Medicare Enrollment Periods: Why Do They Matter?

Initial Enrollment Period, General Enrollment Period, Annual Election Period, Special Enrollment Period – find out the differences and what they mean for you.
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Introduction

When it comes to enrolling in Medicare there are many rules around ‘enrollment periods’. Enrollment periods matter as they dictate when you can enroll or switch Medicare plans. In some circumstances they are also crucial, as failing to enroll within the enrollment period can cause you to incur Late Enrollment Penalties for Medicare Part A, B, or D.

In this article, we’ll define the key enrollment periods you need to know. They include:

  • Initial Enrollment Period (IEP)
  • General Enrollment Period (GEP)
  • Annual Election Period (AEP) (also known as ‘Annual Open Enrollment Period’)
  • Medicare Advantage Open Enrollment Period (MA-OEP)
  • Medicare Supplement (‘Medigap’) Open Enrollment Period (MS-OEP)
  • Special Enrollment Period (SEP)

Initial Enrollment Period (IEP)

The 7-month period around your 65th birthday

If you are turning 65, and already receiving Social Security or Railroad Retirement Board (RRB) benefits at least 4 months prior to turning 65, you will automatically be enrolled in Medicare Parts A and B.

If you are not automatically enrolled in Medicare, you will have to enroll in Medicare during your Initial Enrollment Period (IEP).

Your Initial Enrollment Period is the 7-month period that begins 3 months before the month you turn 65.

During this same period you may also choose to:

  • Enroll in a Medicare Advantage (Part C) plan (you will need to be enrolled in both Part A and B in order to be eligible for part C)
  • Enroll in a standalone Part D (Prescription Drug Coverage) plan (If you intend on keeping Original Medicare Part A and B)

You may choose to defer your enrollment if you are working past 65. You should only delay enrollment if you are eligible to delay penalty-free.

General Enrollment Period (GEP)

January 1 – March 31 each year

If you happen to miss your Initial Enrollment Period (and are not delaying enrollment in Medicare because you are still working) you can sign up for Part A and/or Part B during the General Enrollment Period (GEP) between January and March in any year after the year you are first eligible.

If you sign up during GEP, your coverage will start on July 1.  However, you may have to pay a higher premium for late enrollment in Part A and/or Part B. You can find out more about Late Enrollment Penalties here.

Annual Election Period (AEP)

October 15 – December 7 each year

The Annual Election Period (AEP) (also known as the Annual Open Enrollment Period) takes place on October 15 and December 7 each year and is available to all Medicare beneficiaries.

During the AEP, beneficiaries may:

  • Enroll into, disenroll (and return to Original Medicare) or switch Medicare Advantage (Part C) plans
  • Enroll in, disenroll or switch Prescription Drug Plans (PDP)

No action is required if you are choosing to keep your current plan, although it is always best practice to evaluate your options each year as both drug and plan benefits can change from year-to-year. The changes can include whether your doctor is covered (which is relevant if you are enrolled in the Medicare Advantage plan).

During AEP, you may choose to make more than one enrollment choice but the last choice made during AEP will be the election that takes effect on January 1st of the following year.

Medicare Advantage Open Enrollment Period (MA-OEP)

January 1 – March 31 each year

The Medicare Advantage Open Enrollment Period (MA-OEP) is often confused with the Annual Election Period (which is also sometimes called the Annual Open Enrollment Period), however, the two are not the same.

The MA-OEP is only for individuals who are enrolled in the Medicare Advantage plan as of January 1. This could be someone who has renewed (or in other words did not make a change during AEP), who is newly enrolled, or switched Medicare Advantage plans during AEP.

During the MA-OEP, anyone enrolled in a Medicare Advantage plan may:

  • Change to a different Medicare Advantage plan
  • Disenroll from Medicare Advantage and return to Original Medicare

You may only change plans once during the MA-OEP.

Special Enrollment Periods (SEP)

Variable periods depending on your situation

Medicare beneficiaries who experience a certain ‘qualifying event’ are provided a special period to enroll or change their Medicare coverage. These special periods are known as a Special Enrollment Period (SEP).

The time frames for SEPs vary, however, most will typically begin on the first of the month in which you experience the ‘qualifying event’.

Some of the more common situations (but not all) that result in a SEP are:

  • Losing employer coverage: if you had previously deferred enrollment into Medicare you have an 8-month SEP to enroll in Original Medicare or Medicare Advantage after you lose your employer coverage (or coverage from your spouse).
  • Change in residence: Medicare Advantage or Part D enrollees who move out of their plan’s service area have 4-month SEP beginning 1 month prior to the month you move.
  • Gaining or losing Medicaid eligibility / Low Income Subsidy (LIS): If you become eligible for Medicaid or LIS, you will be eligible for a SEP every calendar quarter between January and September (and can therefore change plans once per calendar quarter).
  • Chronic conditions: If you gain or have a severe or disabling chronic condition, you have a continuous SEP to make one enrollment into a Medicare Advantage plan that specifically covers your condition (known as C-SNP (chronic condition special needs plan)).
  • Medigap SEP: If you have previously dropped a Medigap policy to enroll in Medicare Advantage, you have a 12-month SEP to disenroll from and return to Original Medicare with a Medigap plan

You can find a comprehensive list of ‘qualifying’ circumstances here.

Medicare Supplement (‘Medigap’) Open Enrollment Period (MS-OEP)

6-months after you enroll in Part B

The Medicare Supplement Open Enrollment Period (MS-OEP) is the 6-month period after you enroll in Part B. For most people this will happen when you turn 65, however, some people may delay enrollment into Part B while they are still working.

Medigap is provided by private insurance carriers and the federal law does not require Medigap insurance carriers to accept you except in certain situations such as the MS-OEP.

During the MS-OEP, Medigap companies: (i) must sell you a policy without medical questions, (ii) cannot deny you coverage, and (iii) cannot charge you an additional premium for coverage because of your medical history.  This is known as a ‘guaranteed issue’.

The MS-OEP only happens once and does not renew once it has lapsed. This is the best time to purchase a Medigap policy if you want one. If you apply for Medigap coverage after your MS-OEP there is typically no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements. Some states may have other certain guaranteed issue periods outside of MS-OEP.

Final Words

It’s important to make sure you understand your enrollment periods.  Missing critical enrollment periods can result in both Late Enrollment Penalties and gaps in healthcare coverage leaving you exposed.  If you are ever unsure make sure to reach out to a licensed health insurance agent.

At CoverRight, we’re here to help you find the right coverage that you deserve.   Reach out today and start finding the best Medicare plan for you.