Medicare Enrollment Periods: When To Enroll & When To Make Changes?
A Medicare enrollment period is a time frame during which you may enroll in various types of Medicare coverage. A Medicare election period is a separate period of time during which you may make changes to your Medicare coverage if you desire to do so. Understanding these important dates on the Medicare calendar is critical in order to maximize your coverage and avoid late penalty costs (or even worse, being without coverage).
Let’s take a quick look at the key Medicare dates you need to know. (Continue reading below for a more detailed explanation of each, as well as why it is imperative to enroll during these time frames.)
Medicare Calendar Guide
- Initial Enrollment Period (IEP): You have 3 months before and 3 months after your 65th birthday month to enroll in Medicare Parts A and B. In cases of disability, enrollment eligibility varies (see below). These dates will vary by individual.
- General Enrollment Period: January 1st to March 31st each year. You may enroll in Medicare Parts A and B during this period only if you did not enroll during your Initial Enrollment Period.
- Medicare Supplement (Medigap) Open Enrollment Period (OEP): Once you are enrolled in Medicare Parts A and B, you have six months to enroll in a guaranteed-issue Medicare Supplement (or Medigap) plan without answering health questions. These dates will vary by individual.
- Medicare Advantage (or Part C) Open Enrollment Period: January 1st to March 31st each year. Medicare Advantage plans replace your Medicare Parts A and B, and usually offer Part D coverage as well.
- Annual Election Period (AEP): October 15th to December 7th each year. During this time you can make changes to your Medicare coverage (more details below).
- Special Enrollment Periods: In unusual circumstances, you may be eligible for a Special Enrollment Period; however, this does not apply to most people (see more below). These dates will vary by individual.
1. Initial Enrollment Period for Medicare
The Medicare initial enrollment period for most people occurs when they reach age 65 (or just prior to their 65th birthday).
- The Medicare initial enrollment period is a seven-month window around your 65th birthday month, during which time you can enroll in Medicare Part A and Medicare Part B for the first time.
- The initial enrollment period begins three months before your 65th birthday month and ends three months after your birthday month. For example, if your birthday is in April, you may enroll in Medicare from January 1st to July 31st.
- For most people, enrolling in Part A and Part B at this time is in your best interests; otherwise, you may face late enrollment penalties for your Part B coverage which will be added to your premium each month. An exception to this rule is if you already have creditable coverage through an employer; in that case, you may opt to enroll in Part A to take advantage of $0 monthly premiums, but delay your Part B enrollment at no penalty (see “Special Enrollment Periods” section below).
Good to Know:
If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Medicare Part A and Medicare Part B.
Disability Cases: If you are disabled and receive Social Security Disability insurance benefits (SSDI) or Railroad Retirement Board benefits, your initial enrollment period will begin on your 65th birthday OR when you receive your 24th disability benefits payment from Social Security or Railroad Retirement, whichever is earlier. Children between the ages of 18 and 20 who receive SSDI based on a disability they first developed before age 18, as reflected by an IEP, can also qualify for Medicare.
End-Stage Renal Disease (ESRD) Cases: If you are diagnosed with ESRD, as long as you have applied and met the earnings requirements for SSDI, your Medicare enrollment may begin as follows:
- Three months after you first began a regular dialysis course, or
- The first month of a regular dialysis course, if you went through self-dialysis training, or
- The month you receive a kidney transplant, or
- Two months before a kidney transplant, if you were hospitalized to prepare for your transplant during that time
Note: A minor child with end-stage renal disease can also qualify for Medicare based on their parent’s work credits.
Lou Gehrig’s Disease (amyotrophic lateral sclerosis or ALS) Cases: If you are diagnosed with ALS, your disability and Medicare eligibility for enrollment is immediate.
For information on Medicare coverage effective dates (when you can begin using your Medicare coverage), speak with one of our licensed insurance agents for a personalized explanation, or visit Medicare.gov for a basic overview.
2. General Enrollment Period for Medicare
The general enrollment period for Medicare Part A and Part B lasts from January 1 to March 31 each year.
You may enroll in Medicare Part A and/or Part B during the general enrollment period as long as the following conditions apply:
- You did not enroll in Medicare Parts A and B when you were first eligible.
- You aren’t eligible under a special enrollment period, as explained below.
You might be penalized if you wait until the general enrollment period to enroll in Medicare instead of enrolling during the initial enrollment period. Your coverage will begin on July 1 following your enrollment in Medicare during the general enrollment period.
3. Medicare Supplement Open Enrollment Period
The open enrollment period for Medicare Supplement (or Medigap) plans begins on the first day of your birth month and lasts for six months (for example, if your birthday is in February and you have enrolled in Part B, your Medigap open enrollment period is from February 1st to July 31st). Note: open enrollment period dates apply only if you have already enrolled in Part B and paid your Part B premium. Medigap plans help cover the medical expenses that Original Medicare does not pay.
The best time to purchase a Medicare Supplement (or Medigap) plan is during your Medigap open enrollment period. During this window of time, you have guaranteed issue rights to a Medigap policy. Guaranteed issue rights mean that insurance companies cannot deny your application based on pre-existing health conditions. If you try to apply for a Medicare supplement after the open enrollment period, insurance companies may ask you questions related to your medical conditions and possibly deny you coverage based on that information.
Medicare supplement plan coverage generally begins the 1st day of the month after you apply.
4. Medicare Advantage Open Enrollment Period
The open enrollment period for Medicare Advantage (or Part C) plans runs from January 1st to March 31st each year.
A Medicare Advantage (or Part C) plan uses a private insurance company to replace your Part A and Part B coverage, often adding prescription drug coverage as well as other plan benefits. If you are enrolled in a Medicare Advantage plan and want to either change to a different plan or switch back to Original Medicare, you must make that change (often referred to as an election) during this open enrollment period each year. This type of change is only allowed once each year. You may also add a Part D plan for prescription coverage at this time if you desire.
If you use this open enrollment plan, your new benefits will begin on the first day of the month after you make the election.
If you are hoping to switch from a Medicare Advantage plan to a Medicare Supplement plan, check to see whether you are still within your Medicare Supplement open enrollment six-month window (details above) in order to enroll without answering health questions. If your Medicare Supplement open enrollment period has passed, you may have to answer questions regarding pre-existing conditions, face higher premiums due to underwriting, or possibly be denied coverage.
5. Annual Election Period for Medicare
The annual election period for changing your Medicare coverage runs from October 15th to December 7th each year.
During the annual election period, you may make any number of changes to your Medicare coverage. Here are some examples:
- You may change to a Medicare Advantage plan from Original Medicare, or back to Original Medicare from a Medicare Advantage plan
- You may change from a Medicare Advantage plan without drug coverage to a Medicare Advantage plan with drug coverage, or vice versa.
- You may sign up for a Part D plan for prescription drug coverage or choose to drop your Part D prescription drug plan.
- You may change to a new plan from your current insurance company or change to a new plan with a new insurance company.
If you decide to change your coverage during the Annual Enrollment Period, your new benefits will start on January 1st. However, you are not required to make changes to your plan. If you don’t make changes, your current plan should automatically renew on January 1st.
6. Special Enrollment Periods
Special enrollment periods occur for rare and special circumstances, and eligibility must be proven in these cases. Special enrollment periods may apply for the following cases:
- If you delayed your Original Medicare enrollment (Part A and/or Part B) because you had creditable medical insurance through your employer. In this case, after your employer coverage ends, you will have an 8-month special enrollment period during which you may enroll in Original Medicare.
- If you delayed your Part D prescription drug coverage enrollment because you had creditable medical insurance through your employer. After your employer coverage ends, you will have a 63-day special enrollment period to enroll in Part D prescription drug coverage. This is crucial in order to avoid Part D late enrollment penalties.
You may also qualify for a special enrollment period if you experience a life-changing event while on a Medicare Part D or Medicare Advantage plan. Qualifying examples include but are not limited to the following:
- You move out of your plan’s service area
- Your plan stops providing services in your area
- You move into a skilled nursing facility or long-term hospital, or you move out of one of these facilities
- You gain or lose Medicaid coverage
- You are approved for extra help benefits or lose such benefits
- Various other situations, as explained in detail on Medicare.gov
If you are unsure whether you might be eligible for a special enrollment period, you may wish to talk to one of our licensed health insurance agents about your Medicare health plan options. Our Medicare guides can provide information to help you understand your plan options and qualifications and enroll in an insurance plan that meets your needs within the correct enrollment window.
How to Enroll in Medicare
You have a few options when you are ready to apply for Original Medicare:
- Apply online (this is the fastest option). As you prepare to apply, use the Medicare Documentation Checklist to gather the information you need in order for the process to go smoothly.
- Call the Social Security Administration toll-free at 1-800-772-1213 (TTY 1-800-325-0778).
- Visit your local Social Security office. The agency has a Social Security office locator on its website.
Applying for Original Medicare is a fairly straightforward process. When you are ready to explore your options for a Medigap or Medicare Advantage plan, the wisest course of action is to consult with a licensed insurance agent. The vast amount of plan options and insurance carriers to choose from can quickly become overwhelming. To avoid the unnecessary time, energy, and expense spent considering all these options on your own, a Medicare guide can quickly narrow down your coverage needs and budget preferences.
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With Policy Guide’s assistance, you will have access to the knowledge and expertise of professional agents who can help you compare different health plans, quotes, and policies to ensure that you make an informed decision. Let us guide you through this process so that your chosen plan best suits your needs.