Medicare Enrollment Periods

Learn about Medicare Enrollment Periods – Special Enrollment, General Enrollment, Annual Election Period, and when you can change plans.

Your Medicare enrollment period is when you can sign up for different types of Medicare plans. Your open enrollment period will depend on the coverage you want. Below, you will learn about the various sign-up periods for different Medicare plans and when you can change yours if you don’t like your current plan.

Many people are confused about Medicare enrollment periods and when they can enroll in Medicare. Some believe that they must already be retirees before they can enroll. There are different types of enrollment periods with different dates, which makes the confusion understandable. Depending on your situation, you might not need to enroll when you first become eligible for Medicare. People receiving Social Security benefits when they turn 65 are automatically enrolled in Original Medicare.

  • Quick tip:

    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.

However, if you don’t qualify for automatic enrollment or would like to enroll in a Medicare Advantage or Medigap plan, you will need to take advantage of other enrollment periods.

1. Initial Enrollment Period

  • The Medicare initial enrollment period is a seven-month window around your 65th birthday, during which 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 until three months after your birthday month.

Suppose you are disabled and receive Social Security Disability insurance benefits (SSDI) or Railroad Retirement Board benefits. In that case, your initial enrollment period will occur when you receive your 24th disability benefits payment from Social Security or Railroad Retirement or on your 65th birthday, 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. A minor child with end-stage renal disease can also qualify for Medicare based on their parent’s work credits.

You can apply for Medicare Part A and B if you have an end-stage renal disease (ESRD). As long as you have applied and met the earnings requirements for SSDI, your Part A health coverage will be available 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

You can enroll in Original Medicare Parts A and B during your initial enrollment period, or you can choose to only enroll in Part A while delaying your enrollment in Medicare Part B. Since most people qualify for $0 monthly premiums for Part A, signing up for Part A during the initial enrollment period makes sense. However, if you already have creditable insurance coverage through a group health plan, you might choose to delay enrolling in Medicare Part B.

When your coverage starts will depend on when you enroll in Medicare. If you enroll three months before you turn 65, your benefits will begin on the first day of your birth month. For example, if you enroll in Original Medicare in November and turn 65 on February 18, your benefits will begin on February 1. If you enroll in Medicare on your 65th birthday on February 18, your coverage will start on March 1. If you wait to enroll in Medicare until April 5, your benefits will begin on May 1.

2. Medicare Supplement Open Enrollment Period

The best time to purchase a Medicare Supplement or Medigap plan is during the Medigap open enrollment period. This period starts on the first day of your birth month and lasts for six months. However, you must have signed up for Part B coverage and paid your Part B premium before you can enroll in a Medicare Supplement plan. In addition, Medigap plans do not offer prescription drug benefits. However, you can get Medicare prescription drug coverage through a Part D plan.

Suppose you wait to purchase a Medicare Supplement plan until later instead of doing so during the Medicare Supplement open enrollment period. In that case, you might not be able to enroll in a Medigap plan. During the open enrollment period, you have guaranteed issue rights, which means that insurance companies can’t deny your application based on pre-existing health conditions. However, if you don’t enroll during open enrollment and apply later, the insurance companies might ask you some questions about your medical conditions and could deny you during underwriting.

3. General Enrollment Period

  • There is a general enrollment period for Part A and Part B that lasts from January 1 to March 31 each year.

You can enroll in Medicare Part A and/or Part B during the general enrollment period as long as the following conditions apply:

  • You didn’t 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.

4. Annual Election Period

If you want to change your Medicare coverage, you can do so by enrolling in a different plan between Oct. 15 and Dec. 7 as follows:

  • You can change to a Medicare Advantage plan from Original Medicare or back to Original Medicare from a Medicare Advantage plan.
  • You can change from a Medicare Advantage plan without drug coverage to a Medicare Advantage plan that includes it or vice versa.
  • You can sign up for a Part D plan for prescription drug coverage or choose to drop your Medicare prescription drug plan.
  • You can change to a new plan from your current insurance company or change to a new insurer.

If you decide to change your coverage during the Annual Enrollment Period, your new benefits will start on Jan. 1. If you don’t want to change your coverage, you don’t have to. In that case, your current plan should automatically renew on Jan. 1.

5. Medicare Advantage Open Enrollment Period

Each year, the government releases its star ratings for Medicare Advantage plans. Private insurance providers offer Medicare Advantage plans and offer coverage options you might not get with Original Medicare, including special needs plans. If your current plan has a low star rating, you might want to change it. During this period, you can make a one-time election to switch to a different Medicare Advantage plan or Original Medicare for your health care. You can also enroll in a Part D prescription drug plan during this period. If you use this open enrollment plan, your new benefits will begin on the first day of the month after you make the election.

Suppose you decide to switch back to Original Medicare during the Medicare Advantage open enrollment period. In that case, you can also choose to add a Medicare Supplement plan following your dis-enrollment in Part C and enrollment in Original Medicare. However, you should note that if you are outside the six-month Medicare Supplement Enrollment Period, an insurance company will ask you medical questions before you qualify for coverage.

6. Special Enrollment Period

The Medicare Special Enrollment period is among the most complicated for people to understand. Many Medicare beneficiaries will not be eligible for a Medicare Special Enrollment Period. Eligible people have to prove that they qualify.

A Special Enrollment period might occur when you delay enrolling in Original Medicare instead of signing up when you first became eligible. The most common reason someone might delay their enrollment is when they have medical insurance through their employers when they turn 65.

After your employer coverage ends, you will have a Special Enrollment Period during which you can enroll in Original Medicare. This type of Special Enrollment Period will last eight months from when your employer-provided coverage ended.

There is also a Special Enrollment Period for you to enroll in Medicare Part D. You will have 63 days to enroll in Part D after you enroll in Original Medicare. To avoid the Part D late enrollment penalty, you should enroll in a drug plan when you lose your employer benefits.

You will also qualify for a Special Enrollment Period if you experience a life-changing event while on a Medicare Part D or Medicare Advantage plan. The qualifying life-changing events include the following:

  • You move out of the plans service area.
  • Your plan stops providing services in your area.
  • You move into a skilled nursing facility or out of one.
  • You gain or lose Medicaid coverage.
  • You lose or are approved for Extra Help benefits.

If you are unsure whether you might be eligible for a Special Enrollment Period, you can talk to one of our licensed health insurance agents about your Medicare health plan options. An agent can provide Medicare information to help you understand your plan options and qualifications and enroll in an insurance plan that meets your needs within the enrollment window.

Understanding Medicare and the Medicare Enrollment Periods is not as difficult as it might initially seem. As long as you apply for the type of plan during its enrollment period, you should be able to get the type of plan you want to meet your medical needs and your budget.