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Medicare Enrollment and Election Periods


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Summary: If you’re eligible for Original Medicare, Part A and Part B, generally you can only enroll, switch plans, or drop a plan at certain times of the year. The same is true Medicare health and prescription drug plans. If you happen to miss the time window when you can make changes, you may have to wait up to a year in some cases.

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 Fall Open Enrollment? Fall Open Enrollment runs from October 15 through December 7 each year. As you may know, Medicare comes in different “parts,” and each part has specific rules when it comes to when you can sign up or make changes.

Don’t get caught unprepared.  Here’s a handy overview of the different enrollment periods for each type of Medicare coverage, so you can plan ahead.

Enrollment in Medicare coverage – you can do this online

Did you know that you can compare plans, and enroll in the plan of your choice, at your convenience and right at home? Online enrollment may be a growing trend. An eHealth study showed that more people enrolled online (through eHealth’s enrollment tool) in 2018 than in 2017.

Online Enrollment for Major Medicare Products

Source: Medicare Online Enrollment Trends, eHealth Inc., 2019

Just type your zip code in the box on this page to start comparing plans. When you’re ready to enroll, eHealth’s plan comparison tool also lets you sign up.

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, goes for seven months. It 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 (typically through Social Security) during your Initial Enrollment Period.

You might qualify for Medicare before 65 if you’ve been receiving Social Security or Railroad Retirement Board disability benefits for two years. You’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.

If you live in Puerto Rico, even if you qualify for automatic enrollment in Medicare Part A, you need to sign up for Medicare Part B. You may want to do so during your IEP to avoid possible late-enrollment penalties.

If you’re not automatically enrolled in Medicare Part B, you may enroll in Part B during your Initial Enrollment Period (IEP), described above. If you miss this enrollment period, then you may have other options for enrolling in Part B, such as the General Enrollment Period described below, but you may have to pay a late-enrollment penalty.

Some people decide to delay enrollment in Medicare Part B. You pay a premium for this coverage (many people don’t pay a Part A premium). Perhaps you’re still covered under an employer’s plan. Learn more about delaying Part B enrollment.

General Enrollment Period for Original Medicare

Missed your Initial Enrollment Period? Your next chance to enroll in Medicare is typically during the General Enrollment Period, from January 1 to March 31 each year. You can sign up for Medicare Part A and/or Part B during this time.

Keep in mind that you may have to pay a late-enrollment penalty for Medicare Part B if you didn’t sign up 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 paying a premium if you worked at least 10 years (40 quarters) and paid Medicare taxes.

Special Enrollment Period for Original Medicare

In some situations, you can delay Original Medicare enrollment and sign up 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, 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 usually 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 period When it happens What you can do
Initial Enrollment Period (IEP)
  • If you qualify by age, it starts 3 months before you turn 65, includes your birthday month, and ends 3 months later.
  • If you qualify by disability, it starts three months before the 25th month of disability benefits from Social Security or the Railroad Retirement Board, includes the 25th month of disability benefits, and ends 3 months later.
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 generally last for eight months. Enroll in Medicare Part A and/or Part B.


Enrollment periods for Medicare Advantage and prescription drug 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, like Medicare Advantage plans and stand-alone Medicare Part D prescription drug plans.

  • Medicare Advantage plans offer an alternative way to get Original Medicare (Part A and Part B benefits). Many of these plans offer additional benefits like routine vision, dental services, prescription drug coverage, or health wellness programs.
  • Stand-alone Medicare Part D prescription drug plans can work with your Original Medicare coverage to help pay for your medications.

Both these types of Medicare plans are available through Medicare-approved private insurance companies. Let’s take a look at enrollment periods for them.

Initial Coverage Election Period for Medicare Advantage plans

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).

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 Original Medicare, described above. If you delay Medicare Part B enrollment, 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.

Initial Enrollment Period for Medicare Part D (prescription drug coverage)

You can get prescription drug coverage through Medicare Advantage prescription drug plan (above), or through a stand-alone Medicare Part D prescription drug plan. Note that not all Medicare Advantage plans include prescription drug coverage, but most do.

To qualify for a stand-alone Medicare Part D prescription drug plan, you have to:

  • Have Medicare Part A and/or Part B.
  • Live in the service area of a Medicare plan that covers prescription drugs.

You can enroll during your Initial Enrollment Period, at the same time that you’re first eligible for Medicare Part A and Part B.

Fall Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage

A popular time to make Medicare coverage changes is during the Annual Election Period, also called Fall Open Enrollment. It runs from October 15 to December 7 every year. You can 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
  • Dropping your Medicare prescription drug plan

Over 1,300 participants in an eHealth study planned to review their Medicare coverage during Fall Enrollment. This enrollment period may give you an opportunity to change your Medicare plan options to a plan that works well for your needs.

Medicare Coverage Review Intentions

Source: Medicare Choices Survey: Open Enrollment for 2020, eHealth Inc., 2019

If you currently have this type of coverage: You can make the following changes:
Original Medicare, (Part A and Part B) with or without a stand-alone Medicare Part D prescription drug plan
  • Enroll in a stand-alone Medicare prescription drug plan
  • Switch Medicare prescription drug plans (if you already have prescription drug coverage)
  • Disenroll from your Medicare prescription drug plan
  • Switch from Original Medicare to a Medicare Advantage plan
Medicare Advantage plan
  • Switch Medicare Advantage plans
  • Switch from a Medicare Advantage plan that doesn’t include prescription drug coverage to one that does (and vice versa)
  • Drop your Medicare Advantage plan and return to Original Medicare


Medicare Advantage Open Enrollment Period

Changed your mind about your Medicare Advantage plan? You can switch to a different one during the Medicare Advantage Open Enrollment Period (January 1 to March 31 ). Or, if you don’t like your Medicare Part C coverage and would like to go back to Original Medicare, you can do so during this time. Then, you can also use this same period to enroll in a stand-alone Medicare prescription drug plan.

Here’s what some Medicare beneficiaries want out of their Medicare plans. This chart shows preferences from over 1,300 survey participants in an eHealth study.

Reasons for Switching Medicare Plans

Source: Medicare 2019 Open Enrollment: Costs and Sentiments, eHealth Inc., 2019

During this period, you can: During this period, you cannot:
  • Drop your Medicare Advantage plan and return to Original Medicare.
  • Enroll in a stand-alone Medicare Prescription Drug Plan, which works alongside Original Medicare if you had Medicare Advantage .
  • Switch Medicare Advantage plans
 

  • Switch from Original Medicare to a Medicare Advantage plan
  • Sign up for a Medicare prescription drug plan if you have Original Medicare
  • Switch from one stand-alone Medicare prescription drug plan to another


Special Election Periods for Medicare Advantage and prescription drug coverage

In certain situations, you may be able to make changes to your Medicare Part C or Part D coverage outside of the normal times. For example, if you move out of your Medicare plan’s service area, or your plan leaves the Medicare program, you may get a Special Election Period to switch to a new Medicare Advantage plan or Medicare prescription drug plan. Special Election Periods may happen anytime you have a qualifying situation.

Enrollment periods – here’s one more reason to review your coverage every fall

Are you sure you have the best Medicare coverage for your needs? An eHealth study found that only 8% of people who used eHealth’s drug comparison tool had the prescription drug plan that may best suit their needs for their medications. This 2018 study looked at more than 17,000 user sessions during the Fall Enrollment in 2017.

Plan Optimization for Prescription Savings

Source: Medicare Choice and Impact Report, eHealth Inc., 2018

Medicare Supplement enrollment

Medicare Supplement insurance plans may help pay the out-of-pocket costs of Medicare Part A and Part B. The best time to buy a plan may be during your Medigap Open Enrollment Period (OEP). This period begins on the first day of the month that you are both enrolled in Medicare Part B and aged 65 or over, and lasts for six months. During this time, you generally have the guaranteed-issue right to buy a Medigap plan of your choosing, as long as you’re enrolled in Medicare Part A and Part B and you live within the Medigap plan’s service area. An insurance company may not deny you enrollment in a Medigap policy based on any pre-existing conditions* during your Medigap OEP. If you miss this enrollment period, you can still apply for a plan anytime, but you may be subject to medical underwriting. A Medicare Supplement insurance company might turn down your application or charge more for a health condition.

We hope you now have a better idea of when you can make changes to your Medicare coverage. To see what Medicare plan options are out there, type your zip code into the box on this page. eHealth’s plan finder will display plans available in your area, and you can start shopping and comparing today.

*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.

 

The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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