It can be hard to interpret all the Medicare Enrollment Periods and what they mean for your coverage. After all, there is a Medicare initial enrollment period, a Medicare Annual Enrollment Period, a Medicare supplement open enrollment period, and Medicare special enrollment periods. Yes, it’s a lot to take in.
But the agents at Cornerstone Senior Advisors will break it all down for you. Below, we explain the different Medicare enrollment periods that you should be aware of. You don’t want to end up without health care coverage or have to pay extra for the coverage you desire.
What Is the Medicare Initial Enrollment Period?
Your Initial Enrollment Period is perhaps the most important date for you to discern as you get closer to being eligible for Medicare.
Your Initial Enrollment Period (IEP) is a seven-month span that begins three months before the month you turn 65. Then it includes the month of your birthday and continues for three months after your birth month. For example, if you turn 65 on June 20th, your Medicare IEP would go from March 1st to September 30th. There’s an exception to this. If you were born on the first of the month, your IEP (and your Medicare) will begin one month early.
During your IEP, you can enroll in Part A and Part B (Original Medicare) or Part C (a Medicare Advantage plan). When you enroll during your IEP, you avoid any late enrollment penalty. You can also enroll in Part D (drug coverage) during this same window to avoid late penalties.
Medicare Supplement Open Enrollment Period
It’s common for those who enroll in Original Medicare to want added coverage, so they use their Medicare Supplement Open Enrollment Period to sign up for a Medigap plan. This period is 6 months and starts on your Part B active date.
So, what makes using the Medigap OEP significant? It means:
- You can’t be rejected for any Medigap plan available in your area no matter your health status.
- Your insurer can’t charge you higher premiums because of your health or pre-existing conditions.
- Your coverage for any pre-existing conditions can’t be delayed.
What If I Miss My Initial Medicare Enrollment Period?
If you miss your IEP, you could face lousy consequences. Unfortunately, it happens to a lot of people. The aftereffects apply only if you don’t have other suitable coverage, such as employer coverage.
- If you don’t enroll in Part B during your IEP, you’ll likely have to pay a late enrollment penalty for as long as you have Medicare coverage. The fee is 10% for every 12-month period that you should have had Part B, but didn’t enroll. You’ll pay this fee even if you ultimately select Medicare Advantage.
- You could also go without Part B coverage for a long time. Not signing up during your IEP will require you to wait until the next General Enrollment Period (GEP). Your coverage won’t begin until July 1 that year.
- If you don’t have suitable Part D coverage and miss your IEP, you’ll face a penalty with your Part D premium for as long as you have the coverage. The fee is 1% per consecutive month that you didn’t have coverage for prescription drugs.
Creditable Coverage
People who are still working often have group insurance coverage through their (large) employer or union plan. Group coverage lets you delay enrollment in Medicare Part A and/or B. When you retire, you can register for those Parts during a Special Enrollment Period (SEP).
The Medicare SEP is an eight-month window that starts either the month you or your spouse stops working or the month your group coverage concludes, whichever comes first.
The Medicare General Enrollment Period
If you neglected your IEP and you don’t qualify for a SEP, you can register for Original Medicare during the General Enrollment Period (GEP). This goes from January 1 through March 31 every year. Know that the GEP only applies to Original Medicare, and you’re still susceptible to the late enrollment penalties. Also, your coverage won’t start until July 1.
Getting Part C or Part D If You Miss Your IEP
If you prefer a Medicare Advantage plan or Part D coverage for prescription drugs, you’ll need to wait for the Annual Enrollment Period (AEP). This occurs annually between October 15 and December 7. If you miss your IEP, you can use the next AEP to join a new plan, switch to a different plan (if you’re enrolled already), or return to Original Medicare.
Certain situations will cause a Special Enrollment Period (SEP) that’s unique to you.
A Medicare SEP is typically a two-month span when you can make adjustments to your coverage because of a special circumstance. For example, if you move to a new state (outside the plan’s service area), you’ll qualify for a SEP. You can use this SEP to switch to a new Part C or Part D plan, or return to Original Medicare with no fees.
Also, there are other situations in which you might be eligible for a SEP. If we didn’t mention your situation above, contact Cornerstone Senior Advisors to discover your options.
As mentioned above, once you’re enrolled in Parts A and B, you’ll also qualify for a 6-month open enrollment period for Medigap plans. This one-time election period begins with your Part B effective date. You may enroll in any Medigap plan you want with zero health questions asked.
Know that this enrollment period only happens once for most folks. Then, it vanishes completely, so it’s an enrollment period that you simply can’t miss!
It can be challenging to keep track of all the Medicare enrollment periods, especially when you’re not sure which one you need to monitor! If you’re concerned about missing a deadline, we’ll make sure that doesn’t happen. Call (316) 260-3331 for a free consultation at Cornerstone Senior Advisors.