Medicare Enrollment Periods are specific windows of time that allow you to enroll in Medicare or a Medicare Plan. If you miss the window, depending on the enrollment period, you may not be able to enroll until the next window and in some cases may be subject to late enrollment penalties for missing the window.
Here’s a look at the different enrolment periods that you should be aware of to enroll in the program at the appropriate time.
Medicare Part A and B: INITIAL ENROLLMENT PERIOD (IEP)
The first time to enroll in Medicare Parts A and B is during your Initial Enrollment Period (IEP). This is the most important date for you to remember when you are approaching age 65.
During this time you can enroll in Original Medicare Parts A and B as well as Medicare Advantage (Part C) and prescription drug coverage (Part D) and enrolling during your IEP avoids any late enrollment penalties.
It is a seven-month period that begins three months before your 65th birthday, the month of your birthday, and three months after your birthday month.
If your birthday falls on the 1st of a month your IEP will start one month earlier.
Medicare General Enrollment Period (GEP)
If you miss your IEP for Parts A and/or B, and don’t have other creditable coverage like employer or union coverage, you will likely have a late enrollment penalty, for as long as you have Medicare coverage and you may have to go without coverage until the General Enrollment Period (GEP). During this period, beneficiaries can only enroll in Original Medicare, and they may not be able to enroll in Medicare Advantage or Part D coverage until the next Annual Enrollment Period (AEP).
You can enroll during the General Enrollment Period (GEP), which runs from January 1 to March 31 each year and your coverage won’t start until the 1st of the month after you apply.
You may pay a penalty for not having coverage from your IEP which is 10% of the standard premium for every 12-month period you should have had Part B but didn’t enroll.
There is also a permanent Part D penalty of 1% of the national base premium per consecutive month that you went without prescription drug coverage.
Medicare Annual Election Period (AEP):
The Medicare Annual Election Period (AEP) is a specific time of year when Medicare beneficiaries can make changes to their Medicare Advantage and Part D coverage.
During this period, beneficiaries can make changes to their Medicare Advantage (Part C) and prescription drug (Part D) coverage. This includes switching from Original Medicare to Medicare Advantage, switching from one Medicare Advantage plan to another, changing from one Part D plan to another, or dropping or adding drug coverage.
Medicare supplement (Medigap) plans do not need to change during the AEP which only applies to Part C Advantage plans and Part D drug plans.
It's important to review your coverage and make any necessary changes during the AEP to ensure that you have the best coverage for your needs for the following year. Once this election period ends, you will be unable to change until the next AEP.
The AEP takes place from October 15 to December 7 each year and plan changes become effective on January 1st of the following year.
Medicare Advantage Open Enrollment Period (MA-OEP):
The Medicare Advantage Open Enrollment Period (OEP) offers another opportunity from January 1 to March 31 each year for Medicare beneficiaries who are enrolled in a Medicare Advantage plan to make changes to their coverage.
During the OEP, beneficiaries can switch from one Medicare Advantage plan to another, or they can switch from a Medicare Advantage plan back to Original Medicare with or without a Part D plan. It does not allow a change from one Part D to another.
It's important to note that the OEP is not the same as the Annual Election Period (AEP), which takes place from October 15 to December 7 each year. The OEP is a one-time opportunity for beneficiaries who have already enrolled in a Medicare Advantage plan to make changes to their coverage. The change will take effect on the first of the month following your change.
Medicare Supplement (Medigap) Open Enrollment Period:
The Medicare Supplement Open Enrollment Period is a one-time window of 6 months that begins the month you enroll in Medicare Part B. For most people, this is at age 65, but if you qualify for Medicare early due to disability you will get a second 6-month window when you turn 65.
During this period, you have the right to enroll in any Medicare Supplement (Medigap) plan available in your state, regardless of your health status. This means that insurance companies cannot deny you coverage or charge you higher premiums based on pre-existing conditions.
It's important to note that if you miss your Medicare Supplement Open Enrollment Period, you may still be able to enroll in or switch your plan at any time of year, but insurance companies are allowed to underwrite (medically qualify you) for their plan and accept or deny coverage based on your health status. This could result in higher premiums or the inability to obtain a Medigap plan.
Special Enrollment Periods (SEP) for both Medicare and Marketplace plans:
Here are the most common Medicare SEPs but there are more than a dozen SEPs depending on individual circumstances, and many are unique to Medicare Advantage or Part D plans.
Leaving Employer or Union Coverage: The Special Enrollment Period (SEP) for leaving employer or union coverage applies to individuals who delayed enrolling in Medicare because they had health coverage through an employer or union (either their own or a spouse’s).
You have 8 months from when employment or coverage ends (whichever comes first) for Medicare Supplement to sign up for Medicare Part A and/or part B without a late penalty.
If you need prescription drug coverage, you have only 2 months after employer coverage ends to enroll in a Medicare Part D plan.
Moving to a New Location: This Sep is for if you move outside your current plan’s service area, move back to the U.S. after living abroad, or move into or out of a skilled nursing facility.
You have 2 months after the move (or from notification of the move).
Losing Medicaid Eligibility: People who lose Medicaid eligibility and need to enroll in Medicare or switch plans.
You have 6 months from when Medicaid ends.
Enrolling in or Leaving a Medicare Advantage or Part D Plan Due to Other Coverage Changes: If you lose creditable drug coverage, enter a skilled nursing facility, or become eligible for other forms of coverage like VA benefits you will have a SEP to change your Medicare coverage to something more appropriate to your situation.
You have 2 months after the event.
Extra Help or Low-Income Subsidy (LIS) Status Changes: If you gain, lose, or have changes in eligibility for Medicare’s Extra Help program you will gain a SEP to change your Medicare coverage to something more appropriate to your situation.
It varies, but often 2-3 months from notification.
Natural Disasters or Emergency Declarations: If a FEMA-declared emergency prevents you from enrolling during another eligible period a new SEP is opened to people who were unable to enroll due to the disaster.
It depends on the emergency and federal guidance.
If you have any additional questions, contact our team today!
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