Are You Aware of Medicare Enrollment Rules?

By Crystal Manning

Medicare open enrollment is the annual period from Oct. 15 to Dec. 7 when people who have Medicare can change their health insurance plan. Specifically, you can apply for or make changes to your Medicare Part C (Medicare Advantage) and Medicare Part D prescription drug plans. All plan changes go into effect on January 1st of the following year.

Open enrollment for Medicare, also known as the annual election period or AEP, is the time when everyone who has a Medicare Advantage plan is allowed to make changes to their current Medicare coverage. There are a few other times throughout the year when some Medicare recipients can change their health plans, but not everyone qualifies to make changes during those other times.

What is Medicare open enrollment?

Medicare open enrollment starts Oct. 15 and ends Dec. 7 each year.

Specifically, open enrollment allows you to-

  • Switch from Original Medicare (Part A and Part B) to Medicare Advantage (Medicare Part C)

  • Switch from a Medicare Advantage plan to Original Medicare

  • Switch from one Medicare Advantage plan to another

  • Enroll in a Medicare Part D (prescription drug) plan

  • Switch from one Medicare prescription drug plan to another

Who can apply during Medicare open enrollment (AEP)?

The Medicare open enrollment period is for current Medicare beneficiaries, no matter what types of Medicare you’re enrolled in. It doesn’t matter if you use Original Medicare (Part A and B) or if you have a Medicare Advantage Plan (Part C).

What if I miss Medicare open enrollment?

The Medicare Advantage Open Enrollment Period (MA OEP) is the time when you can switch from one Medicare Advantage Plan to another, or switch from a Medicare Advantage Plan to Original Medicare with or without a Part D plan, if you did not do this before December 7the.  The MA OEP occurs each year from January 1 through March 31, and changes take effect on the first of the month following the month you enroll. You can only make one change during the MA OEP.

Special enrollment periods (SEPs)

Special enrollment periods allow Medicare beneficiaries to sign up for or make changes to their Medicare health plans following certain life events. Different events allow you to sign up for different parts of Medicare through a SEP.

If you need to sign up for Original Medicare but do not qualify for special enrollment, you won’t be able to enroll in Medicare until the next general enrollment period, which is from Jan. 1 to March 31 each year. The only exception is if you are in your initial enrollment period, meaning you just became eligible for Medicare.

Medicare Supplement Insurance coverage (Medigap)

Medicare Supplement Insurance, also known as Medigap, helps beneficiaries pay out-of-pocket expenses associated with Original Medicare, including your copays, deductibles, and coinsurance. If you’re struggling with out-of-pocket costs, consider a Medicare supplement plan.

To apply for a Medigap plan, you must already be enrolled in Original Medicare. Once you enroll in Medicare Part B, you will have a six-month period to enroll in Medigap plans. You can also enroll in a Medigap plan during the standard Medicare open enrollment. It’s possible to cancel and enroll in a new Medigap plan at any time during the year, but insurers aren’t required to accept you for a new plan outside of the Medigap enrollment period, based on medical past history.

Getting Medicare for the first time — initial enrollment period

Individuals who are enrolling in Medicare for the first time do not sign up for Medicare or apply for plans during open enrollment. Instead, they have a seven-month initial enrollment period when they can apply. Initial enrollment starts three months before you turn 65, includes the month of your 65th birthday, and ends three months after your birthday month.

Some Americans are automatically enrolled in Medicare Part A and Medicare Part B (Original Medicare) when they turn 65 if they are already claiming Social Security benefits or Railroad Retirement Board benefits.

If you aren’t automatically enrolled and you don’t sign up during the initial enrollment period, you usually must wait until the next Medicare general enrollment period to sign up. General enrollment takes place from Jan. 1 to March 31 each year. Coverage then goes into effect on July 1. Penalties may apply if you do not follow Medicare enrollment guidelines.

The Medicare rules are complex and can be confusing. And mistakes can be costly. For more guidance as you make these decisions, please contact Crystal Manning, Licensed Medicare Specialist, for a no-cost consultation at 412-716-4942 or crystalmanning33@gmail.com.