Medicare Enrollment and Election Periods
Have you ever wanted to make changes to your Medicare coverage or switch plans — only to realize you couldn’t because you were outside of the Fall Open Enrollment? As you may know, Medicare comes in many “parts,” and each type of coverage has specific rules when it comes to when you can sign up or make changes.
If you’re enrolled in a Medicare plan, generally you can only enroll, switch plans, or disenroll from a plan during certain times of the year, and if you happen to miss the time window when you can make changes, you may have to wait an entire year in some cases. (Note that in qualifying situations, you may be eligible to make changes outside of the Annual Election Period also known as the Fall Open Enrollment.)
Don’t get caught unprepared again: Here’s a handy overview of the different election periods for each type of Medicare coverage, so you never miss your yearly opportunity to make changes to your current coverage if it isn’t meeting your needs.
Enrollment periods for Medicare Part A and Part B
Initial Enrollment Period for Original Medicare (Part A and Part B)
When you first sign up for Medicare, you’re enrolling in Original Medicare (Part A and Part B), the federally administered health-care program.
Most people qualify for Medicare because of age. If this is you, your first chance to sign up for Medicare is usually your Initial Enrollment Period, which starts three months before your 65th birthday, includes the month of your 65th birthday, and ends three months later. Most people don’t need to sign up; you’re automatically enrolled in Medicare if you’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65. However, if you do need to manually enroll, you can do so during your Initial Enrollment Period.
Some individuals may qualify for Medicare before 65 if they’ve been receiving Social Security or Railroad Retirement Board disability benefits for two years; they’ll be automatically enrolled in Medicare Part A and Part B in the 25th month of disability benefits. You may also be eligible for Medicare at any age if you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or end-stage renal disease.
General Enrollment Period for Original Medicare
Missed your Initial Enrollment Period? Your next chance to enroll in Medicare is during the General Enrollment Period, which occurs from January 1 to March 31 each year. Keep in mind that you may have to pay a late-enrollment penalty for Part B if you didn’t sign up for Medicare when you were first eligible. If you aren’t eligible for premium-free Part A, you may owe a late-enrollment penalty for Part A as well; you usually get Part A without a premium if you’ve worked at least 10 years (40 quarters) and paid Medicare taxes.
Special Enrollment Period for Original Medicare
In some situations, you can delay Medicare enrollment and sign up for Medicare through a Special Enrollment Period. For example, you or your spouse may still be working when you’re first eligible for Medicare and may have group health coverage through an employer. Since Medicare Part B comes with a monthly premium (and Part A, if you haven’t worked long enough to get it at no cost), you may want to wait to sign up for Medicare so you aren’t paying an additional premium for coverage you don’t need. When your employer-sponsored coverage ends or you stop working (whichever happens first), you’ll get an eight-month Special Enrollment Period to enroll in Medicare. You generally won’t pay a late-enrollment penalty if you sign up during this time.
Enrollment Periods for Original Medicare
|Enrollment period||When it happens||What you can do|
|Initial Enrollment Period (IEP)||
||Enroll in Medicare Part A and/or Part B.|
|General Enrollment Period (GEP)||January 1 to March 31||Enroll in Medicare Part A and/or Part B.|
|Special Enrollment Period (SEP)||The timing of your SEP may vary, depending on your qualifying situation; however, once you are eligible for the SEP, it will last for eight months.||Enroll in Medicare Part A and/or Part B.|
Election periods for Medicare plans
Once you’re enrolled in Original Medicare (Part A and Part B), you may have other types of Medicare coverage available to you as well, including Medicare plans that are available through Medicare-approved private insurance companies. Some of your coverage options may include Medicare Prescription Drug Plans (Part D), which provide stand-alone prescription drug benefits that work with your Original Medicare coverage. You may also be interested in Medicare Advantage plans, which are an alternative to Original Medicare and provide at least the same level of coverage as Part A and Part B. Also known as Medicare Part C, these plans offer additional benefits like routine vision or dental, prescription drugs, or health wellness programs.
Both of these types of Medicare coverage come with different rules for when you can sign up and make changes. Let’s take a look at each of them.
Initial Enrollment Period for Part D
If you have Medicare and want prescription drug coverage (Medicare Part D), you can either enroll in a stand-alone Medicare Prescription Drug Plan that works alongside your Original Medicare coverage, or you can enroll in a Medicare Advantage plan that covers prescription drugs (also known as a Medicare Advantage Prescription Drug plan). You’re first eligible for Part D when:
- You have Medicare Part A and/or Part B.
- You live in the service area of a Medicare plan that covers prescription drugs.
When it comes to Medicare prescription drug coverage, you can enroll during your Initial Enrollment Period for Part D, which normally takes place at the same time that you’re first eligible for Medicare Part A and Part B, either by turning 65 or through disability. If you qualify for Medicare because of age, this period overlaps with your Initial Enrollment Period for Medicare Part A and/or Part B and starts three months before you’re first eligible for Medicare, includes the month you become eligible, and ends three months later.
If you become eligible for Medicare retroactively, your Initial Enrollment Period for Part D starts the month you receive notification that you are eligible for Medicare and continues for three additional months.
Initial Coverage Election Period for Medicare Advantage plans
As mentioned, Medicare Part C is another way to get your Medicare Part A and Part B coverage. This type of coverage is offered through Medicare Advantage plans, which are available through Medicare-approved private insurance companies. So, instead of getting your Medicare coverage directly through the government-run program, you’ll get them through your Medicare plan.
You’re eligible to enroll in a Medicare Advantage plan if:
- You have Medicare Part A and Part B.
- You live in the service area of a Medicare Advantage plan.
- You don’t have end-stage renal disease (with some exceptions).
If you’re considering Medicare Part C as an alternative to Original Medicare, you’re usually first eligible to enroll in a Medicare Advantage plan during your Initial Coverage Election Period (ICEP). For most people, this period takes place at the same time as their Initial Enrollment Period for Part B, starting three months before they have Medicare Part A and Part B and ending seven months later. If you delay Medicare Part B, your ICEP starts three months before you have both Medicare Part A and Part B and ends the last day of the month before your Medicare Part B coverage starts.
Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage
If you didn’t sign up for a Medicare Advantage or Medicare Prescription Drug Plan when you were first eligible or would like to make changes to your current coverage, your next chance to do so will be from October 15 to December 7. Also known as the Annual Election Period or Fall Open Enrollment, this is your yearly opportunity to make changes like:
- Enrolling in a stand-alone Medicare Prescription Drug Plan for the first time
- Switching Medicare Prescription Drug Plans
- Enrolling in a Medicare Advantage plan or switching plans
- Disenrolling from your Medicare Advantage plan and returning to Original Medicare
- Disenrolling from your Medicare Prescription Drug Plan
Fall Open Enrollment (October 15 to December 7)
|If you currently have this type of coverage:||You can make the following changes:|
|Original Medicare, (Part A and Part B) with a stand-alone Prescription Drug Plan||
|Medicare Advantage plan||
Special Election Periods for Medicare Advantage and prescription drug coverage
In certain situations, you may be able to make changes to your Medicare Part D or Part C coverage outside of the normal times. Some examples of situations that might qualify include (but aren’t limited to) if you move out of your Medicare plan’s service area or your plan leaves the Medicare program, you may get a Special Election Periodto switch to a new Medicare Advantage plan or Medicare Prescription Drug Plan. Special Election Periods can take place any time you have a qualifying situation. Not sure if you have a situation that qualifies? Feel free to give eHealth a call to speak with a licensed insurance agent and get your questions answered.
Medicare Advantage Open Enrollment Period
Changed your mind about your Medicare Advantage plan? If you don’t like your Medicare Part C coverage and would like to go back to Original Medicare, you can do so during the Medicare Advantage Open Enrollment Period (January 1 toMarch 31 ). During this period, you can disenroll from your Medicare Advantage plan and return to Original Medicare. Then, regardless of whether your Medicare Advantage plan had prescription drug coverage, you can also use this same period to enroll in a stand-alone Medicare Prescription Drug Plan, since Original Medicare’s coverage of prescription drugs is limited. Medicare Advantage Open Enrollment Period Chart (January 1 to March 31 )
|During this period, you can:||During this period, you cannot:|
Hopefully you now have a better idea of when you can make changes to your coverage when it comes to the different types of Medicare coverage. Would you like help finding Medicare plan options that could work for you? Feel free to give eHealth a call to speak with a licensed insurance agent and get personalized assistance with your Medicare coverage needs.
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