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Medicare Enrollment Periods

Are you having trouble understanding the Medicare enrollment periods that happen throughout the year and which apply to you? Instead, think of it this way. Deadlines can motivate you to focus more clearly and establish objectives while keeping projects on course and on schedule.

Each year, Medicare enrollment has several windows of time when people can enroll in Original Medicare or switch health/drug plans. Although each of these periods provide an opportunity to enroll, there are different qualifying factors, and the effective date of your coverage will depend on the rules of the enrollment period. So, understanding each enrollment period is essential if you are new to Medicare or wish to change your Medicare coverage. Healthpilot is here to help. Keep reading to learn about eligibility, when these Medicare enrollment windows occur, and when coverage starts.

When are you eligible to enroll in Original Medicare?

There are a few ways to find out if you are eligible for Medicare Part A and/or Medicare Part B coverage or if you have been signed up for it automatically.

If you are 65 and are getting Social Security or Railroad Retirement Board (RRB) benefits, then you are likely already enrolled in Medicare Parts A and B (unless you live in Puerto Rico, where you don’t get Part B automatically and need to sign up for it). If you’re not yet getting Social Security benefits, you’ll have to sign up for at least Original Medicare.

How do you sign up for Medicare?

You are covered by Medicare, but you must sign up for it through Social Security. This is because the Social Security Administration (SSA) decides who is eligible for Medicare. For example, the SSA decides if you’ve been paying Medicare taxes long enough to get Part A for free. (They also take care of requests to join Medicare Part B.)

At Social Security, you can do it online. It’s the quickest and easiest way to sign up and get help if you need it. You can also call 1-800-772-1213 to talk to Social Security if you’d rather. (TTY: 1-800-325-0778). Call the Railroad Retirement Board at 1-877-772-5772 if you or your spouse worked for a railroad.

It is also possible to qualify for Original Medicare before you are 65 if:

  • You have a qualifying medical condition
  • A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working

Now let’s get to the main event and why you are really here. Keep reading to learn about the different Medicare enrollment periods and how they can apply to you.

Medicare Enrollment Periods Explained

Here is a quick overview of some of the enrollment windows, enrollment dates, and your options.

Initial Enrollment Period

With your Initial Enrollment Period (IEP), everything begins. You can now sign up for a Medicare plan. From three months prior to becoming 65, through your birthday month, to three months after the month you turn 65, you have a seven-month opportunity to join during this time. During this period, you can:

  • Sign up for Medicare Parts A and B (Original Medicare)
  • Enroll in a Medicare Advantage plan (Part C)
  • Enroll in an independent Medicare prescription medication plan (Part D)

This part’s important: You may be subject to fines in the form of higher premiums if you choose not to enroll in Medicare Parts A, B, or D when you become initially eligible.

Initial Coverage Election Period for Medicare Advantage

So many acronyms…we know. But stick with us because they are all very necessary. The Initial Coverage Election Period (ICEP) doesn’t usually come up because IEP and ICEP typically happen at the same time for people, but we did want to mention it just in case ICEP was the whole reason you were spending your time reading about Medicare enrollment periods.

During the Initial Coverage Election Period you can enroll in a Medicare Advantage plan. The ICEP is usually the same as your IEP if you enroll in Medicare Part B when you are first eligible. However, if you delay your enrollment in Medicare Part B, your ICEP is the three months before your Part B coverage takes effect. This means that you will want to fill out your enrollment application within the three months before your Medicare Part B is effective. Your Medicare Advantage plan will be effective the same month your Medicare Part B is effective.

General Enrollment Period for Original Medicare

If you don’t enroll in Part A or Part B during your Medicare Initial Enrollment Period (IEP), you still have the opportunity to do so during Medicare’s General Enrollment Period (GEP). Every year, the GEP for Medicare is between January 1 and March 31. If you enroll in Medicare Part A or B during the GEP, your coverage will begin on July 1 of that year.

However, remember that you might be required to pay a monthly penalty if you didn’t sign up for the parts of Original Medicare during your IEP and you don’t qualify for a Special Enrollment Period (SEP).

Speaking of SEP…

Special Enrollment Period for Original Medicare

The good news: Outside the main enrollment windows, you can enroll in, change to, or leave a Medicare Advantage or prescription drug plan during a Medicare Special Enrollment Period (SEP).

The not-so-great news: Let’s just get this out of the way. Special enrollment periods may be even more challenging to navigate than regular enrollment periods. Not all Medicare recipients will ever be qualified for a Special Enrollment Period, and those who are, must provide evidence of their eligibility.

A Special Enrollment Period happens when Original Medicare enrollment is postponed after being initially eligible. The most common reason for postponing Original Medicare coverage is if you or your spouse are actively employed and have health insurance coverage through the employer. You can delay your enrollment in Medicare until you or your spouse retires. Upon retirement, you will be granted an SEP to enroll in Original Medicare. The Special Enrollment Period lasts for eight months after your employer group coverage expires.

Special Enrollment Periods for Medicare Advantage and Prescription Drug Plans

When certain life events occur, such as moving or losing other insurance coverage, you will be given a Special Enrollment Period (SEP) to enroll in a new Medicare Advantage or Medicare prescription drug plan. Each SEP has its own set of rules determining when and what kind of revisions are permitted.

Typical occurrences include:

  • You move and leave the coverage area of your plan
  • You enter or leave a long-term care facility, rehab hospital, skilled nursing facility, or mental facility
  • Your employment or the employer’s plan expires
  • You return to the United States after living overseas
  • Your plan changes its contract with Medicare

Annual Enrollment Period

The Annual Enrollment Period (AEP) occurs annually from October 15 to December 7. Also referred to as the Annual Election Period, this Medicare enrollment period is designed to allow people with Medicare to change their coverage. Common changes include:

  • Switching from Original Medicare to a Medicare Advantage plan
  • Joining or changing a Medicare Advantage plan
  • Joining or changing a Medicare Part D prescription drug plan
  • Joining or changing a Medicare Supplement Insurance (aka Medigap) plan

Changes made during the AEP period take effect on January 1 of the following year.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period (MAOEP) is every year from January 1 to March 31. During this time, anyone with a Medicare Advantage plan can make a one-time change to their coverage. This is extremely helpful if you were unable to modify your healthcare plans during the Annual Enrollment Period. Furthermore, if you are dissatisfied with your new Medicare Advantage plan coverage, this is the time to switch.

You can even return to Original Medicare during the Medicare Advantage Open Enrollment Period if you would like, but keep in mind that this enrollment period is only for people already on Medicare Advantage. You may not initially enroll in a Medicare Advantage plan during the MAOEP.

Let’s find your Medicare plan

Phew! You made it. Now you know all about Medicare Enrollment Periods, right? It’s not at all still a bit confusing…right?

Here at Healthpilot, we understand that interpreting all the different parts of Medicare can be complex, and adding these different timeframes and deadlines is downright stressful.

Want a better way? We can do the hard work for you. Simply answer a few questions, then we analyze all the information to recommend the best plan for you at the right time, always on time, because you can enroll with us too, in minutes, securely online.

Best of all, once you’re a Healthpilot customer, we do this for you every year for the rest of your life. No need to memorize enrollment periods when you have Healthpilot on your side.

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