Medicare Enrollment Periods
Medicare, a U.S. government-funded health insurance program, has several enrollment periods. Persons who qualify for Medicare can sign up for Medicare within these time frames, or they risk late enrollment penalties and stressful paperwork.
Persons who qualify for Medicare include:
● Persons aged 65 and above
● Persons under 65 living with disabilities and certain medical conditions
Will I Be Automatically Enrolled In Original Medicare?
The federal government regulates Medicare, and according to its policy, you are automatically enrolled into Original Medicare if you fit into any of the following categories:
● You are receiving either Social Security or Railroad Retirement Benefits when you turn 65 years old. Usually, your Medicare card will be mailed to you about three months before your 65th birthday.
● You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS).
● You have End-Stage Renal Disease where you require regular dialysis or a kidney transplant.
● You have received Social Security Disability Insurance (SSDI) for at least 24 months. So, you are automatically enrolled in your 25th month.
If I Need To Enroll In Original Medicare, When Can I Do So?
If you do not qualify for automatic enrollment, Original Medicare has two enrollment periods you should be aware of. They include:
Original Medicare Initial Enrollment Period (IEP)
If you are not drawing Social Security at age 65 and without creditable coverage then you must go on Medicare and you will need to apply during your Initial Enrollment Period. The Initial Enrollment Period is a 7-month window where if needed you are able to enroll in Original Medicare. This 7-month period includes the three months before the month you turn 65, your birth month, and three months after the month you turn 65.
For example: If you were born on April 15th 1957, then your “IEP” would begin in January of 2022. This would make July of 2022 the last month of your “IEP”
Original Medicare Special Enrollment Period (SEP)
Some people delay Original Medicare Enrollment beyond age 65 due to having Employer Group Coverage. Once your Initial Enrollment Period ends you will be able to sign up for Original Medicare if you meet the following criteria. If you’re covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B at any time as long as you or your spouse is working, and you’re covered by a group health plan through the employer or union based on that work.
If you are considering delaying your enrollment into Medicare beyond age 65 it is important that you confirm you have creditable coverage to ensure you do not incur any late enrollment penalties.
General Enrollment Period (GEP)
The General Enrollment Period is for persons who didn't sign up when they were first eligible and weren't eligible for a Special Enrollment Period (SEP) into Original Medicare. Penalties may apply.
The General Enrollment Period runs from January 1st to March 31st each year. In this period, you can sign up for Part A and/or Part B. Original Medicare coverage starts on the 1st of July each year in this scenario.
Medicare Advantage and Part D Enrollment During (IEP)
Once you are enrolled in Original Medicare you are also able to enroll in a Medicare Advantage Plan (Part C) or a standalone Medicare Drug plan (Part D) during this same IEP time period. Outside of your IEP you will only be able to enroll in one of these plan types during the Annual Election Period (AEP) or if you have a qualifying Special Election Period (SEP).
For persons Medicare eligible due to disability, the initial enrollment period for Part C and Part D enrollment is also a 7-month period. It begins three months before their 25th month of disability benefits, includes the 25th month, and ends three months after.
Therefore, regardless of whether you are automatically enrolled into Original Medicare or had to apply, you will still have an Initial Enrollment Period. During this 7 month window you can buy, switch, or cancel Medicare plans or make some decisions about your coverage.
The dates when Medicare coverage kicks in vary depending on the month you enroll. It's recommended that you process any enrollments as soon as you are able, to ensure no lapses in coverage.
It's important to note that your IEP often coincides with your one time Medigap Open enrollment period. During this period of time you are able to purchase a Medigap Plan without any medical underwriting. Outside of this 6 month window an insurance company can charge you more in premiums or deny you coverage.
Annual Election Period (AEP)
The Medicare Annual Election Period is often referred to as the Open Enrollment Period. This yearly period is in the fall and runs from October 15th to December 7th each year.
During this period, you can:
● Switch from Original Medicare to a Medicare Advantage plan (Medicare Part C).
● Switch from an Medicare Advantage plan back to Original Medicare
● Change from one Medicare Advantage plan to another Medicare Advantage plan
● Enroll into a standalone Medicare Part D plan
● Switch from on Part D drug plan to another, or drop your drug plan altogether
These changes begin to take effect on January 1st of the following year.
**It's important to note that AEP has nothing to do with Medigap Plan enrollment. Medigap plan changes can be done at any time as long as the individual is able to pass the underwriting of the company they are applying for coverage through.
It is the best time to review your Medicare options and make the best decisions for you and your family. Remember to consider health status, health needs, cost, and coverage when weighing your options. Once this window is over, you can only enroll in or change your plan if you experience a major life event, which is only during a Special Enrollment Period (SEP).
However, there is an additional period called Open Enrollment Period (OEP) for persons already signed in a Medicare Advantage plan. It runs from January 1st to March 31st every year. During these three months, you can change from your current Medicare Advantage plan to another Medicare Advantage plan or change back to Original Medicare. This was created as a safety net for people who made a poor choice during AEP to avoid being stuck on a bad plan all year long.
Part C and Part D Special Enrollment Periods (SEP’s)
During a qualifying SEP an Original Medicare beneficiary can:
● Switch from Original Medicare to a Medicare Advantage plan (Medicare Part C).
● Switch from an Medicare Advantage plan back to Original Medicare
● Change from one Medicare Advantage plan to another Medicare Advantage plan
● Enroll into a standalone Medicare Part D plan
● Switch from on Part D drug plan to another, or drop your drug plan altogether
There are over 15 different Special Enrollment Period Situations. Here is a list of some of the most common SEP’s;
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You move (Having a permanent change in residence)
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Having, gaining, or losing Low Income Subsidy
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Having, gaining, or losing Medicaid
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Losing Employer Group Coverage
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If you want to enroll in a 5 Star rated Medicare Advantage Plan
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