There are several enrollment periods for Medicare, depending on your individual situation and the type of Medicare service you sign up for. These enrollment periods have different names, and the lack of standardization can sometimes lead to confusion over exactly when an eligible person can enroll. Let’s discuss each one below, in order to clarify how they may or may not apply to you.
INITIAL ENROLLMENT PERIOD (IEP)
If you become eligible for Medicare because you are turning 65, your IEP is a seven month period that begins three months before the month of your 65th birthday, and extends three months after the month of your 65th birthday. For example, if your 65th birthday occurs in the month of July, then your IEP begins April 1 and ends October 31. You may sign up for original Medicare Part A and/or B. You may also sign up for a stand-alone prescription drug coverage plan, Part D. If you sign up for BOTH A and B, then you are also eligible to sign up for a private Medicare Advantage Part C plan, either with or without drug coverage. (Exception: In most cases, if you have End-Stage Renal Disease (ESRD), you cannot join a Medicare Advantage Part C plan.)
A Medicare Advantage Part C plan combines original Medicare Part A and B into one package, and most plans include prescription drug coverage as well. However, they are only available in certain selected locations, and their network providers may be limited to that particular geographic region. If you travel extensively, these plans may not cover you outside your local network, depending on the insurance carrier.
If you are already eligible for original Medicare due to a disability and are turning 65, your IEP is a seven month period that begins three months before the 25th month of disability benefits received from Social Security or the Railroad Retirement Board, and extends three months after that 25th month. For example, if you began receiving disability benefits in June, the 25th month of benefits would be two years later in July. Thus, your IEP would begin April 1 and ends October 31. You may sign up for a Medicare Advantage Part C plan (with or without prescription drug coverage) or a stand-alone prescription drug Part D plan. You may also switch from your current Medicare Advantage Part C or Part D plan to another plan, or you can drop a Medicare Advantage Part C or Part D plan completely and return to original Medicare Part A and/or B.
If you become newly eligible for Medicare because you have a disability and you’re under 65, your IEP period begins 21 months after you begin to receive Social Security or Railroad Retirement Board (RRB) disability benefits, through the 28th month after you began receiving these benefits. During this IEP, you may sign up for a Medicare Advantage Part C plan (with or without prescription drug coverage) or a Medicare stand-alone prescription drug Part D plan
If you already have Medicare Part A, and you enroll in Part B for the first time during the Open Enrollment Period (OEP) of January 1 through March 31, you may sign up for a Medicare Advantage Part C plan (with or without prescription drug coverage) between April 1 and June 30. If you did not sign up for Medicare Part B when you were first eligible, you may have to pay a late-enrollment penalty.
ANNUAL ENROLLMENT PERIOD (AEP)
Also known as the Annual Election Period (AEP), this runs from October 15 through December 7. This period allows many changes, which is why private companies offering various Medicare plans saturate the market with heavy advertising. During AEP, you may:
■ Change from Original Medicare to a Medicare Advantage plan
■ Change from a Medicare Advantage plan back to Original Medicare
■ Switch from one Medicare Advantage plan to another Medicare Advantage Plan
■ Switch from a Medicare Advantage plan without drug coverage to a Medicare Advantage with it
■ Switch from a Medicare Advantage plan with drug coverage to a Medicare Advantage plan without it
■ Join a Medicare prescription Part D plan
■ Switch from one Medicare prescription Part D plan to another Part D plan
■ Drop your Medicare prescription Part D plan completely.
OPEN ENROLLMENT PERIOD (OEP)
If you happen to miss your IEP, the next chance to enroll is the OEP, from January 1 through March 31. If you did not sign up for Medicare Part B when you were first eligible, you may have to pay a late-enrollment penalty. If you aren’t eligible for premium-free Part A, you may owe a late-enrollment penalty for Part A as well. You usually get Part A without paying a premium if you worked at least 10 years (40 quarters) and paid Medicare taxes.
If you already have a Medicare Advantage Part C plan, you may make one change during OEP:
■ Switch to another Medicare Advantage Part C plan (with or without prescription drug coverage)
■ Disenroll from your Medicare Advantage Part C plan and return to Original Medicare. If you choose to do so, you’ll be able to join a Medicare prescription Part D plan
■ If you enrolled in a Medicare Advantage Part C plan during your Initial Enrollment Period (IEP), you may change to another Medicare Advantage Part C plan (with or without drug coverage) or return to original Medicare (with or without a Medicare prescription Part D plan) within the first 3 months you have original Medicare.
However, if you are already enrolled in original Medicare, OEP does not allow you to enroll into a Medicare Advantage Part C plan, or enroll into a Medicare prescription Part D plan, or switch from one Part D plan into another.
SPECIAL ENROLLMENT PERIOD (SEP)
You can make changes to your Medicare Part A and B plans and Medicare prescription Part D plans when certain events happen in your life, such as moving to a new location or losing other insurance coverage. The chance to make these changes are called Special Enrollment Periods (SEPs), and are in addition to the enrollment periods listed above. Rules about when you can make changes and the type of changes you can make are different for each SEP. These rules are complex and involve many different individual scenarios. Please contact a Medicare Specialist to discuss Special Enrollment Period details that may apply to your individual circumstances.
MEDICARE SUPPLEMENTS, or “Medigaps” are popular private plans that pick up costs after original Medicare Part A and B has paid the maximum benefit. They are available nationwide, and people can enroll in these plans with or without a stand-alone prescription Part D plan. However, Medicare Supplement plans cannot be used with a Medicare Advantage Part C plan. Washington is a “guaranteed issue” state for Medicare Supplement plans, and they are not subject to the same enrollment period restrictions outlined above.
Information Complied by:
Gary Floring, We Speak Medicare agent Clallam and Jefferson counties Email: GaryFloring@WeSpeakMedicare.org Phone: 360-434-6791