Medicare Enrollment Periods Explained

Medicare, the federal health insurance program primarily for people aged 65 and older, as well as some younger individuals with disabilities, has specific enrollment periods that determine when you can sign up or make changes to your coverage. Understanding these periods is crucial to avoid late penalties and gaps in coverage.

1. Initial Enrollment Period (IEP)

• Who It’s For: Anyone turning 65 or those under 65 with a qualifying disability.

• When It Happens:

  • Starts three months before your 65th birthday month.

  • Includes your birthday month.

  • Ends three months after your birthday month.

  • If you qualify due to disability, IEP starts three months before your 25th month of disability benefits and lasts for seven months.

• What You Can Do:

  • Enroll in Original Medicare (Part A and Part B).

  • Sign up for a Medicare Advantage plan (Part C) or a Prescription Drug Plan (Part D) if you already have Part A or Part B.

• Late Penalties:

  • If you miss enrolling in Part B and don’t have qualifying coverage elsewhere, you may face a lifetime late enrollment penalty.

  • Part D also has a late enrollment penalty if you don’t sign up when first eligible.

2. General Enrollment Period (GEP)

• Who It’s For: Those who missed their Initial Enrollment Period and don’t qualify for a Special Enrollment Period.

• When It Happens:

  • Annually from January 1 to March 31.

• What You Can Do:

  • Enroll in Medicare Part A and/or Part B.

  • Enroll in a Medicare Advantage plan (Part C) or Part D from April 1 to June 30 (if you already have Parts A and B).

• Late Penalties:

  • Part B premiums increase by 10% for every full 12-month period you were eligible but didn’t enroll.

  • Part D penalties apply if you go without creditable drug coverage for 63 days or more.

• Coverage Start Date:

  • As of 2023, coverage begins the month after you enroll (previously, coverage started in July).

3. Special Enrollment Periods (SEP)

• Who It’s For: People who have qualifying life events allowing them to enroll or change plans outside of regular enrollment periods.

• When It Happens:

  • Depends on the event.

• Common Qualifying Events:

  • Employer Coverage Ends: If you had health insurance through an employer, you have an 8-month SEP after losing coverage to sign up for Part B without penalty.

  • Moving Out of Your Plan’s Service Area: You can switch to a new Medicare Advantage or Part D plan.

  • Qualifying for Medicaid or Extra Help: May allow for plan changes at any time.

  • Natural Disasters or Other Exceptional Circumstances: The government may declare an SEP in certain situations.

• What You Can Do:

  • Enroll in Part A, Part B, Part C, or Part D, depending on the event.

4. Medicare Advantage Open Enrollment Period (MAOEP)

• Who It’s For: People already enrolled in a Medicare Advantage (Part C) plan.

• When It Happens:

  • January 1 – March 31 annually.

• What You Can Do:

  • Switch to another Medicare Advantage plan (with or without drug coverage).

  • Drop Medicare Advantage and return to Original Medicare (and enroll in a Part D plan if needed).

• What You CANNOT Do:

  • Switch from Original Medicare to Medicare Advantage.

  • Join a Medicare Prescription Drug Plan if you have Original Medicare and aren’t switching from Medicare Advantage.

5. Annual Enrollment Period (AEP)

• Who It’s For: Anyone with Medicare who wants to change their coverage.

• When It Happens:

  • October 15 – December 7 each year.

• What You Can Do:

  • Switch from Original Medicare to Medicare Advantage (or vice versa).

  • Change Medicare Advantage plans.

  • Enroll in, change, or drop a Part D prescription drug plan.

• Coverage Start Date:

  • January 1 of the following year.

Key Takeaways

• Enroll early to avoid penalties.

• Keep track of deadlines to avoid gaps in coverage.

• Review your plan annually to ensure it still meets your needs.

Would you like help determining which period applies to your situation?

Call or text Darko (440) 537-0518