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.
Medicare General Enrollment Period
If this has happened to you, don’t worry! It’s still possible to get the Medicare coverage you need.
Medicare General Enrollment Period (GEP) takes place each year from January 1st through March 31st. If you missed your Initial Enrollment Period (IEP), you still have options.
First, you must be enrolled in Original Medicare.
Original Medicare is Medicare Part A (hospital insurance) and Part B (medical services coverage).
“I missed my initial Medicare general enrollment period. What do I do?”
If you missed your initial enrollment period (for most people, the seven-month period surrounding the month in which they turn age 65), you can either stay in an employer’s plan, if you have coverage, or do a late enrollment in both Part A and B during the Medicare General Enrollment period.
“I’m still working and have coverage through my employer. What do I do?”
If you have coverage in place from your employer or your spouse’s employer, or from some other plan, then you may choose to stay enrolled in that plan and delay enrolling in Part B.
As long as you maintain that creditable coverage from your employer or union plan or other plan, delaying Part B enrollment won’t count against you.
When you drop that coverage, you will still have guaranteed issue rights to enroll in Part B, Medigap, and Medicare Advantage plans, and will not have to pay a penalty—provided you complete your enrollment in Original Medicare and enroll in a Medigap or Medicare Advantage policy within your limited special enrollment period, which is typically 60 days.
If you fail to complete enrollment, you may face late enrollment penalties, higher premiums, and potential declines from Medigap plans.
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Enrolling in Original Medicare
The first order of business is to complete your enrollment in Original Medicare.
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 coverage, you can delay enrolling in Part B for a while, without having to worry about penalties.
This is a great option if you have coverage through your employer or through a spouse’s employer, and your employer’s health plan provides better coverage than Medicare Part B.
Once you lose that coverage, you can enroll in Part B. If you maintained creditable coverage the whole time, you would qualify for a limited-time special enrollment period to enroll in Part B.
As long as you enroll during the limited special enrollment period, you will not have to pay a late enrollment penalty.
If you did not maintain creditable coverage the whole time, then you will have to wait until the January 1st – March 31st General Enrollment Period.
What’s more, the Part B late enrollment penalty would 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
Medigap and Medicare Advantage are separate and distinct Medicare-approved programs that allow you to buy private insurance to help you cover deductibles, co-insurance, and other out-of-pocket costs under Medicare Original Medicare.
Medi-Share 65+ is a private health-sharing plan designed specifically for Medicare beneficiaries. It’s a non-insurance alternative to Medigap.
Once you have completed enrollment in both parts of Original Medicare, you can choose to enroll in one of these options.
Each of these options has advantages and disadvantages, discussed below.
“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. In some states, there are guaranteed issue policies for Medigap. These policies require companies to cover you regardless of your health status. However, this might only be available at specific times of the year.
- 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.
Another option is to enroll in a Medicare Advantage plan.
Medicare Advantage plans are always open to everyone, regardless of their health history. There’s no medical underwriting. But you can only enroll during specific time frames: Specifically, you can only enroll in Medicare Advantage if you qualify for a Special Enrollment period, or during the Medicare Fall Open Enrollment period, which runs from October 15th through December 7th.
Medicare Advantage plans have very low premiums. Many plans have a monthly premium of zero. And most plans also include a prescription drug component.
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 Coverage. It covers the 20% of medical costs that Medicare Parts A & B do not, ensuring more comprehensive health coverage.
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.
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.
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
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.
*Note: Most Medicare Advantage plans, but not all, include a prescription drug plan. Medigap and Medi-Share 65+, however, do not include prescription drug coverage.
If you have Medigap or you choose Medi-Share 65+, you should consider buying a separate Medicare Part D policy, which helps you pay for prescription drugs.
If you choose not to enroll in Medicare Part D during your IEP, it is crucial to have a creditable prescription drug coverage in place to avoid the Medicare Part D late enrollment penalty.
*Note: It’s important to verify with your plan administrator or the Social Security Administration that your current coverage is creditable before delaying Part D enrollment.
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If you’ve missed your Medicare Initial Enrollment deadline, it’s important to be prepared for the upcoming General Enrollment Period so you don’t get hit with costly penalties.
During the GEP, you can enroll in Original Medicare (Parts A and B).
Once you’re enrolled in Original Medicare, you can explore additional options like Medicare Supplement (Medigap), Medicare Advantage (Part C), the Medi-Share 65+ health sharing plan, or Medicare prescription drug insurance (Part D).
Each of these provide distinct benefits and considerations:
- Medigap offers supplemental coverage, but may require medical underwriting if you missed the initial eligibility period.
- Medicare Advantage provides comprehensive coverage with no medical underwriting, but has specific enrollment periods.
- Medi-Share 65+ is a cost-effective alternative to traditional Medigap plans, providing additional coverage with unique benefits like telehealth access and stable pricing.
- Securing a Medicare Part D plan is critical for prescription drug coverage, especially if you opt for Medigap or Medi-Share 65+, as these do not include drug coverage.
Choosing the right services will help make sure that your health needs are fully covered, and will help you avoid late penalties!
Every individual’s health and financial situation is unique, so it’s wise to seek personalized advice.
Consulting with healthcare experts and a Personal Benefits Manager will help you make the most of the Medicare General Enrollment Period.
Make your appointment today, before the General Enrollment Period expires and you lose some important options.
Consultations are free – and we make things much easier!
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)
Tom Lockwood is a Personal Benefits Manager at MediGap Advisors. Tom has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Tom on his Bio page.