Understanding Medicare Enrollment Periods

Understanding Medicare Enrollment Periods

Aug 28 2019

Knowing when to enroll is important. Sign up when you first become eligible for Medicare to avoid penalties later on.

Turning 65 soon? If so, Medicare enrollment may be on your horizon. The overall process can seem confusing, so it’s important that you know the ins and outs of how to enroll, when to do it and what you may have to navigate.

The basics.
The enrollment timing is the same for Original Medicare, Medicare Advantage and Part D. Once you turn 65, you’re typically eligible for Medicare Part A (hospitalization) at no charge if you paid into the Medicare program through your taxes for at least 10 years. You’re also eligible for Part B (medical), if you’re a citizen or permanent resident of the United States.

The three months before your birthday, your birthday month and the three months after your 65th birthday are your initial enrollment period (IEP). During this time, you can sign up for Original Medicare (Parts A and B), a Medicare Advantage plan (Part C) and/or a prescription drug plan (Part D). If you have a disability, you may qualify even if you aren’t yet 65. Some additional points to consider are:

  • If you’re already receiving benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically be enrolled in Original Medicare (Parts A and B) on the first day of the month you turn 65. Watch for your red-white-and-blue Medicare card to come in the mail.
  • If you’re not already receiving Social Security or RRB benefits, you can enroll in Parts A and B by visiting ssa.gov or calling 1.800.772.1213 (TTY 1.800.325.0778). Enroll during the three months before your birthday to prevent any delays in Part B coverage.

Watch out for penalties.
The timing of enrollment is important to understand, especially in regards to Parts B and D. These plans can carry late enrollment penalties if you don’t apply while eligible, especially if you don’t meet certain conditions or have “creditable coverage,” which refers to coverage that’s as good as or better than Original Medicare.

Keep in mind that many Medicare Advantage plans include prescription coverage which meets your Part D requirement. You would pay these penalties for the duration that you are enrolled in Medicare Part B and Part D.

Medigap (Medicare Supplement) open enrollment period.
Your six-month Medigap (Medicare Supplement) open enrollment period begins from the moment you turn 65 and are enrolled in Part B. During this time you can add a Medigap plan to your Original Medicare and/or Part D plan. Applying at this time allows for a preferred rate of acceptance, ideal for anyone that may be hesitant about the enrollment process.

Annual election period for Medicare Advantage plans.
After you’ve signed up for Medicare for the first time, you can change plans during your annual election period (AEP) from October 15 – December 7. This is the ideal time to review your plan to make sure you have the coverage you need. Reading through things a second time is never a bad idea.

Special election period for Medicare Advantage plans.
In some situations, you’ll have a special election period (SEP), which gives you the opportunity to change your Medicare Advantage coverage outside of normal time constraints. These situations could include:

  • Moving outside of the area your plan covers
  • Loss of current coverage, such as an employer or union plan or Medicaid eligibility
  • Plan no longer meets the standards that the Centers for Medicare and Medicaid Services (CMS) requires, or doesn’t renew its contract

Outside of your open enrollment period for a Medigap plan, there are other situations where you might also have a “guaranteed issue right,” meaning insurance companies must sell you a Medigap plan, regardless of any pre-existing health conditions and can’t charge you more based on your health history. Some examples of guaranteed issue right include:

  • Your Medicare Advantage plan leaves your service area
  • You move from the service area of your Medicare Advantage plan
  • Your Medigap insurance company ends its coverage through no fault of your own

This whole process can definitely leave your head spinning, however knowledge is key when it comes to Medicare enrollment. We strongly encourage you to consult the official U.S. Medicare website for any further information you may need. You can also go to Priority Health’s Medicare Learning Center to access a plan advisor, cost calculator, a schedule of in-person Medicare Explained meetings and other helpful learning tools.

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