An Overview of Medicare Periods of Enrollment

When you become eligible for Medicare healthcare coverage, you only have a small timeframe to enroll. Using the time allotted to consider and subsequently enroll in coverage is imperative. The Centers for Medicare & Medicaid Services (CMS) has strict guidelines for Medicare enrollment, so if you miss the time to enroll, you may face a delay of coverage or be assessed penalties later on. Knowing when you will become entitled to Medicare and what options are available can help when choosing the best option to fit your unique needs.

There are several Medicare enrollment periods when beneficiaries can enroll, make changes, or drop coverage. Not everyone will qualify to participate in each type of enrollment period. If you miss the enrollment period, you may have to wait several months before you can rectify the situation.

The six main Medicare enrollment periods are as follows:

Initial Enrollment Period

Who qualifies: Anyone entitled to Medicare health coverage for the first time due to turning 65.
Timeframe for Medicare enrollment: The three months before turning 65, the 65th birthday month, and the three following months.
Changes you can make: Enroll in an available Medicare plan, including Original Medicare, a Part D Prescription Drug plan, a Supplemental Plan, or a Medicare Advantage Plan.
Changes take effect: The month of your 65th birthday if the Medicare enrollment occurred prior to that. If not, the month after enrollment is complete.

Supplemental/Medigap Open Enrollment Period

Who qualifies: Beneficiaries who turn 65 and have signed up for Medicare Part B.
Timeframe for enrollment: The month of entitlement and the five months after.
Changes you can make: Buy a Supplemental plan policy.
Changes take effect: Generally, the month after enrollment.

General Enrollment Period

Who qualifies: Individuals who miss their chance to apply for coverage during their Initial Enrollment Period.
Timeframe for Medicare enrollment: January 1st to March 31st
Changes you can make: Sign up for Medicare Part A and Medicare Part B.
Changes take effect: The month following enrollment.

Special Enrollment Period

Who qualifies: Qualification varies, but certain life events, including losing existing coverage or moving, can trigger a Special Enrollment Period.
Timeframe for enrollment: Enrollment periods can vary, but will typically last two months. If coverage ends due to a change in employment, beneficiaries may have up to eight months to enroll.
Changes you can make: Sign up for Medicare Part A and Medicare Part B or enroll in or make changes to a Medicare Advantage or Medicare Part D Prescription Drug plan.
Changes take effect: The month following enrollment.

Advantage Open Enrollment Period

Who qualifies: Beneficiaries currently receiving their healthcare coverage through a Medicare Advantage Plan.
Timeframe for enrollment: January 1st to March 31st
Changes you can make: Switch to another Medicare Advantage plan or change back to Original Medicare, with or without a Prescription Drug plan. Only one change can be made during this period.
Changes take effect: The month after enrollment.

Annual Open Enrollment Period

Who qualifies: Anyone enrolled in a Medicare plan, including Medicare Advantage or Original Medicare.
Timeframe for enrollment: October 15th to December 7th
Changes you can make: Switch Medicare Advantage plans, add, drop, or change Medicare Part D Prescription Drug coverage, or move to/from Original Medicare to a Medicare Advantage plan.
Changes take effect: January 1st of the following year.

Disability and Medicare

Individuals out of work due to a disabling condition and receiving Social Security Disability Insurance (SSDI) benefits can qualify for Medicare after a waiting period of twenty-four months after their initial entitlement to SSDI benefits. In addition, individuals with Amyotrophic Lateral Sclerosis (ALS – or Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD) can qualify for Medicare coverage much sooner than twenty-four months.

A Deeper Look at Special Enrollment Periods

A Special Enrollment Period can allow beneficiaries to change their coverage outside of a typical Medicare enrollment period when certain life events happen. Circumstances and qualifications will vary, but Special Enrollment Periods can help close gaps in coverage that arise expectedly or unexpectedly.

Understanding the importance of Medicare, recently enacted changes through the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act expanded the availability of Special Enrollment Periods, providing opportunities for even more Medicare beneficiaries to make changes to or enroll in a plan that best fits their medical and financial needs.

Qualifications for Special Enrollment Periods

The list of qualifications for a Special Enrollment Period includes, but is not limited to, individuals:

• Missing coverage due to termination of or change in Medicaid eligibility;
• Whose Extra Help/the Low Income Subsidy (LIS) assistance has terminated or changed;
• Who voluntarily or involuntarily lost their current healthcare coverage, including Medicare, employer, or other creditable coverage;
• Who received misinformation about coverage eligibility from their employer, health plan provider, agent, or broker;
• Moving back to the United States or a different county within the United States;
• Who want to enroll in a 5-star plan but are not currently enrolled in one;
• Impacted by an emergency or disaster as declared by a federal, state, or local government; or,
• Who were formerly incarcerated or institutionalized.

In addition, other exceptional circumstances will be reviewed on a case-by-case basis.

Speak with an Experienced Licensed Insurance Agent

Medicare enrollment can be complicated, so making an informed decision about coverage is important. A licensed insurance agent can provide Medicare assistance and support during this critical decision-making period. Agents can offer a complete overview of Medicare, eliminating any confusion at the start.

Contact us to speak with an agent about your Medicare enrollment options. Guidance extends through every step of the enrollment process, starting with helping select a Medicare plan that meets medical and financial needs.

Nothing in this post is intended as advice or a suggestion to elect or not elect to claim benefits of any kind, including Social Security or Medicare benefits, nor is it intended as financial advice in any way. The decision to claim benefits is a personal one that is contingent upon each individual’s unique circumstances. Nothing herein is considered medical advice, diagnosis, or treatment.

Please note that as of 2021, The Advocator Group now conducts business as Brown & Brown Absence Services Group. While our name may have changed, our commitment to excellent service and helping our clients in as many ways as possible has not.