There are several Medicare Enrollment Periods available to the public. This article will identify and explain these enrollment periods while also highlighting the criteria that make individuals eligible for these enrollment periods in hopes of simplifying future decisions.
The Initial Medicare Enrollment Period
The Initial Medicare enrollment period is the time frame in which individuals should sign up for a Medicare plan. Dependent on eligibility, this enrollment period covers a seven-month time frame beginning three months before an individual’s 65th birthday. The enrollment period will then cover the month of the individual’s 65th birthday and extend for three months afterwards.
During the Initial Medicare Enrollment Period, there are several options for those eligible for a Medicare plan.
Individuals can sign up for:
- Medicare Part A (Hospital Insurance) – This plan covers most hospital fees, including inpatient stays and nursing care. Medicare Part A also covers certain health services that may take place in your home.
To be eligible for Part A, an individual must be a permanent resident or citizen of the United States. They must also be 65 or older, though individuals with disabilities can qualify before their 65th birthday.
Individuals diagnosed with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease are also eligible for Medicare Part A.
- Medicare Part B (Medical Insurance) – This plan covers a variety of services including doctor’s visits, flu shots, and chemotherapy. Medicare Part B may also cover equipment such as wheelchairs.
To be eligible for Part B, you must be a citizen or permanent resident of the United States. You may qualify for Part B before the age of 65 if you have a disability, but most individuals will qualify at age 65. You are also eligible if you suffer from Amyotrophic Lateral Sclerosis or End-Stage Renal Disease.
- Both Part A and Part B
After selecting from one of the three options above, there is then a choice to enroll in:
- Medicare Advantage Plan (Part C) – The Medicare Advantage Plans are offered by private insurance companies. A Medicare Advantage Plan allows individuals to benefit from the coverage of Part A and Part B.
An individual’s eligibility for a Medicare Advantage Plan depends on whether they are eligible for, or in possession of, both Part A and Part B Plans. Medicare Advantage Plan eligibility also depends on whether the individual lives within the plan’s service area and has a valid election period. The Advantage plan continues until it is changed or canceled.
- Medicare Prescription Drug Plan (Part D) – The Medicare Prescription Drug Plan covers the costs of many brand name prescriptions and generic drugs ranging from prescription medication for HIV treatment to the best period medicine. Several Part D plans divide the prescription drugs that are covered into tiers which have different costs.
Individuals who are eligible for Medicare Part A or B coverage are also eligible for coverage under Part D. To enroll in Part D, you must first be enrolled in either Part A or B or both.
The Part D enrollment period runs alongside the Initial Medicare Enrollment Period. However, since you must first be enrolled in Part A or Part B to be eligible for Part D, the Medicare Part D enrollment period would begin after you have enrolled on Part A or B.
In addition, the deadline for the Medicare prescription plans shares the timeframe of the open enrollment periods. Meaning that any change should be added between October 15th and December 7th.
Special Enrollment Periods
If you miss the Initial Enrollment Period, you may have an option to sign up for Part A and Part B during what is known as Special Enrollment Periods (SEP). This option will only be available under specific circumstances. These may include the loss of previous coverage or moving.
If you are still employed or under a group health plan provided by an employer, you may be eligible to sign up for Medicare. You will also have an eight-month SEP that will start either a month after your employment ends or a month after the group health plan offered by your employer is terminated. Another option for SEP exists for individuals who are overseas.
Special Enrollment Periods also doubles as the Medicare Advantage Special Enrollment Period as during this time you may make changes to your Medicare Advantage Plan and to your Prescription Drug Plans.
General Enrollment Period
In cases where an individual missed the chance to sign up during their Medicare enrollment period, there is still a chance to enroll for Medicare.
Individuals are allowed to sign up for Part A or Part B, or both between January 1st and March 31st. If found eligible, the individual will be covered starting the 1st of July. Signing up during the general enrollment period carries the risk of penalties.
Medicare Supplement Open Enrollment Period
Also known as Medigap, the Medicare Supplement Open Enrollment Period is when individuals can change or supplement their original Medicare coverage plan with additional features and expenses. Medicare Supplement may be added to Original Medicare at any time after you are enrolled in both part A and Part B, but you may not have “Guaranteed Issue Rights”. You may be required to pay more and/or be denied coverage based on Health conditions.
The Medicare Supplement Period applies to individuals who have signed up for Medicare Part A and Part B. Eligible individuals have six months starting from the first day of the month that they turn 65 to sign up.
If the Medicare Supplement Period is missed, individuals may not be able to register at any other time.
Annual Enrollment Period
Each year individuals have the chance to change or drop the Medicare Plan that they possess. This period is the Annual Enrollment Period, and it stretches from October 7th to December 7th.
During this time, individuals can switch between their Original Medicare Plan and the Medicare Advantage Plan. There is also the option to change to a new insurer or to add or drop any drug coverage or prescription drug plan that you might be a part of.
Any changes enacted during the Annual Enrollment Period will not take effect until January 1st and in order for these changes to be processed, your request must be received and noted by December 7th.
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period is when individuals who are signed up to a Medicare Advantage Plan have the option to switch to another Medicare Advantage Plan or the Original Medicare Plan.
This is an annual option and must be completed between January 1st and March 31st. Upon completion of the switch, your new plan will activate on the first day of the following month.
Conclusion
With such a wide variety of Medicare plans and enrollment periods in existence, finding the right Medicare plan for you shouldn’t be difficult. Just like finding the right Medicare plan is important, finding the right provider that is in-network with whichever Medicare plan you choose is just as important.
