When to Enroll in Medicare
Knowing when to enroll in Medicare is equally as important as choosing your Medicare benefits.
Specific enrollment periods were created to accommodate various life events and changes. First, let’s identify the different enrollment period scenarios to determine which best applies to you and your situation. Here are five key categories that guide when you enroll:
- You’re turning 65
- You’re working past 65
- You have a qualifying life event or change
- You missed your Initial Enrollment Period
- You need a plan and prescription review
Enrollment is not automatic for everyone, and it’s important to take the time to familiarize yourself with these dates and have a clear understanding of your options, enroll on time, and avoid the risk of underwriting or incurring a late penalty fee.
Initial Enrollment Period (IEP)
For most of us, the Initial Enrollment Period (IEP), which is triggered by our 65th birthday, is the first chance and the best time to enroll in Medicare.
Your IEP is unique to only you, as it is a 7-month window that begins 3 months prior to your 65th birth month, includes your birth month, and the 3 months that follow your birth month.
It provides you the opportunity to enroll penalty-free in Medicare Parts A and B, as well as a Part D prescription plan.
Special Enrollment Periods for Working Past 65
Today, many people are choosing to work past age 65. By doing so, you might elect to keep your employer benefits until you decide to dis-enroll from these benefits or retire. With either scenario, you are eligible for a Special Enrollment Period (SEP) that would provide you a period of time to enroll in Parts B and D penalty-free.
Prior to determining your SEP eligibility after your Initial Enrollment Period, you should discuss with your employer how your existing health plan coincides with Medicare enrollment. Next, determine what documentation is required to qualify you for a Special Enrollment Period.
Special Enrollment Periods for Qualifying Special Circumstances
The Centers for Medicare and Medicaid Services (CMS) understand that life changes and, depending on your situation, you could qualify for a Special Enrollment Period (SEP) to assist in enrolling and managing your Medicare benefits.
A SEP allows you to delay enrolling in Part B and D without incurring a late enrollment penalty (LEP). If you elected not to enroll for Parts B and D during your IEP, you would need to provide documentation of your Special Enrollment Period (SEP) eligibility to CMS in order to avoid any penalties.
Special Circumstances approved by CMS to qualify for an SEP:
• Your Medicare plan is withdrawn from the Medicare program.
• Moving out of your Medicare plan’s service area.
• Residing, moving in to, or moving out of a nursing facility or other institution.
• Becoming eligible or losing your Medicaid coverage.
• Becoming eligible and receiving Extra Help (also known as Low-Income Subsidy) with your Medicare prescription drug costs.
To avoid paying any of the late penalty fees for Parts A, B or D, verify your Special Enrollment Period eligibility before deciding to delay coverage.
Determining Enrollment Period Eligibility
Not sure if this enrollment period applies to you? Let us help you. We can explain when and how you’ll need to enroll to have the coverage you need, when you need it, without late penalties.
General Enrollment Period (GEP)
If you didn’t sign up during your Initial Enrollment Period, and you’re not eligible for a Special Enrollment Period, don’t panic – you still have an opportunity to enroll in Parts A and B during the General Enrollment Period (GEP).
This enrollment period is from January 1 through March 31 of each year, and your coverage would start on July 1 of the same year.
During the General Enrollment period, you can enroll for Parts A and B; however, you must wait for the Annual Enrollment Period (AEP) in October to enroll in Parts C and D.
It’s important to understand that the GEP is not the ideal time for you to sign up for Original Medicare because you still risk facing late penalties and coverage gaps by enrolling during this period.
However, while it’s best to sign up for Medicare during your Initial Enrollment Period, we realize that sometimes things happen and it’s not possible. Therefore, the General Enrollment was created to help you secure the coverage that you need.
Annual Enrollment Period and Medicare Advantage Open Enrollment Period
– The Annual Enrollment Period applies to changing your existing Medicare coverage.
– The Medicare Advantage Open Enrollment Period applies to changing your existing Medicare Advantage plan.
Annual Enrollment Period
The Annual Enrollment Period is the only opportunity for most of us to make changes to our existing Medicare coverage. This enrollment period runs from October 15th – December 7th every year.
During this period, you can add, change or drop your Medicare coverage depending on your enrollment. Unless you qualify for a Special Election Period, this will be the only time each year you can make changes to your Medicare benefits.
Coverage Changes You Can Make During AEP:
You can use the Annual Enrollment Period to:
• Leave your Original Medicare plan and switch to Medicare Advantage.
• Leave your Medicare Advantage plan and return to Original Medicare.
• Leave a Medicare Advantage plan that you’re currently enrolled in and change to another Medicare Advantage plan.
• Enroll in a Part D Prescription Drug plan.
• Switch to a different Part D Prescription Drug plan if you’re currently already enrolled in one.
• Drop your Part D coverage completely, without being penalized, if you have creditable coverage through an employer or other source.
Medicare Advantage Open Enrollment Period (OEP)
Changing your Medicare Advantage benefits once you enroll:
Medicare beneficiaries who enroll in a Medicare Advantage plan have an opportunity to make a one-time change to their benefit plans after enrolling during the Open Enrollment Period (OEP). Read below for more details.
In January 2019, the Medicare Open Enrollment Period (OEP) returned and replaced the Medicare Disenrollment Period. Under Medicare OEP, Medicare beneficiaries can make a one-time change to their Medicare Advantage benefit plans from January 1st – March 31st. This change can only occur one time during the duration of their coverage.
During the OEP, there are two changes that you can make to your Medicare coverage. You can either switch from one Medicare Advantage plan to another Medicare Advantage plan, or you can disenroll from Medicare Advantage and return to Original Medicare, with or without Part D benefits.
Why did Medicare OEP come back?
Medicare OEP returned for two reasons. With the Medicare Advantage Disenrollment period, enrollees were only allowed to drop their Medicare Advantage plan and return to Original Medicare. They were not allowed to switch from one Medicare Advantage plan to another.
Additionally, OEP is being reinstated because it was recognized that, due to the complex nature of Medicare Advantage plans, many beneficiaries were making uninformed decisions when they selected their Medicare Advantage benefits, and wound up stuck in a plan that they didn’t like and/or couldn’t afford for an entire year.
Medicare Advantage plans can be complicated, and without thorough research or the assistance of a Medicare broker, it is easy to overlook important details, such as confirming that a specific doctor is in a plan’s network, or that a specific prescription drug is covered.
The OEP allows a beneficiary a one-time opportunity to rectify that mistake and switch to another plan that better meets their needs.
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