending limits. In other words, comparing prices and services offered from different vendors may be the best way to find a Medicare Advantage plan that works for you.³

Part D: Prescription drug plans. While Medicare Advantage plans often offer prescription drug coverage, insurers also sell federally standardized Medicare Part D plans as a standalone product to those with Medicare Part A and/or Part B. Every Part D plan has its own list (i.e., a “formulary”) of covered medications. Visit Medicare.gov to explore the formulary of approved drugs for your Part D plan as well as their prices, organized by tier.^3,4

In fact, Medicare.gov is a great place to start all your research. Once there, you’ll find answers to your most common questions and more information on the different Medicare plans offered in your area.

1. CMS.gov, 2022
2. Medicare.gov, 2024
3. Medicare.gov, 2024
4. Medicare.gov, 2024

Lehigh Valley Medicare Part C

Lehigh Valley Medicare Part D

Medicare’s prescription drug benefit (Part D) is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the federal government—it is never provided directly by the government (unlike Original Medicare).

If you want to get Part D coverage, you have to choose and enroll in a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage (MAPD). Enrollment is optional (though recommended to avoid incurring future penalties) and only allowed during approved enrollment periods. Typically, you should sign up for Part D when you first become eligible to enroll in Medicare.

Whether you should sign up for a Medicare Part D plan depends on your circumstances. You may have creditable drug coverage from employer or retiree insurance. If so, you don’t need to enroll in a PDP until you lose this coverage. Also, some people already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare drug plan and receive additional financial assistance paying for their medicines.

©2022 Medicare Rights Center. Used with permission.

Lehigh Valley Medicare Part D