What Can I Do During Medicare General Enrollment?

Medicare is a key part of healthcare for people over 65. 

But understanding when and how to enroll can be tricky. It’s especially challenging if you miss your initial Medicare general enrollment period deadline. 

In this blog, we guide you through the steps of enrolling in Medicare if you missed the enrollment period deadline. Let’s get started!

Medicare General Enrollment Period

Medicare General Enrollment Period (GEP) takes place each year from January 1st through March 31st.  

If you missed your Initial Enrollment Period (IEP) for Medicare, you still have options.

NOTE: This section refers to those who have not enrolled in Medicare at all. If you have enrolled in Medicare, but you have not enrolled in Medigap, Medicare Advantage, or the Medi-Share 65+ health sharing plan, the Medicare General Enrollment Period does not apply to you.

However, you may want to consider enrolling in Medicare Advantage, applying for a late enrollment in a Medigap Plan, or the Medi-Share 65+ plan.

Learn More: How To Self-Enroll in the Medi-Share 65+ Health Sharing Plan

What to Do if You Missed Your Initial Enrollment Period

The initial enrollment period when you can sign up for Medicare is typically the seven-month window surrounding your 65th birthday (3 months before and 3 months after your birthday month).

If you missed your Medicare initial enrollment period entirely, for whatever reason, you have two options:

You can either maintain creditable coverage through an employer’s plan, or opt for late enrollment in both Medicare Part A and Part B during the Medicare General Enrollment Period.

This General Enrollment Period runs from January 1st through March 31st every year. That’s your opportunity to do a late enrollment in Original Medicare.

However, if you have not maintained creditable coverage (such as through a workplace plan), you could potentially face late enrollment penalties when you sign up for Part B, and also for Part D (prescription drug coverage), if you choose that coverage. 

LEARN MORE: Medicare Late Enrollment Penalties and How to Avoid Them

Still Working and Have Employer Coverage?

If you are still employed and covered by your employer’s plan, your spouse’s plan or another source, you may choose to delay enrolling in Medicare Part B. 

As long as you have creditable coverage from your employer or union plan, delaying Part B won’t penalize you.

When you eventually leave that coverage, you’ll retain guaranteed issue rights to enroll in Part B, as well as Medigap and Medicare Advantage plans, without facing penalties. However, you must complete your Original Medicare enrollment and select a Medigap or Medicare Advantage policy within the 60-day special enrollment period.

Failure to complete enrollment during this period may lead to late enrollment penalties, higher premiums, and possible denials from Medigap plans.

This streamlined approach ensures you understand your options and can make informed decisions about your Medicare coverage.

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Enrolling in Original Medicare

If you haven’t enrolled in Medicare yet, and you’ve dropped your prior health insurance coverage, the first order of business is to complete your enrollment in Original Medicare.

Remember, you only have 60 days from the time you dropped your prior coverage to enroll in Original Medicare before Part B and Part D late enrollment penalties start to accrue.

If you are past your initial enrollment eligibility window, the best course of action depends on whether you currently have credible health insurance in place from an employer, union, or some other source.

If you do not have current creditable coverage

You can enroll in Medicare Part A and/or Part B during the January 1st – March 31st General Enrollment Period if you missed doing so during your Initial Enrollment Period when you turned 65.

This is the best course of action if you are not currently covered under an existing health insurance plan, such as an employer group health insurance plan.

Tip: Coverage starts on the first day of the month following your enrollment. For instance, if you enroll on February 15, your coverage begins on March 1.

So if you’re leaving an employers’ plan, or dropping your existing coverage, you should coordinate the end date of your current plan with your Medicare start date. That way you won’t face a potential gap in coverage. 

*It’s important to note that late enrollment during the GEP might lead to late enrollment penalties, especially if you didn’t have creditable coverage prior to enrolling. This penalty is added to your Part B premium, and may be in effect for the rest of your life.

If you have current coverage in place

If you have current creditable coverage, you can delay enrolling in Part B without worrying about penalties.

This option is particularly beneficial if you have coverage through your employer or your spouse’s employer, and your employer’s health plan offers better coverage than Medicare Part B.

Key Points to Remember:

• When you lose your current coverage, you can enroll in Medicare Part B. If you maintained creditable coverage throughout, you qualify for a limited-time special enrollment period for Part B.
• Enrolling during this special period ensures you won’t face a late enrollment penalty.
• If you didn’t maintain creditable coverage, you’ll need to wait for the January 1st – March 31st General Enrollment Period. Late enrollment penalties for Part B would then apply.

In either case, once you do enroll in both Medicare Part A and Part B, then you’re able to enroll in one of three other valuable Medicare-related programs: 

• Medicare Supplement insurance (Medigap)
• Medicare Advantage (Part C)
• Medicare prescription drug insurance (Part D)
• Medi-Share 65+ (a health sharing plan).

Each of these Medicare-related options are important to consider. But you need to complete enrollment in Original Medicare first, before you can enroll in any of them.

If you don’t qualify for a special enrollment period, then it’s the Medicare General Enrollment Period that allows you to complete your Original Medicare enrollment. This, in turn, kicks open your enrollment options for these other plans.

Enroll in a Medicare Supplement (Medigap), Medicare Advantage Plan, or the Medi-Share 65+ Health Sharing Plan

After enrolling in both parts of Original Medicare, you can explore additional coverage options:

Medicare Supplement (Medigap), Medicare Advantage Plans, and Medi-Share 65+

These are separate Medicare-approved programs that offer various ways to supplement your Medicare coverage:

• Medicare Supplement (Medigap): Provides private insurance to help cover deductibles, co-insurance, and other out-of-pocket costs under Original Medicare.
• Medicare Advantage Plans: Offered by private insurers, these plans often include prescription drug coverage and may offer additional benefits like dental and vision. They may have network restrictions.
• Medi-Share 65+: A health-sharing plan specifically for Medicare beneficiaries, offering a non-insurance alternative to Medigap.

Each option has its own advantages and considerations, which we’ll explore in more detail below.

Medigap

“Medigap” is another name for Medicare Supplement insurance.

These are private insurance policies you can buy that help you pay for the many out-of-pocket costs that Medicare Parts A and B (Original Medicare) would still leave you with if you didn’t have that extra protection.

You can enroll in a Medigap plan at any time after you are enrolled in both parts of Original Medicare.

However, if you’ve missed your initial eligibility coverage, and you haven’t maintained creditable coverage via an employer or through some other means, you may have to undergo medical underwriting before approval.

That’s the process where the insurance company requires you to answer health questions and goes through your medical records. If you’ve had health problems, it’s possible that a Medigap company may charge you a higher premium, or turn you down altogether.

So the sooner you can complete your application, the better, before any health issues come up that could jeopardize your application.

If you do have some health issues, here are a few strategies that may help you get Medigap coverage at an affordable price:

• Choose lenient providers. Some insurance companies are more flexible in their underwriting and might be more likely to accept you. For help selecting a more flexible insurance company, make an appointment with a Medigap Advisors Personal Benefits Manager.
• Look for “Guaranteed Issue” Policies. Some states offer guaranteed issue rights, which mandate that Medigap policies cover you regardless of your health status. These rights are typically available during specific periods, such as when you’re leaving a Medicare Advantage plan or employer coverage.
• Try again at a later time. If you’re initially declined, you can try reapplying after some time has passed. This is especially helpful if your health situation improves. You can take measures like losing weight, quitting smoking, improving your blood sugar numbers or getting Type 2 diabetes under control, improving your blood pressure and cholesterol numbers to improve your chances of being accepted or reducing your premiums.

Medicare Advantage

Medicare Advantage plans, often referred to as Medicare Part C, offer an alternative to Original Medicare (Parts A and B). 

These plans are provided by private insurance companies approved by Medicare, offering all your Part A and Part B coverage. Here’s an expanded view of Medicare Advantage plans:

Medicare Advantage plans provide comprehensive coverage beyond what Original Medicare offers. They often include additional benefits like dental, vision, hearing, and prescription drug coverage. These plans may also offer services such as wellness programs and telehealth options, which can be convenient for managing healthcare needs from home.

One advantage of Medicare Advantage plans is their low premiums. Many plans have premiums as low as zero dollars per month, making them an affordable option for beneficiaries. Additionally, Medicare Advantage plans typically have out-of-pocket maximums, providing financial protection against high medical costs.

Enrollment in Medicare Advantage plans is restricted to specific periods:

• Initial Enrollment Period (IEP): When you first become eligible for Medicare.
• Annual Enrollment Period (AEP): Also known as Medicare Fall Open Enrollment, runs from October 15th through December 7th each year. During this time, you can switch Medicare Advantage plans or switch from Original Medicare to a Medicare Advantage plan.
• Special Enrollment Period (SEP): You may qualify for an SEP if you experience certain life events, such as moving to a new area that isn’t serviced by your current plan, losing other healthcare coverage, or qualifying for both Medicare and Medicaid.

Choosing a Medicare Advantage plan requires careful consideration of your healthcare needs and budget. Each plan varies in terms of coverage, costs, and network of providers. Comparing plans based on these factors can help you find one that meets your specific needs.

Downsides of Medicare Advantage

However, unlike Medigap plans and Medi-Share 65+ (discussed below), Medicare Advantage plans are managed care plans that restrict you to using a defined network of authorized care providers.

That is, while Medigap and Medi-Share 65+ let you choose your own doctor, Medicare Advantage plans keep you in network for non-emergency care.

Also, while the very low monthly premiums can look tempting, Medicare Advantage plans leave you exposed to much higher potential out-of-pocket costs than Medigap Plan G – the most popular Medigap plan currently available to new Medicare beneficiaries, or Medi-Share Advantage.

While Medigap Plan G limits your cost exposure to Medicare Part A and B-covered charges to your Part B annual deductible ($240 as of 2024), and Medi-Share 65+ limits your exposure to an annual household contribution of $500, your risk under Medicare Advantage plans in 2024 can be as high as $8,850 for approved services.

So while Medicare Advantage can save you money on the front end, you take on much more risk on the back end.

Medicare Advantage may be best for people in good health who don’t need to see the doctor very much, and for people who don’t mind staying in network.

*Both Medigap and Medicare Advantage plans offer additional coverage beyond Original Medicare, but they differ in terms of enrollment requirements, coverage options, and cost implications. It’s important to evaluate your healthcare needs and preferences when deciding between these two options.

Medi-Share 65+ (Health Sharing)

Medi-Share 65+ is a health sharing plan: A non-insurance alternative to Medigap specially designed for seniors aged 65 and older who already have Medicare Parts A & B.

It’s an excellent alternative to Medigap Plan G, which is the most comprehensive and popular of the Medigap plans currently available to new Medicare enrollees.

It acts as a supplemental option, helping to pay costs that Medicare doesn’t. This plan can provide additional coverage alongside an existing Medicare plan.

What does Medi-Share 65+ include? 

• 24/7 Telehealth Access. Get healthcare advice anytime without extra costs.
• Medicare Deductibles & Copays. Helps with costs that Medicare doesn’t fully cover.
• Office Visits and Nursing Facility Care. Provides additional support for regular health check-ups and nursing care.
• Hospitalization and Durable Medical Equipment. Offers financial assistance for hospital stays and medical equipment needs.

In addition to the above benefits, Medi-Share 65+ stands out with other unique features:

• Stable Pricing. Enjoy a fixed price for up to 10 years.
• Flexible Switching. You can switch to this plan anytime you would like to.
• Extended Sharing. It shares for the 20% of medical costs that Medicare Parts A & B do not, ensuring more comprehensive protection.

Medi-Share 65+ pays all out-of-pocket costs under Medicare Part A and B, with the exception of your Annual Household Portion (AHP) of $500 per year per household.

That is, once enrolled in Medi-Share 65+, your out-of-pocket exposure to hospital bills (Part A), doctor’s bills, durable medical equipment, medical services, and lab costs (Part B) are limited to $500 per year for your household. 

Cost Advantages of Medi-Share 65+

Medi-Share 65+ also costs much less each month than Medigap Plan G: Currently just $99 per month for those ages 65-74, and $150 per month for those ages 75 and older.

This compares very favorably with typical Medigap Plan G costs.

Currently, Medi-Share is offering a price lock-in guarantee until age 75. 

Where your Medigap plan may impose rate increases each year. Over time, the Medi-Share price lock in benefit may prove to be very valuable.

To get a price quote or comparison shop, make an appointment with a MediGap Advisors Personal Benefits Manager.

Pre-existing conditions

Medi-Share 65+ imposes a 6-month waiting period before it will share costs related to treating pre-existing conditions. However, this waiting period is waived.

Purchase Prescription Drug (Part D) Coverage

Enrolling in Medicare Part D during the GEP involves a few specific steps and considerations.

To be eligible for Medicare Part D, you must first be enrolled in either Medicare Part A, Part B, or both. Once you have enrolled in Original Medicare, you become eligible to sign up for a Medicare Part D plan, which provides prescription drug coverage.

Coverage Considerations: Most Medicare Advantage plans include prescription drug coverage, but not all. Medigap and Medi-Share 65+, however, do not cover prescription drugs. If you have Medigap or Medi-Share 65+, it’s essential to purchase a separate Medicare Part D policy to ensure prescription drug coverage.

Enrollment Timing: If you choose not to enroll in Medicare Part D during your Initial Enrollment Period (IEP), ensure you have creditable prescription drug coverage to avoid the Medicare Part D late enrollment penalty.

Creditable Coverage Verification: Verify with your plan administrator or the Social Security Administration that your current prescription drug coverage is creditable before delaying enrollment in Medicare Part D. Creditable coverage means your current prescription drug coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

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Here to Help You Navigate Medicare Enrollment

If you’ve missed your Medicare Initial Enrollment deadline, it’s crucial to prepare for the upcoming General Enrollment Period to avoid costly penalties. 

During this period:

• Enroll in Original Medicare (Parts A and B).
• Explore additional options like Medicare Supplement (Medigap), Medicare Advantage (Part C), Medi-Share 65+ health sharing plan, or Medicare prescription drug insurance (Part D).

Each option offers unique benefits and considerations:

• Medigap: Provides supplemental coverage but may require medical underwriting if you missed your initial eligibility period.
• Medicare Advantage: Offers comprehensive coverage with no medical underwriting, but enrollment is restricted to specific periods.
• Medi-Share 65+: Offers a cost-effective alternative with additional benefits like telehealth access and stable pricing.
• Medicare Part D: Essential for prescription drug coverage, especially if opting for Medigap or Medi-Share 65+, as they do not include drug coverage.

Choosing the right plan ensures your health needs are met and prevents late penalties. 

Since everyone’s health and finances are different, it’s smart to chat with a healthcare expert and a Personal Benefits Manager to make the most of your Medicare options. 

Schedule your appointment before the General Enrollment Period ends to lock in the best coverage for you. Consultations are free, and we’re here to make navigating Medicare easier for you!

For Further Reading:

• Medicare and Creditable Coverage: What You Need to Know