Contrary to popular belief, managing your Medicare is not something that is complete the day you turn 65. While some people get Original Medicare (Part A & B) automatically, most people will have to take additional action to get the level of coverage that they actually need.
Whether you are adding a Medicare Supplement Plan or switching to the full-service convenience of a Medicare Advantage Plan, it is vital that you understand how the various enrollment periods work.
Remember: Medicare is quite strict when it comes to enrollment. Knowing the details of the different enrollment periods can help you get coverage faster and avoid penalties.
Turning 65: Medicare’s Initial Enrollment Period
Almost every individual in the U.S. will be eligible to enroll in Medicare near the time of their 65th birthday. This Initial Enrollment Period (IEP) is the first time that coverage becomes available.
It begins three months before the 65th birthday and lasts for a total of 7 months. There are a few exceptions to this requirement, including certain disabilities that occurred or developed before the age of 65.
During IEP, it is possible to sign up for:
- Medicare Parts A & B (Original Medicare)
- Medicare Part D (Stand-alone prescription coverage
- Medicare Part C (A Medicare Advantage Plan)
If you miss the initial enrollment period, your coverage will be delayed, and it is possible that you will incur penalties. After the IEP is expired, you will have to wait for the Annual Enrollment Period.
When to Sign Up for a Medicare Supplement Plan:
When it comes to Medicare supplement insurance (also known as Medigap) the timing of your enrollment can greatly affect both the cost and coverage options available to you.
The best time to enroll in a Medicare Supplement plan is during the Medicare Supplement Open Enrollment period. This period begins on the first day of the month you turn 65 and lasts for six months. In order to enroll in a supplement plan, you must first be enrolled in Medicare Part B.
If you skip the Medigap OEP, then it might be more difficult to find a supplement plan down the line. Premiums will likely be much higher, and pre-existing health conditions might limit your plan options.
When to Enroll in Medicare Part D & Medicare Advantage
Unlike a Medicare Supplement plan, a Medicare Advantage Plan is a “one-stop-shop” for health coverage. These plans are designed to combine the coverage of Original Medicare with Part D prescription coverage. Depending on the plan you enroll in, additional coverage benefits might include dental, vision, and hearing care.
Enrolling in Medicare Advantage must be done during one of several strict periods:
- The IEP that begins three months before your 65th birthday, extending for a total of 7 months.
- Medicare’s OEP lasting from October 15th to December 7th of each year
- A special enrollment period based off of qualifying personal circumstances (see below).
Changing Your Coverage During the Annual Enrollment Period
Persons who are over 65 and already enrolled in Medicare will need to use the Annual Enrollment Period (AEP). The AEP is the only time of the year that Medicare enrollees can switch plans. It takes place every year from October 15th to December 7th.
In addition, the AEP allows anyone enrolled in a Medicare Plan to:
- Switch to a Medicare Advantage plan
- Switch from a Medicare Advantage plan back to Original Medicare
- Add or remove a prescription drug coverage plan
- Switch Medicare plans and/or insurers
Remember: any changes that you make during the AEP will not go into effect until January 1st of the following year.
Q: What About Special Enrollment Periods?
There are a number of specific situations that might qualify an individual to sign up for or change Medicare coverage outside of the periods that we described above. This Special Enrollment Period (SEP) allows individuals to join, drop, or alter their Medicare Advantage or Medicare Supplement options.
“Qualifying Events” include:
- Moving outside of your plan’s service area
- Losing your employer-sponsored healthcare or prescription coverage
- You have a new opportunity to enroll in employer-sponsored coverage
- You have a severe or disabling condition and are in need of a Special needs Plan (SNP)
- Medicare terminates your plan’s contract
You can see a full list of qualifying circumstances at Medicare.Gov.
Learn More About Enrollment Periods
We get it: even starting at all of these dates and rules is enough to make one’s head spin. But understanding the basics of these enrollment periods puts you in a stronger position to take control of your healthcare.
If you are looking for more information about enrollment periods, or are simply curious about changing your coverage, give us a call. Your Personal Benefits Manager has the experience and insights to get your health coverage to where it needs to be.
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.