Medicare Enrollment
When can I enroll in Medicare benefits?
There are quite a few enrollment periods during the year and it can be very confusing to figure out. Let’s make this a little easier to understand. Here is a quick list and description of the Medicare Enrollment Periods during the year.
- IEP – Initial Enroll Period
- AEP – Annual Enrollment Period
- MAOEP – Medicare Advantage Open Enrollment Period
- GEP – General Enrollment Period
- SEP – Special Enrollment Period
- Supplement (Medigap) – Open Enrollment Period
When you first become eligible for Medicare you have an Initial Enrollment Period (IEP). As you approach the age of 65, you approach the age of Medicare eligibility. Remember that you may also qualify for Medicare with certain disabilities, ESRD or ALS.
Automatic enrollment
If you receive benefits from Social Security, you’ll get Medicare Part A and Part B automatically and won’t need to sign up. Medicare will send you a “Welcome to Medicare” packet three months before you turn 65, with important deadlines and actions to take that will be listed in the packet.
(IEP) - Initial Enrollment Period
The Initial Enrollment Period (IEP) is a seven-month period.
It begins three months before your 65th birthday, includes the month of your 65th birthday, and extends three months after your birthday.
When you enroll during the first 3 months ‘before’ your 65th birth month, then your effective date is usually the 1st day of your birth month. There is an exception if your birthdate is the 1st of any month, then you can start a month earlier.
When you enroll during the 3 months ‘after’ your 65th birth month, coverage is delayed. So, it is best to sign up early as the processing time from Medicare and from the insurance carriers takes time. This same 7-month window is also used to enroll in a Medicare Advantage or Part D plan.
What If I have Employer Coverage?
Most people sign up for Part A and Part B during their IEP (Initial Enrollment Period). If you are still working past age 65, and you have employer coverage, you may defer getting Part B.
If this employer has 20 or more people on the plan, then they deem this credible insurance and you can defer getting Part B until your employer coverage ends. At that point, you will need to get Part B, or you may incur the Part B Penalty when you return to Medicare.
If your employer does not have 20 or more people on the plan and is deemed not credible insurance, then you would need to get Part B during your (IEP) Initial Enrollment Period or you may incur the Part B Penalty. Check out the Medicare Penalties here.
(AEP) - Annual Enrollment Period
The Annual Election Period (AEP) begins October 15th and ends December 7th of each year. Medicare beneficiaries that already have Part A and Part B can use this election period to enroll in, change, or disenroll from a Part D or Medicare Advantage plan. The effective date for a new plan is Jan 1st.
During this period you will more advertising than you can imagine. Medicare Booths in stores, Social Media ads, TV, Newspaper, Direct Mail, etc will be advertising daily about Medicare plan options. You should contact an ‘independent’ agent to help you make any changes. Sannes Insurance is available year round and our services to you are always free!
Most people will stay with their current plans. Some may have a change in their prescriptions, doctors, or benefit needs and will then want to change.
The Annual Enrollment Period is generally for Medicare Advantage and Prescription Drug Plan changes. Supplement Plans have their open enrollment during the first 6 months after starting Part B. Then you can change to a different supplement anytime during the year. However, you may have to answer health questions to qualify. This would be the same if you dropped a Medicare Advantage plan, went back to Original Medicare and then wanted a Supplement Plan.
(MAOEP) - Medicare Advantage Open Enrollment Period
This period is strictly for people on a Medicare Advantage plan already and want to make a change. You can change only once during this period and your choices are to go to another Medicare Advantage plan or back to Original Medicare and elect to add a Part D – Prescription Drug Plan.
The Medicare Open Enrollment Period, or MAOEP, runs from January 1 through March 31 each year with the effective date starting on the 1st of the next month.
Their are several reasons that they put this period in place. Some times people sign up for a Medicare Advantage plan not fully understanding the many deductibles, co-pays and co-insurance amounts in the policy. Perhaps they thought all of their doctors were contracted with the plan and found out one is not. This is a great time to make your one time change without having to wait until the Annual Enrollment period (Oct 15-Dec 7th) and next year effective date (Jan 1st) to change plans.
Here are your options during the Medicare Advantage Open Enrollment Period:
- MAPD to MAPD
- MAPD to Original Medicare and/or a Part D
- MA Only plan to MA Only plan
- MA Only plan to Original Medicare
Keep in mind, if you go back to Original Medicare now, you may not be able to buy a Medicare Supplement Insurance (Medigap) policy.
(GEP) - General Enrollment Period
Because you can only enroll in Medicare during select times, make sure you add enrolling in Medicare to your calendar, because waiting to sign up can lead to fines and gaps in coverage.
If you miss your Initial Enrollment Period, you can sign up for Original Medicare during the General Enrollment Period, or GEP. The General Enrollment Period runs from January 1 through March 31 each year with the effective starting date July 1st. Though you will be able to enroll in Original Medicare this time, you will still incur late enrollment penalties.
The General Enrollment Period only applies to Original Medicare. If you want to enroll in a Medicare Advantage Plan or Medicare Part D, you’ll have to wait for the Annual Enrollment Period, which is October 15 through December 7.
(SEP) - Special Enrollment Periods
What Qualifies for a Medicare Special Enrollment Period to Switch Plans?
People who already have Medicare may qualify for a 2-month Special Enrollment Period with certain qualifying life events anytime during the year. This Special Enrollment Period lets you switch to a different Medicare Advantage or Part D prescription drug plan.
You may qualify for a 2-month Medicare Special Enrollment Period in the following situations:
- You move out of your plan’s service area.
- Your plan closes, stops serving the area where you live, significantly reduces its provider network or your plan consistently receives low Medicare star ratings.
- You want to enroll in a 5-star plan at any time or drop your first Medicare Advantage plan within 12 months of enrolling.
- You move into or out of a qualified institutional facility, like a nursing home.
- You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
- You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help (LIS-Low Income Subsidy), or you gain or lose eligibility for any of these.
- You enroll in or leave the Program of All-Inclusive Care for Elderly (PACE).
- You gain or lose eligibility for a Special Needs Plan.
Some situations not listed here may qualify for a Special Enrollment Period as well. If you have questions about your personal situation, call us for help.
Supplement (Medigap) Open Enrollment Period
The best time to buy a Medigap policy is the 6-month period that starts the first day of the month you’re 65 or older and enrolled in Part B. You can ‘apply’ for a Supplement plan during the 6 months ‘before’ your Part B Effective Date Month and 6 Months ‘after’ your Part B Effective Date Month. This period allows you to sign up for Supplement plan without answering any health questions.
After the Supplement Enrollment period you can sign up for a Supplement anytime during the year, however you may be subject to underwriting and answering those health questions.
What is important to know, is that in most states this is your one time sign up for any supplement plan and not worry about pre existing issues and not having to answer any health questions.
There are always exceptions of course. In the state of Washington, once you are on a Supplement plan, you can move to any other Supplement Plan monthly with Guaranteed Issue Rights (no health questions). Some other states like Oregon and California have a ‘Birthday Rule’ where you can switch from certain Supplement Plans to other certain Supplement Plans within 30 days (Oregon) and 60 days (California) after your Birthday. These enrollment periods can get confusing, so it’s best to check with an Independent Agent like us to help you.
Supplement Open Enrollment Period While Still Under Employer Health Coverage
Many people miss their Medigap Open Enrollment window because they are still working. Some of these people may have enrolled in BOTH Part A and B at age 65 to coordinate with their group health insurance and reduce their medical spending. When they are ready to retire a few years later, their Medicare Supplement Open Enrollment window has long passed.
Fortunately, Medicare has a guaranteed issue law in place for these people. As long as they maintained creditable employer group health coverage, they will be given a 63-day guaranteed issue window. During their guaranteed issue period, they can enroll in certain Supplement plans with no health questions. They do not need to worry about pre-existing conditions.
