The annual Medicare Open Enrollment Period occurs annually from October 15 to December 7, commonly known as the Annual Enrollment Period (AEP). Within this timeframe, beneficiaries have the flexibility to enroll in, modify, or discontinue an Original Medicare or Medicare Advantage plan.

However, in the event that you overlook the Medicare Open Enrollment Period, you might qualify for a Special Enrollment Period if you experience a qualifying event. Alternatively, there could be additional enrollment alternatives accessible to guarantee you obtain the necessary Medicare coverage.

Understanding the Medicare Open Enrollment Period

The Medicare Open Enrollment Period, often referred to as the Annual Enrollment Period (AEP), runs from October 15 to December 7 each year. This window allows individuals to make changes to their Medicare plans, including switching, dropping, or joining a plan. Insurers provide beneficiaries with an Annual Notification of Changes (ANOC), outlining any alterations to plan details, such as premium rate increases or adjustments to coverage.

Exploring Options During Open Enrollment

During the Medicare Open Enrollment Period, beneficiaries have the opportunity to:

Change from Original Medicare to Medicare Advantage, or vice versa

Individuals can transition between Original Medicare and Medicare Advantage plans based on their evolving healthcare needs.

Switch from one Medicare Advantage plan to another

Beneficiaries can explore different Medicare Advantage plans to find one that better suits their preferences and requirements.

Join a Medicare drug plan

Enrollment in a Medicare drug plan allows individuals to ensure coverage for prescription medications.

Remove your drug coverage

Beneficiaries also have the option to adjust their prescription drug coverage based on their specific healthcare needs.

Regardless of the chosen action, the new coverage takes effect on January 1. Failure to take any action maintains the existing Medicare plan, with the new premium as stated in the ANOC. 

Dropping a plan incurs no penalty, providing the flexibility to sign up for an alternative plan.

Options After Missing Open Enrollment

If you miss the Medicare Open Enrollment Period, also known as the Annual Enrollment Period, various alternatives exist:

General Enrollment Period

When: January 1 – March 31
Coverage Begins: July 1
What You Can Do: Sign up for Part A and Part B

The General Enrollment Period offers the opportunity to enroll in Part A or Part B coverage if the initial enrollment period or open enrollment was missed. Unlike the Open Enrollment Period, modifications to coverage are not allowed during this period.

Medicare Advantage Open Enrollment Period

When: January 1 – March 31
Coverage Begins: The first of the month after the month you ask to join the plan
What You Can Do: Switch your Medicare Advantage Plan or drop it and enroll in Original Medicare

The Medicare Advantage Open Enrollment Period allows beneficiaries to switch between Medicare Advantage Plans or transition back to Original Medicare. However, specific restrictions apply.

Special Enrollment Period

When: Depends on the circumstance
Coverage Begins: Depends on the circumstance
What You Can Do: Depends on the circumstance

Special Enrollment Periods (SEPs) are not tied to specific dates but are triggered by life events or circumstances, allowing changes to Medicare coverage without penalties.

Switching to a 5-Star Plan

When: December 8 and the following November 30
Coverage Begins: January 1
What You Can Do: Change from a lower-star Medicare Advantage or Part D plan to a 5-star plan

The 5-star special enrollment period provides the opportunity to switch to a higher-rated Medicare Advantage or Part D plan.

Learn more about Medicare Enrollment Periods here.

Potential Penalties for Late Medicare Enrollment

Missing the Medicare enrollment deadline may result in various penalties:

Part A Late Enrollment Penalty

If not eligible for premium-free Part A, individuals may face a penalty for late enrollment, increasing the monthly premium by 10% for each full year without coverage.

Part B Late Enrollment Penalty

Failure to enroll in Part B when initially eligible can lead to a permanent premium increase of 10% for each 12-month period without coverage.

Part D Late Enrollment Penalty

Going without Medicare or creditable drug coverage for 63 consecutive days or more incurs a Part D late enrollment penalty based on the number of months without coverage.

Avoiding Late Penalties

Special Enrollment Periods offer avenues to avoid late penalties by addressing specific circumstances, such as loss of job-based coverage.

Enrollment Requirements

To enroll in Medicare, certain documents are necessary, including a birth certificate, proof of U.S. citizenship or residency, Social Security card, and details about other health insurance coverage.

For Original Medicare enrollment, options include online applications, assistance from insurance agents, phone applications, or in-person visits to local Social Security offices. Exploring Medicare Advantage plans can be done independently or with the guidance of an insurance agent.

Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.