For the most part, enrollment into Medicare Advantage and Prescription Drug Plans—and similar Medicare Health Plans—are governed by enrollment periods. This means that without a special exception—known as a special enrollment period—you can only enroll in these programs during specific yearly time windows. Read on for details about the important enrollment periods you need to know about and how to best take advantage of each of them to obtain the coverage you need.
Everyone who qualifies for Medicare gets an Initial Enrollment Period (IEP) to sign up for Medicare Parts A and B. Most people who are actively receiving Social Security or Railroad Retirement Board benefits are automatically signed up for Parts A and B during this period. For people who are qualifying for Medicare by age, this important period begins three months before the month you turn 65 (or three months before the month you first qualify for Medicare, if under age 65), runs through your birthday month and then ends three months after the month you turn 65 years old.
It’s important to stay on top of these dates as delaying enrollment until your 65th birthday—or the three months after—could delay your activation in the system and cause a coverage gap. If your birthday happens to fall on the first of the month, your eligibility for Medicare A and B starts one month earlier. That means your Initial Enrollment Period (IEP) will begin three months before and end three months after that month instead of your birthday month. Keep in mind that if you don’t have adequate coverage through another source—such as an employer or spouse’s plan—you may be financially penalized for late enrollment and required to pay higher premiums when you do eventually sign up.
If you enroll in both Part A and Part B, you can also use your IEP to enroll in a Medicare Advantage Prescription Drug plan (Parts C and D combined) or a stand alone prescription drug plan (Part D). If you enroll in either Part A or Part B (not both), you can use your IEP to enroll in a stand alone Prescription Drug Plan only.
If you missed your Initial Enrollment Period (IEP) and don’t qualify for a Special Enrollment Period (SEP) you can enroll in Medicare Part A and/or B during the General Enrollment Period (GEP) which runs yearly from January 1st – March 31st. People who enroll during the general enrollment period will usually become eligible July 1 of the same year.
If you have qualifying health insurance through a different source that allows you to delay signing up for Medicare during your initial enrollment period, you may qualify for a special enrollment period or SEP. Qualifying for an SEP allows you to sign-up for Medicare Parts A and B at any time as long as you or your spouse is still working and you have group health insurance through that employer, a union or another source. If after your “Initial Enrollment Period” you lose your non-Medicare health insurance for any reason, you have an 8-month SEP window to sign up for Medicare without penalties. The SEP period starts the month after your group health insurance coverage ends.
You may also qualify for a special enrollment period (SEPs) for various other reasons such as moving out of the plan’s coverage area, losing coverage through no fault of your own, or qualifying for programs like Medicaid or Extra Help. The length of time and types of coverage changes you can make vary depending on the situation. Visit the Medicare Special Circumstances page for more information.
The end of the year is an important time for existing Medicare members who are looking to make changes to their plans. During this time—which happens annually between October 15 and December 7—you are able to add, drop or switch your Medicare Advantage or Part D prescription drug plans. You may make as many enrollment changes as you want during this period, and the last coverage election processed by Medicare will be the one you receive. All enrollments or plan changes during AEP go into effect on January 1 of the following year. Until then, you will remain under the coverage you had before AEP.
This period runs for the first three months of every year, from January 1st through March 31st. During this time people who are already enrolled in a Medicare Advantage plan can switch plans or switch back to Original Medicare.
The Medicare Supplement Open Enrollment period occurs when you turn 65 or enroll in Part B, whichever one is later. During this 6-month window you are able to enroll in any Medicare Supplement plan available in your area without being disqualified for having preexisting health conditions, and they cannot charge you a higher rate due to your medical history. After this one-time 6-month window passes, you may be required to answer health history questions or to undergo medical underwriting when applying for Medicare Supplement plans, the results of which may be used to increase your premiums or deny you coverage.
Keeping track of these important dates can help ensure you make the most of your Medicare benefits. For help with these enrollment periods and to find out if you can save money on your Medicare Supplement policy by being a health conscious senior talk to a friendly, licensed Health IQ agent today.