When it comes to health insurance, most people don’t enjoy taking the time to sit down and unpack the intricate world of rules and regulations about when you can and cannot enroll in coverage. This becomes increasingly more complex once you hit the magic age of 65. When turning 65 and becoming eligible for Medicare, it is crucial to understand the time frames for enrollment because they can be a factor in your Medicare coverage options/decisions.
We will walk through most of the major Medicare enrollment situations and time periods that are available to you, not only when your initially eligible, but throughout the year as well.
Initial Enrollment Period
Your Initial Enrollment Period (IEP) starts three months before the month you turn 65, runs through the month of your birth month, and up to the three months following the month you turn 65. During this time, you can enroll in Medicare Part A and Part B (contact Social Security for enrollment). Once you have Part A and Part B, you are then eligible to enroll into a Medicare Advantage Prescription Drug Plan or a stand-alone prescription drug plan (usually coupled with a Medicare Supplement).
During your IEP, it is important to enroll or make a decision on your coverage to avoid penalties or delay in coverage. In the event you do not signup during this time frame, you may face late enrollment penalties if you do not have other credible coverage elsewhere (e.g., an employer based health plan).
Medicare Supplement Open Enrollment Period
While there are various Medicare Supplement plans available and every client’s budget and situation will be different, the enrollment time frame is the same. The Medicare Supplement enrollment period will start the month an individual turns 65 (assuming they have Medicare Part B in place) and continue for five months following. During this six-month window, your Medicare Supplement enrollment is considered guaranteed issue, which means that you do not have to complete a medical questionnaire to meet eligibility requirements. If you are not enrolled into a Medicare Supplement by the end of this six-month window, then there may be medical underwriting and questions to answer to determine eligibility.
General Enrollment Period
The General Enrollment Period only applies to people who meet both of the following two criteria: you did not signup when you were initially eligible and you are not eligible for for a Special Enrollment Period (which is discussed below). This enrollment period starts on January 1 and runs through March 31 every year. During this time, eligible individuals may enroll in Medicare Part A and Part B. The catch is that the plan year will not start until July 1 of that year. Along with a delayed start date, there may also be late enrollment penalties.
Annual Enrollment Period
The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year and is the time to make changes to your current coverage. Additionally, you can make these changes during AEP:
- If you have only Medicare Part A and Part B, you can also pickup a Medicare Advantage plan or switch off a Medicare Advantage plan back to just Medicare Part A and Part B.
- You can switch off a Medicare Advantage plan that has drug coverage to another Medicare Advantage plan that does not have drug coverage.
- You can join or drop a Medicare prescription drug plan.
- Beneficiaries can switch existing prescription drug coverage or Medicare Advantage plans to another plan of the same type.
Changes made during this time will take effect on January 1 of the following year. If no changes are needed or made, the insuring company will generally renew the plan automatically for January 1.
Medicare Advantage Open Enrollment
For those with a Medicare Advantage plan, from January 1 to March 31 every year, individuals can make a change to their current plan. This change can be to go to either another Medicare Advantage plan with or without prescription drug coverage or to Original Medicare. Any changes made will take effect the first of the following month in which they apply.
Special Enrollment Periods
Special enrollment periods come into play when an individual meets certain criteria or a particular event takes place. If you qualify for one of these special enrollment periods you can join, switch, or drop a Medicare Advantage or prescription plan. Below are some of the more common scenarios (see Medicare.gov for a full list)…
- You move out of your plan’s service area.
- You move back to the U.S. after living abroad.
- You move into or out of a skilled nursing facility, psychiatric facility, rehab hospital or long-term care facility.
- Your employment or your employer-provided plan ends.
Medicare can be confusing and we are here to be your translators. If you have questions about an existing plan or are looking to get started with Original Medicare, please give us a call today so our licensed agents can walk you through your options and let you know how the rules apply to you.