As you approach your 65th birthday, you’ll likely hear a lot of information about Medicare. While it’s tempting to dive into the type of plan you’ll want to sign up for, one of the very first things you should do is determine when you are eligible to enroll in Medicare.
Without taking the time to understand Medicare enrollment periods, you might miss your opportunity to enroll, leaving you with a gap in coverage and potentially raising your premiums with late enrollment penalties. Between the numerous periods you might hear about—annual enrollment, initial enrollment, and special enrollment—many seniors get confused on when they’re supposed to sign up and when it’s possible to switch plans.
If you’re new to Medicare, here’s what you should know about enrolling to ensure you’re covered.
Enrolling in Medicare for the first time
For the majority of Americans, Medicare benefits will be available to you when you turn 65 years old. Some younger individuals may be eligible for Medicare prior to 65 if they have a disability.
Enrolling in Medicare for the first time might differ depending on if you’ve already begun taking Social Security benefits or not. If you accept Social Security benefits before your 65th birthday, you will automatically be enrolled in Medicare Part A and Medicare Part B (Original Medicare). If you have not begun taking Social Security, you might need to enroll in Parts A and B yourself.
Either way, your Medicare benefits become available to you around this time in what’s called an Annual Enrollment Period. This seven-month period begins three months before your 65th birthday, includes the month of your 65th birthday and ends three months after your 65th birthday.
It is during this period that you are eligible to—and should—sign up for Original Medicare. If you decide that you want a Medicare Advantage plan (Part C), you may enroll in Part C during the AEP, also.
Your AEP is one of the most important enrollment periods for your Medicare coverage. It is expected that you enroll in Part A and Part B before the AEP ends. If you don’t enroll during this time period, you’ll need to wait until the Medicare General Enrollment Period or a Special Enrollment Period to sign up for benefits. Failing to enroll during your AEP may lead to gaps in coverage and/or late enrollment penalties.
What if you’re turning 65 but you’re still covered by your employer’s health plan? If your employer’s company has 20 or more employees, you are allowed to retain your group health plan as your primary form of coverage.
In this case, you are allowed to delay enrollment in Parts A and B. You may only want to delay enrollment for Medicare Part B to avoid paying the additional monthly premium, while still enrolling in free Part A, but you can delay both if you choose.
You are allowed to do this until you stop working for your employer or your creditable coverage ends—whichever comes first. When this happens, you will have eight months to enroll in Medicare Parts A and B without incurring penalties.
Prescription drug coverage enrollment
Your AEP is also the ideal time to purchase a Medicare Prescription Drug plan (Part D) if you need one. You can purchase Part D as a standalone plan, or you may get prescription drug coverage as part of a Medicare Advantage plan.
If you go 63 days or more without Medicare Part D, prescription drug coverage under Part C or creditable coverage from an employer, you may owe a lifetime late enrollment penalty on any future Part D plans.
Medicare Supplement Open Enrollment
If you’re new to Medicare and are interested in a Medicare Supplement (Medigap) plan, there is one more open enrollment period you should be aware of. The Medicare Supplement Open Enrollment Period is a six-month window that begins on the first day your Medicare Part B coverage is effective.
During this period, you are allowed to enroll in a Medigap plan under a few unique circumstances. You cannot be denied a Medigap plan based on pre-existing health conditions, nor can private insurance companies ask health questions to potentially raise your rates. Therefore, you can get the best premium rates and guaranteed coverage if you enroll at this time.
General Enrollment Period
If you didn’t sign up for Original Medicare when you were eligible, you have another option. You can enroll in Parts A and B only during the General Enrollment Period (GEP). This period runs between January 1 and March 31 every year.
If you enroll for Medicare Parts A and B for the first time during the GEP, your coverage will begin on July 1 of that year.
Making changes to your Medicare plan
After you’ve enrolled in Medicare in some form—whether Original Medicare with or without prescription drug coverage and Medigap or Medicare Part C—you are eligible to change your plan during certain times of the year.
Annual Enrollment Period
The Medicare Annual Enrollment Period runs October 15 to December 7 each year. This period allows seniors to choose how they want to receive Medicare benefits for the following year. During it, you can enroll in Medicare Parts C and D only.
During the AEP, you can make changes to your existing Original Medicare, Medicare Advantage and Medicare Prescription Drug plans. Your options include:
- Switch from Original Medicare to Medicare Advantage
- Switch from Medicare Advantage to Original Medicare
- Switch from one Medicare Advantage plan (with or without drug coverage) to another Medicare Advantage plan (with or without drug coverage)
- Join a Medicare Prescription Drug plan (Part D)
- Drop your existing Medicare Prescription Drug plan
- Switch to a different Medicare Prescription Drug plan
The changes you make during the AEP will go into effect on January 1 of the following year.
Medicare Advantage Open Enrollment Period
One final option for seniors enrolled in a Medicare Advantage plan comes during the Medicare Advantage Open Enrollment Period (OEP). This period runs January 1 to March 31.
During this period, you can switch to a different Medicare Advantage plan (with or without drug coverage) or you can drop your Medicare Advantage plan and return to Original Medicare. If you have Original Medicare, you cannot enroll in a new Medicare Advantage plan at this time.
The changes made during this period go into effect on the first of the following month.
Special Enrollment Periods
Finally, it’s important to note that outside of the AEP, GEP, IEP and OEP, you may be eligible to enroll or change your Medicare plan during special periods. Special Enrollment Periods (SEPs) are triggered by a life-changing event and are only allowed under certain circumstances.
As noted above, if you’re covered by your employer’s health plan but later leave that employer or lose that coverage, you are able to enroll in Medicare. You may also qualify to change your plan during a loss of coverage SEP due to a contract non-renewal, a loss of prescription drug coverage or a Medicare plan termination.
Other special circumstances that allow you to modify your plan during an SEP include a permanent change in location, a change in income or the onset of a chronic health condition. Each SEP has unique rules, so it’s important to speak with to your agent to learn when you are eligible to make changes to your plan.
Understand your enrollment options
We understand that Medicare enrollment periods can be confusing. The most important things for you to remember are to sign up for Medicare when you become eligible and to make any necessary plan changes during AEP.
If you want to learn more about when you’re eligible to enroll in Medicare or change your Medicare plan, SeniorCare Benefits is here to help. We represent a range of Medicare plans to meet your unique healthcare needs. Contact an agent at 1-844-484-4221 to discuss your eligibility and plan options today!
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