Don't get caught off guard. Take help from our handy overview of the different enrollment periods for each type of Medicare coverage and plan.
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 proper 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.
Medicare is a health-insurance program for persons over 65 in the United States. People under 65, such as those with disabilities or irreversible renal failure, may be eligible for Medicare.
Although it does not cover all medical bills or most long-term care costs, the program assists healthcare costs. You can receive Medicare coverage in a variety of ways. You can purchase a Medicare Supplement Insurance (Medigap) policy from a private insurance provider if you opt to have Original Medicare (Part A and Part B) coverage.
The parts of Medicare
Original Medicare is enrolled in you by Social Security (Part A and Part B).
- Part A (hospital insurance) of Medicare helps pay for inpatient care in a hospital or a short period in a skilled nursing facility (following a hospital stay). Part A also covers some home health and hospice services.
- Medicare Part B (medical insurance) helps pay for outpatient care, home health care, durable medical equipment, and some preventive services provided by doctors and other health care professionals.
Other aspects of Medicare are managed by private insurance firms that adhere to Medicare’s guidelines.
- Supplemental (Medigap) insurance helps pay for Medicare copayments, coinsurance, and deductibles.
- All benefits and services covered under Parts A and B are included in the Medicare Advantage Plan (formerly known as Part C).
- Prescription medicines and extra services like vision, hearing, and dental care are bundled into one plan.
- Prescription medications are covered under Medicare Part D (Medicare prescription drug coverage).
If they have worked and paid Medicare taxes long enough, most people aged 65 and up are eligible for free medical hospital insurance (Part A). You can enroll in Medicare medical insurance (Part B). Larger-income participants will pay a higher monthly Part B cost.
Enrollment in Medicare coverage – you can do this online
Did you know that you may compare plans and enroll in the one you want from the comfort of your own home? Online enrollment may become more popular. According to an eHealth survey, in 2018, more persons enrolled online (using eHealth’s enrollment tool) than in 2017.
Enrollment periods for Medicare Part A and Part B
The initial enrollment period for Original Medicare (Part A and Part B)
When you first enroll in Medicare, you’ll be enrolled in Original Medicare (Parts A and B), a federally run health care program.
Because of their age, the majority of people are eligible for Medicare. If this describes you, your first opportunity to enroll in Medicare is often during your Initial Enrollment Period, which lasts seven months. It begins three months before your 65th birthday includes your 65th birthday month, and concludes three months after. Most people don’t have to sign up; if you’re already getting Social Security or Railroad Retirement Board payments when you turn 65, you’ll be automatically enrolled in Medicare. If you need to register personally, you can do so during your Initial Enrollment Period (usually through Social Security).
If you’ve been collecting Social Security or Railroad Retirement Board disability benefits for two years, you might be eligible for Medicare before you turn 65. In the 25th month of disability benefits, you’ll be automatically enrolled in Medicare Parts A and B. If you have amyotrophic lateral sclerosis (ALS, often known as Lou Gehrig’s illness) or end-stage renal disease, you may be eligible for Medicare at any age.
Even if you qualify for automatic enrollment in Medicare Part A, you must enroll in Medicare Part B if you live in Puerto Rico. To avoid late-enrollment fines, you may choose to do so during your IEP.
You can enroll in Medicare Part B during your Initial Enrollment Period if you aren’t automatically enrolled. If you miss this enrollment time, you may have other alternatives for enrolling in Part B, including the General Registration Period outlined below. Still, you may have to pay a late-enrollment penalty.
Some people choose to put off signing up for Medicare Part B. You must pay a premium (many people do not pay a Part A premium). Perhaps you’re still covered under your employer’s healthcare plan. Learn more about deferring enrollment in Part B.
The general enrollment period for Original Medicare
Have you forgotten about your Initial Enrollment Period? The next time you can sign up for Medicare is during the General Enrollment Period, which runs from January 1 to March 31 each year. You can enroll in Medicare Part A and Part B during this time.
Keep in mind that if you didn’t sign up for Medicare Part B when you initially became eligible, you might have to pay a late-enrollment penalty. You may owe a late-enrollment penalty for Part A if you aren’t eligible for premium-free Part A. If you worked for at least ten years (40 quarters) and paid Medicare taxes, you can usually access Part A without paying a premium.
The special enrollment period for Original Medicare
In some circumstances, you may be able to postpone signing up for Original Medicare and instead join during a Special Enrollment Period. You or your spouse, for example, maybe work when you first become eligible for Medicare and obtain group health coverage via your job. Because Medicare Part B has a monthly fee, you may want to hold off on enrolling in Medicare, so you don’t have to pay for coverage you don’t need. You’ll typically have an eight-month Special Enrollment Period to enroll in Medicare once your employer-sponsored coverage finishes, or you stop working (whichever comes first). If you sign up during this time, you won’t be charged a late-enrollment penalty.
Enrollment periods for Medicare Advantage and prescription drug plans
You may have various types of Medicare coverage available to you once you’ve enrolled in Original Medicare (Parts A and B), such as Medicare Advantage plans and stand-alone Medicare Part D prescription medication plans.
Medicare Advantage plans are a different method to acquire Original Medicare coverage (Part A and Part B benefits). Many of these plans include extra benefits such as routine vision, dental, and prescription drug coverage, as well as health wellness programs.
Separate Medicare Part D prescription drug plans can supplement your Original Medicare coverage by helping you pay for your drugs.
These Medicare plans are offered by private insurance companies that Medicare has approved. Let’s have a look at their enrollment times.
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).
During your Initial Coverage Election Period, you are usually initially eligible to enroll in a Medicare Advantage plan (ICEP). For the most part, this period coincides with the above-mentioned Initial Enrollment Period for Original Medicare. If you wait three months to enroll in Medicare Part B, your ICEP will begin three months before you have both Medicare Part A and Part B coverage and will expire on the last day of the month before Medicare Part B coverage begins.
The initial enrollment period for Medicare Part D (prescription drug coverage)
Prescription drug coverage is available through either a Medicare Advantage prescription drug plan (described above) or a stand-alone Medicare Part D prescription drug plan. It’s worth noting that not all Medicare Advantage plans cover prescription drugs, but the vast majority do.
To be eligible for a stand-alone Medicare Part D prescription medication coverage, you must meet the following criteria:
- Have Medicare Part A and 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
The Annual Election Period, also known as Fall Open Enrollment, is a popular period to make Medicare coverage changes. Every year, from October 15 to December 7, it takes place. You can make modifications such as:
- 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
During Fall Enrollment, almost 1,300 participants in an eHealth study planned to examine their Medicare coverage. During this enrollment time, you may be able to alter your Medicare plan selections to one that better suits your needs.
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
Have you made a change of heart regarding your Medicare Advantage plan? During the Medicare Advantage Open Enrollment Period, you can switch to a different one (January 1 to March 31 ). Alternatively, if you don’t like your Medicare Part C coverage and want to switch back to Original Medicare, you can do so now. You can also enroll in a stand-alone Medicare prescription drug plan during this time.
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.
During this period, you can:
- 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
During this period, you cannot:
- 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
You may be able to make adjustments to your Medicare Part C or Part D coverage outside of the typical time frames in certain circumstances. You may be eligible for a Special Election Period to switch to a new Medicare Advantage plan or Medicare prescription drug plan if you move out of your Medicare plan’s service region or if your plan departs the Medicare program. Special Election Periods can occur at any time if you meet the criteria.
Enrollment periods are just another reason to examine your insurance coverage each fall.
Are you confident that you have the most appropriate Medicare coverage for your needs? According to an eHealth survey, just 8% of persons who utilized eHealth’s drug comparison tool had the prescription drug plan that best suited their needs for the year.
Medicare supplement enrollment
Medicare Supplement insurance policies can help with Medicare Part A and Part B out-of-pocket expenditures. During your Medigap Open Enrollment Period, buying a plan may be the best option (OEP). This six-month period begins on the first day of the month in which you are both enrolled in Medicare Part B and 65 or older.
You usually have the guaranteed-issue right to buy a Medigap plan of your choice during this time, as long as you’re enrolled in Medicare Parts A and B and live within the service region of the Medigap plan. During your Medigap OEP, an insurance company cannot deny you enrollment in Medigap coverage because of any pre-existing conditions*. If you miss the enrollment period, you can still apply for a plan, but you may be subject to medical underwriting.
A Medicare Supplement insurance carrier may deny your application or charge you more if you have a health problem.
We hope this information has given you a better picture of when you can modify your Medicare coverage. The plan finder on eHealth will show you what plans are available in your region, and you can start browsing and comparing right away.
*Pre-existing conditions are medical conditions that existed before the policy began. They may limit coverage, exclude you from coverage, or even prohibit you from being approved for a policy; however, each plan’s exact definition and applicable limitations or exclusions of coverage will vary, so read the official plan documentation to see how that plan handles pre-existing conditions.
These eHealth web pages’ product and service descriptions, if any, are not meant to be offers to sell or solicitations in connection with any product or service. All items are subject to applicable laws, rules, and regulations and are not available in all places.
When deciding whether or not to enroll in Part B, the first thing to examine is whether or not a person qualifies for a Special Enrollment Period.
When employees and their dependents first become eligible for Medicare, they must consider whether Part B is good for them. People with job-based insurance must first determine whether they have insurance via their current employer before enrolling in Part B.
In general, if an individual (or their spouse) is currently working and has employer-sponsored Group Health Plan coverage due to their employment, they can defer Part B enrollment and enroll later during a Special Enrollment Period (SEP). They do, however, need to be aware of some specific rules. Employer coverage for retirees or COBRA coverage, for example, does not count as current work. Thus, these people are not eligible for a SEP to enroll in Medicare later. If the person has Medicare based on disability or ESRD, the rules are different.
The second key aspect to consider when deciding whether or not to enroll in Part B is who pays first.
When Medicare and another health insurance plan are liable for paying the same medical claim, coordination of benefits rules govern how Medicare interacts with other insurance. When someone says he is considering delaying or declining Part B, the beneficiary needs to know:
- Whether their employer-sponsored Group Health Plan coverage will pay primary or secondary and,
- If it pays secondary to Medicare, whether and how it will pay if they don’t enroll in Part A and Part B.
It’s worth noting that most retiree and small-business plans (those with fewer than 20 employees) require participation in both Part A and Part B. If your retiree plan involves Medicare enrollment, please let your employees know well in advance if they intend to retire. Suppose a person does not sign up for Part B when they are first eligible. In that case, they may be subject to late enrollment penalties, in addition to the usual Part B premium, for the duration of their Part B coverage, and they may be left with little or no coverage.
Your Medicare card carries a Medicare number that is unique to you to help secure your identity. If you haven’t received your red, white, and blue Medicare card, it’s possible that something has gone wrong, such as your mailing address. You can change your mailing address by logging in or creating a personal Social Security account. Learn everything you need to know about your Medicare card.
The bottom line
You have a seven-month window around the time you turn 65 to enroll in a Medicare plan for the first time.
If you fail to enroll in time, your coverage may be delayed, and you may pay fines later. And this may wind up costing you more. You must be aware of the significant enrollment periods so that you can enroll when it is most convenient for you and by your eligibility.