MEDICARE ENROLLMENT PERIODS & ACRONYMS
Initial Enrollment Period for those “Turning 65”
Most people will sign up for Medicare during this period and it lasts for 7 months. It begins 3 months before the month in which you turn 65, the month of your birthday, and ends 3 months after. Here’s an example: if your birthday is in April, your IEP begins Jan 01 and ends July 31). Your Medicare A&B effective date would typically be Apr 1, if your birthday doesn’t fall on the first day of the month. If your birthday does fall on the first day of the month (let’s say Apr 1), then in this scenario, your Medicare would be effective Mar 1.
You would use the IEP – Initial Enrollment Period to enroll in Medicare Part A (hospital insurance) even if you do not intend to enroll in Part B. (An exception may be if you are still working and have employer health coverage that has a high-deductible plan with an HSA account).
Use this period to enroll in Part B (doctor or outpatient services & medical equipment) if:
You do not have health insurance.
You have individual health insurance that you’ve purchased yourself.
You still have health benefits from a former employer (or benefits from the former employer of your spouse) but have retired or stopped working or plan to stop soon.
You do not qualify for Part A and have no other health insurance.
You are covered by COBRA that extended employer health benefits after you (or your spouse) stopped working. You also should be aware that COBRA is not considered “creditable” coverage if delaying Part B after 65.
You have group health insurance from an employer with less than 20 workers, or your health plan (such as TriCare for military personnel) requires you to enroll in Part B upon turning 65.
You are living (but not working) outside the United States.
IMPORTANT TO NOTE:
For those of you already receiving Social Security benefits when turning 65, Social Security will automatically enroll you in Medicare parts A & B. You have the right to decline Part B if you or your spouse are still working for an employer that provides your health insurance. If you’ve decided to delay your Social Security until FRA (Full Retirement Age), then you will have to contact Social Security (800-772-1213) to enroll yourself in Medicare.
If you delay signing up for Part B beyond your IEP, you could face a late penalty when you eventually do sign up and most likely you will not be able to sign up until the general (open) enrollment period (GEP) at the beginning of each year (Jan – Mar) and coverage will not begin until July 1.
In some situations, if you continue to work beyond age 65 and have group health insurance from an employer for whom you or your spouse are still working, you may be able to delay signing up for Part B without penalty. See "Special Enrollment Period for Part B" below.
You can also enroll in a stand-alone prescription drug plan (Part D) during the IEP. If you already have drug coverage from elsewhere, such as a former or current employer, COBRA or the Veterans Affairs health program, you may not need to sign up at this time. But remember, if you don’t sign up for Part D when you first become eligible, you could receive a late penalty. See "Special enrollment period for Part D" below.
Initial enrollment period for Medicare through disability
If you’re under 65 and become eligible for Medicare because of a disability, you will receive a letter from Social Security indicating when your Medicare coverage will begin. It usually starts 24 months after your disability benefits were approved. Social Security will automatically enroll you in Medicare parts A & B. If you wish to opt out of Part B, you can do so if you or your spouse are still working for an employer that provides health coverage and has over 100 workers.
IMPORTANT TO NOTE: When you turn 65…Congratulations…you'll be entitled to a second 7-month IEP, this time it will be based on age instead of disability. You get to start over, so if for any reason you previously had to pay a Part B late penalty, you would not have to pay it any longer.
Annual (open) Enrollment Period: Oct 15 – Dec 7
Each year, open enrollment gives you the opportunity to review your existing Medicare coverage and change to a different plan for the following year if you so choose. You can:
Switch from one Medicare Advantage plan to another (know all your options first).
Switch from one "stand-alone" Part D drug plan to another.
Change from traditional Medicare (A&B) to a Medicare Advantage plan.
Change from a Medicare Advantage plan to traditional Medicare.
Enroll in a stand-alone Part D drug plan for the first time if you voluntarily opted out of other drug coverage, such as coverage provided by a current or former employer.
Enroll in a stand-alone Part D drug plan if you change from a Medicare Advantage plan to traditional Medicare.
In all cases, your new coverage begins Jan. 1. If you're switching drug plans or Medicare Advantage plans, you do not need to actively "disenroll" from the one you are leaving because enrolling in a new plan will automatically cancel your old coverage. Also, if you're in a Medicare Advantage plan but enroll in a stand-alone drug plan during open enrollment, this automatically cancels the old plan and also switches you to traditional Medicare (A&B).
IMPORTANT TO NOTE: this open enrollment period does not apply to Medicare Supplement insurance (Medigap). You must carefully consider changing from a Medigap plan to a Medicare Advantage Plan as you may not be able to go back to a Medigap plan as you would have to be underwritten (in most cases) and qualify based on your health.
Open Enrollment Period for Medicare Advantage: Jan 1 – Mar 31
This period is specifically for people enrolled in a Medicare Advantage Plan who may want to change to traditional Medicare (and you should consider enrolling in a Medigap plan – if you qualify). It doesn't matter how long you've been in the Medicare Advantage plan. Even if you've just recently signed up during the annual open enrollment period (AEP) and your coverage just began on Jan. 1, you can still use this period to change your mind and switch to traditional Medicare and then enroll in a stand-alone Part D prescription drug plan as well. You also have the option to switch to another Medicare Advantage plan during this time if you so choose. In both cases, your new coverage begins the first day of the month after you make the change.
Special Enrollment Period for Part B
This SEP allows you to enroll in Part B without penalty beyond age 65 provided that you can show you have had group health insurance from an employer (or employers) for whom you or your spouse were still working since you turned 65. The SEP runs for 8 months from the date you (or your spouse) stopped working. But you can enroll before this date to ensure continuity of health coverage. Your Part B coverage begins on the first of the month after you enroll.
If you work outside the United States when you turn 65 or later, you’re entitled to the same SEP when you return to this country if you (or your spouse):
received health coverage from an approved organization (EG: Peace Corps) while working abroad as a volunteer.
had American-style group health insurance from an employer for whom you were working when abroad;
You would not be entitled to this SEP (and must enroll in Part B during your initial enrollment period to avoid a late penalty) in some situations — for example, if you work beyond age 65 for an employer that has fewer than 20 employees; or if you are covered beyond 65 by the employer insurance of a domestic partner to whom you are not married.
Special enrollment period for Part D
Part D drug coverage has different rules than Part B. You can delay enrolling in Part D beyond age 65 if you continue to have "creditable" drug coverage — meaning that Medicare considers it of at least equal value to Part D. When this coverage ends, you will be entitled to this SEP and can sign up immediately and without penalty in the following circumstances:
When drug benefits from your current employer (or from your spouse's employer) terminate on retirement or through no fault of your own.
When you lose drug benefits from a retiree health plan through no fault of your own.
When COBRA coverage terminates.
When you return from abroad to live permanently in the United States.
When you are released from prison.
In all these cases, the special enrollment period lasts for 63 days beyond the key or critical date — such as the end of drug coverage, your return to the USA or your release from prison. But your actual coverage in a Part D drug plan must have begun on or before the 63rd day to avoid a late penalty. Since coverage cannot begin until the first day of the month after enrollment, it's important to sign up no later than the end of the second calendar month after the critical date.
If you let this SEP expire before enrolling in a Part D drug plan, you must wait until the next annual enrollment period (AEP) and you will receive a late penalty which is added permanently to your plan's premiums.
General Enrollment Period for Medicare: Jan 1 through Mar 31
This period is specifically for those unfortunate people who missed signing up for Medicare Part B at the required time — either during their initial enrollment period or during a special enrollment period for Part B. When you sign up for Part B during this period, be aware that your coverage will not begin until July 1 and you may be required to pay a late penalty based on how many years you have delayed.
There are several other SEPs available in specific circumstances:
If you joined a Medicare Advantage plan during your initial enrollment period when you turned 65, your first year in the plan counts as a “Trial Right Period”. You can change to traditional Medicare at any time within these first 12 months. You also have a guaranteed right (no underwriting questions have to be answered) to buy a Medicare Supplement plan within 63 days of your plan coverage ending.
If you gave up a Medicare Supplement policy to join a Medicare Advantage plan and this is your first year ever in such a plan, the first 12 months also counts as a “Trial Right Period”. Within that timeframe you can switch back to traditional Medicare and get your Medicare Supplement policy back.
If you are receiving Extra Help (Low Income Subsidy - LIS) to pay for your prescription drugs, you can change your drug plan at any time. Coverage in the new plan begins the month after you enroll in it.
If you live in a nursing home, you can change your drug plan the month you move into the home and any month while you're living there. You also get a two-month SEP to switch to another plan after you move out.
If you have access to a Medicare Advantage or Part D drug plan that has earned Medicare’s top-quality rating of 5 stars, you can make a one-time switch to that plan at any time of the year. However, you should consider doing this after the OEP.
If you move out of your plan's service area, you have the right to change to a new plan in your new area. Note: if you're in a prescription drug plan that serves an entire state and you only move within that state, your coverage will continue, and you won't be entitled to an SEP.
If your plan withdraws from your service area, leaves Medicare or is terminated, you will receive a letter explaining how long your coverage will last and when you can switch to a different plan of your choice.
If you were misled or felt tricked into joining a Medicare Advantage plan, you can ask Medicare to investigate and grant you a SEP to change to another plan.
Now that these enrollment periods are “CLEAR AS MUD”, it’s time (or it will soon be time) for you to make a decision. I have always advocated to never take the road alone. The best thing to do is to make the “right” choice. The second best thing to do is make the “wrong” choice, and the worst thing to do is to do “nothing”. Trust me, you want to get your Medicare right the first time and choose the best plan that is suited for your specific needs.
Seek out and find an independent insurance broker or agency that specializes in Medicare planning who can be your guide and provide education and unbiased information to help you make an informed decision. In many cases, “The choice you make today can last a lifetime so it’s important to get it right the first time”!
How do you find an agent? That’s a great question and a very important one. Finding the right agent is just as important as choosing the right Medicare plan. In my humble opinion, you should consider working with a professional agent who is engaged and active in a professional organization related to the industry/trade.
An example of that would be the National Association of Health Underwriters (NAHU) which is a US non-profit professional association formed in 1930 and involved in agent (and consumer) advocacy, representation, public relations and professional development. You can go to their website and “FIND AN AGENT” who is local in your area. There are over 20,000 members throughout the country to search. I recommend that you try to find one who has earned the NAHU MEDICARE CERTIFICATION (you can check this box in your search). Just insert your zip code and radius of miles and you will find an agent or some potential agents to work with.