What are Medicare Enrollment Periods and How do they Work?

Are you approaching 65 years of age or nearing eligibility for Medicare? Confused about the enrollment periods and when to sign up for Medicare coverage? Don’t worry, this article will guide you through the Medicare enrollment periods and help you make informed decisions about your health insurance.

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Introduction to Medicare Enrollment Periods

Medicare is a federal health insurance program for people who are 65 years of age or older, people with certain disabilities, and those with End-Stage Renal Disease (ESRD).

The enrollment periods for Medicare are specific times when you can enroll in the program or make changes to your coverage. It’s important to understand these enrollment periods to make sure you have the coverage you need, when you need it.

Below, we delve into the various Medicare enrollment periods and how you can take advantage of them to secure your coverage.

What are the Medicare Enrollment Periods?

With multiple enrollment periods available, it can be difficult to keep track of the specifics for each one. Each enrollment period has its own set of rules and dates for different purposes, especially for those enrolling in Medicare for the first time. However, if you meet certain criteria, you may be automatically enrolled in Medicare coverage without having to take any action. For example, if you are receiving Social Security benefits when you turn 65, you will automatically be enrolled in Original Medicare, including Parts A and B, without needing to enroll yourself.

If you do not meet the criteria for automatic enrollment, it is important to take advantage of the Initial Enrollment Period.

Medicare Enrollment Period Chart

What is the Initial Enrollment Period (IEP) in Medicare?

The Initial Enrollment Period (IEP) in Medicare is a seven-month window during which you can enroll in Medicare Parts A and B. This enrollment period begins on your 65th birthday or after you have received your 24th Social Security disability check, whichever comes first.

During your IEP, you have the option to enroll in both parts of Original Medicare or delay enrolling in Part B. Most people choose to enroll in Part A due to its zero monthly premium, but some individuals may opt to delay Part B if they have creditable coverage. The IEP starts three months before your Medicare qualifying event and ends three months after, covering the month of your event as well.

For instance, if your 65th birthday is on June 1, your IEP begins on March 1 and ends on September 30. If you enroll in Medicare three months prior to your 65th birthday, your Original Medicare benefits will start on the first day of your birth month. If you enroll during your birth month or in the three months following, your coverage will start on the first day of the next month.

What is the Initial Enrollment Period (IEP) for Medicare Before Turning 65?

If you are eligible for Medicare benefits before the age of 65 due to a disability, you will receive another Initial Enrollment Period (IEP) when you turn 65. This period is referred to as the Initial Enrollment Period 2.

For instance, if you become eligible for Medicare at the age of 57 due to a 24-month disability, you will have another opportunity to enroll when you reach 65, with no late enrollment penalties.

During the Initial Enrollment Period 2, you can enroll in a Medicare Advantage or Medicare Supplement (Medigap) plan, as well as a Medicare Part D plan. The length of this enrollment period is the same as the Initial Enrollment Period, which is seven months.

Special Enrollment Period for Medicare

The Special Enrollment Period for Medicare is a complex period of enrollment that is only available to those who meet specific criteria. It occurs when you were initially eligible for Original Medicare coverage but delayed it due to having creditable coverage, such as employer coverage.

When your employer coverage ends, you will be granted a Special Enrollment Period, which lasts for eight months from the termination date of your employer coverage. This period allows you to enroll in Original Medicare. If you are already enrolled in Original Medicare, you have a 63-day Special Enrollment Period to enroll in a Medicare Part D plan, which is essential to avoid paying a late enrollment penalty.

Additionally, life-changing events such as:

moving out of your plan’s service area,
losing or gaining Medicaid coverage,
being impacted by an emergency or disaster, or
being recently incarcerated can qualify you for a Special Enrollment Period, allowing you to change your Medicare coverage.

If you believe you may be eligible for a Special Enrollment Period, our licensed Medicare agents are here to help. They will work with you to ensure that you enroll in new Medicare coverage in a timely manner, as these periods are time-sensitive. To learn more, please fill out our form.

When is the Annual Enrollment Period for Medicare?

The Annual Enrollment Period for Medicare takes place annually from October 15th to December 7th. During this period, Medicare beneficiaries have the opportunity to make adjustments to their coverage. These adjustments can include switching from Original Medicare to Medicare Advantage, going from one Medicare Advantage plan to another, enrolling or changing a Medicare Part D prescription plan, and more.

If you choose to switch back to Original Medicare during the Annual Enrollment Period, you can enroll in a Medicare Supplement plan to help with out-of-pocket costs starting January 1st of the next year. Note that you may be subject to medical underwriting when enrolling in a Medicare Supplement plan.

General Enrollment Period for Those Who Delay Medicare Coverage

The General Enrollment Period is an opportunity for those who did not enroll in Original Medicare during their Initial Enrollment Period and do not have credible coverage to sign up. This period occurs annually from January 1 to March 31. If you enroll during the General Enrollment Period, your coverage will begin the first day of the following month. However, you may face late enrollment fees based on how long you delayed signing up for Medicare benefits without credible coverage.

Health insurance that provides benefits that are equal or better than Original Medicare is known as creditable coverage. To avoid incurring penalties for late enrollment, it’s recommended that you sign up for Medicare as soon as you’re eligible or once you lose your creditable coverage.

What is the Open Enrollment Period for Medicare Supplement Insurance?

The Open Enrollment Period for Medicare Supplement insurance begins the first day of the month in which your Medicare Part B becomes effective. During this six-month period, you have guaranteed access to any Medigap plan offered in your area. Some insurance carriers even allow you to enroll up to six months before your Medicare Part B starts.

Medicare Supplement plans are a good option for people on Medicare who want to minimize their out-of-pocket healthcare costs. These plans cover expenses not covered by Medicare Part A and Part B, eliminating high healthcare costs associated with Medicare.

It’s important to enroll in a Medigap plan during the guaranteed-issue period, especially if you have pre-existing conditions that may lead to a policy denial in the future.

If you miss your Open Enrollment Period for Medicare Supplement insurance, you can still apply for Medigap coverage throughout the year, but there’s a possibility that your application may be denied due to underwriting.

What are the Enrollment Periods for Medicare Advantage Plans?

If you’re on Original Medicare, you have the option of obtaining additional coverage through a Medicare Advantage plan. These plans, offered by private insurance companies, provide additional benefits beyond what Original Medicare covers, such as dental, hearing, vision, prescription drug coverage, and gym memberships. However, they often have high out-of-pocket costs and limited doctor networks compared to Original Medicare.

To join an MA Plan, you must be enrolled in Parts A and B. There are several enrollment periods available for individuals looking to enroll in a Medicare Advantage plan, including

The Initial Enrollment Period (IEP), which is a seven-month period that includes the three months before and after the month of your 65th birth month or the 25th month of collecting disability benefits.
Part B Special Enrollment Period (SEP) for losing job-based insurance that allows you to delay enrollment in Part B without penalty if you had job-based insurance when you first became eligible for Medicare, and you can enroll in an MA Plan after signing up for Part A and B coverage.
Special Enrollment Periods are available for exceptional circumstances such as those living in areas affected by natural disasters.
The General Enrollment Period (GEP) is available in January through March each year and allows individuals to sign up for Medicare if they did not do so when they first became eligible.
The Fall Open Enrollment Period is between October 15 and December 7 each year, and it offers the opportunity to change Medicare coverage, switch between Original Medicare and Medicare Advantage, and change Part D coverage. It’s important to note that individuals should sign up for a plan during the same month that they sign up for Parts A and B.

What are the Enrollment Periods for Medicare Prescription Drug Plans?

To enroll in Medicare Part D for the first time, you will generally do so during your Initial Enrollment Period (IEP), during the Fall Open Enrollment Period, or if you qualify for a Special Enrollment Period (SEP).

During this time, you must

have Part A and/or Part B, and
live in the Part D plan’s service area.

Typically, your Part D Initial Enrollment period coincides with your Medicare IEP, which is a seven-month period that includes the three months before, the month of, and the three months following your 65th birthday. For instance, if you turn 65 in May, your IEP will run from February 1 to August 31.

In some cases, you may qualify for a Special Enrollment Period to enroll in a Part D plan, such as if you

had creditable drug coverage,
have job-based drug coverage through your or your spouse’s employment,
or are eligible for Extra Help. It’s important to note that if you are enrolled in Medicare due to a disability and currently pay a premium penalty, you will not have to pay the penalty once you turn 65. This is because you will qualify for a new Part D IEP when you turn 65.

The Annual Election Period (AEP), also known as the Fall Open Enrollment Period, is an opportunity for those who did not enroll in Part D during their Initial Enrollment Period to enroll in prescription drug coverage. It occurs annually from October 15 to December 7.

During the AEP, you can

make changes to your current Medicare prescription drug coverage for the following year, such as enrolling in a Medicare Prescription Drug Plan,
switch from one Prescription Drug Plan to another, switching from a Medicare Advantage plan with no drug coverage to one that includes it, or
dropping your Medicare prescription drug coverage altogether.

5-Star Special Election Period (SEP)

Medicare Advantage plans and Medicare Prescription Drug Plans are evaluated for their overall quality and performance by Medicare, using a 1 to 5-star rating system. Ratings are based on feedback from plan members, as well as input from healthcare providers, and can change each year. Plans that receive a 5-star rating are considered to be “excellent.”

If you’re enrolled in a plan that does not hold a 5-star rating, you may use the 5-Star Special Election Period to enroll in a Medicare Advantage plan with prescription drug coverage or a Medicare Prescription Drug Plan that has earned a 5-star rating outside of the Annual Election Period (AEP). However, you may only use this enrollment period to enroll in a 5-star plan once per calendar year. The 5-Star SEP is open from December 8 to November 30 of the following year.

Need Help with Medicare Enrollment?

Enrolling in Medicare during a valid enrollment period is crucial to avoiding penalties, ensuring coverage, and avoiding denial of coverage in the future. To make the process easier, we have a team of licensed Medicare experts ready to assist you throughout the enrollment process.

To compare plans in your area during your eligible Medicare enrollment period, simply fill out our online form now or call Health Plans in Oregon at 503-928-6918. Our assistance is at no cost to you.

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I GRANT PERMISSION FOR A LICENSED INSURANCE AGENT TO CALL OR EMAIL ME REGARDING MY MEDICARE OPTIONS INCLUDING MEDICARE SUPPLEMENT, MEDICARE ADVANTAGE, AND PRESCRIPTION DRUG PLANS . Not affiliated or endorsed by Medicare or any state or federal governmental agency.