Medicare Special Enrollment
This is the limited window of time during the year when Medicare opens its doors to those who missed their initial Medicare enrollment period, and allows them to enroll in Medicare Parts A and B (Original Medicare).
GEP runs from January 1 to March 31, 2024, with coverage starting the month after you sign up.
Signing up during the GEP is vital for those who missed enrolling at 65, or when they left the workforce and their employer-sponsored group plans.
Missing the GEP window could result in late enrollment penalties. What’s more, these penalties increase the longer you delay enrollment?.
Medicare Basics
First, let’s review the basic parts of Medicare
Medicare provides a safety net for healthcare costs.
- Part A covers hospital charges.
- Part B covers doctor’s fees, lab fees, and durable medical equipment.
- Part C (Medicare Advantage) offers additional benefits.
- Part D covers prescription drugs.
You can only sign up for Medicare at certain times, and this can be a little confusing for some people.
Get a Free Medicare Supplement Quote
Late Enrollment Penalties
Part A: If you don’t enroll in Part A, you might face a penalty of an additional 10% of your premium for a few years, depending on how long it takes you to sign up??.
Part B: The penalty for not signing up for Part B includes an additional 10% for each year you could have signed up but didn’t. This penalty is added to your monthly Part B premium and continues for as long as you have Part B. (There are exceptions if you or your spouse are still working and have health coverage through your job??.)
Part D: If you don’t join a Medicare drug plan upon first getting Medicare and go 63 days or more without creditable drug coverage, the penalty adds an extra 1% for each month you didn’t sign up to your monthly premium. This penalty also continues as long as you have Part D coverage. (Exceptions include having creditable drug coverage or qualifying for Extra Help.)
Why You Need Medicare
Healthcare needs after age 65 can be very expensive.
The average retired couple turning 65 in 2024 could spend around $315,000 on healthcare and insurance premiums over their lifetime. Medicare alone isn’t always enough to cover your needs, so you may want to add supplemental coverage during GEP as well.
The following are some options to consider:
1. Medicare Supplement (Medigap) Insurance
Medigap policies from private insurance companies can help cover gaps in Medicare, offering more predictable costs and no care network restrictions.
Plans vary in coverage and cost, but popular options include Plan G, which covers almost all Medicare costs except the Part B deductible ($240 as of 2024), and Plan N, similar to Plan G but excludes excess charges and requires copays for doctor visits.
2. Medicare Advantage (Part C)
These plans combine Medicare Parts A and B benefits and often include prescription drug coverage.
They may offer additional benefits like dental, vision, and wellness programs but often have network restrictions and variable costs based on location.
While the low premiums can be attractive, it’s important to note that these plans have much higher out-of-pocket limits compared to Medigap plans and Medi-Share 65+.
3. Part D Prescription Drug Plan:
Essential for covering medication costs, Part D plans vary in drug options, deductibles, and premiums.
Be aware of the coverage gap (“donut hole”) where coverage decreases after a certain amount. For 2024, you will enter the gap once you have spent $5,030 on covered drugs. (This limit changes every year.)
Note: Lower-income individuals should see if they qualify for the “Extra Help” program. Those in this program won’t enter the donut hole.
4. Medi-Share 65+:
A health-sharing plan covering Medicare deductibles, co-pays, and coinsurance.
Members pay an Annual Household Portion (AHP) of $500, after which the plan covers additional out-of-pocket charges. It’s an alternative to traditional insurance, often with lower monthly premiums.
Read More: MediShare 65+ Health Sharing Plan vs. Medigap Plan G
Choosing the Right Plan During Medicare Special Enrollment
When deciding between Medigap and Medicare Advantage, consider the following:
- Medigap Plans. These plans require a monthly premium, but provide extensive coverage flexibility.
They cover costs not paid by traditional Medicare, like deductibles and coinsurance. These plans are particularly beneficial for those who travel frequently, as they offer coverage outside the U.S.There are no network restrictions, meaning you can see any doctor that accepts Medicare. - Medicare Advantage Plans. These plans replace your direct access to original Medicare (Part A and B) with a private managed care organization.Medicare Advantage plans are usually very affordable. They often have zero-premium options, but come with more restrictions.For example, they will limit you to a network of doctors and facilities. These networks can be quite narrow, in some cases, especially with lower-cost and zero-premium plans. Your maximum out-of-pocket exposure will be higher with a Medicare Advantage plan, potentially several thousand dollars.
Medicare Advantage plans usually include additional benefits like prescription drug coverage, dental, and vision care, and they cap your annual out-of-pocket expenses. However, plan availability and costs can vary widely based on location.
Your choice should align with your healthcare needs, budget, and lifestyle.
If you value flexibility and wide coverage, Medigap might be the better choice. However, if you prefer an all-inclusive plan with added benefits and potentially lower monthly costs (but higher potential costs if you have large medical bills), Medicare Advantage could be more suitable.
Medicare Special Enrollment Considerations
Enrollment in Medicare Advantage is generally limited to specific periods, including the IEP, special enrollment periods, and the GEP.
Medigap premiums vary based on individual factors, and not all plans are available everywhere. It’s important to consider your current coverage, like a workplace plan or TRICARE, before enrolling in Medigap or Medicare Advantage.
Get a Free Medicare Advantage Quote
Don’t Miss Out on Medicare Special Enrollment!
Navigating Medicare and its supplements can be confusing and complex.
But if you delay you could miss the next GEP and end up paying additional penalty costs!
Understanding the different parts of Medicare, additional coverage options, and enrollment periods is the key to making informed decisions.
Your health and financial security in retirement are paramount!
Selecting the right coverage can give you peace of mind. For more information and assistance enrolling in the best plan tailored to your needs, reach out to a Personal Benefits Manager.
Consultations are free. And our professional, experienced expert PBMs can save you hours of research and hassle.
Make your appointment before your General Enrollment Period window expires!
Further Reading: Medicare Supplement and Medicare Advantage Plans: Which Are Better? | The Less Expensive Medicare Supplement Alternative: Medi-Share 65+ | What Kind of Medicare Plan Is Best for Me? (Quiz)
Christine Corsini is one of your Personal Benefits Managers at MediGap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.