Medicare Enrollment

medicare-open-enrollment-period

When it comes time for Medicare enrollment, there are some important things to be aware of, specifically when to enroll and what parts of Medicare you can enroll in.

There are many different parts of Medicare that you can be enrolled in, with some being completely optional. You can be enrolled in Original Medicare (Part A & Part B) alone. These two parts of Medicare will include your hospital and outpatient coverage. However, if you want prescription drug coverage, you will also need to enroll in a Part D prescription drug plan. 

Further, you are also given then option to choose to enroll in either a Medicare Advantage or Medicare Supplement/ Medigap plan. If you enroll in a Medicare Advantage plan, that plan completely replaces Original Medicare, and all your benefits with be provided by that plan. You cannot be enrolled in a Medicare Advantage Plan and a Medicare Supplement plan at the same time. 

There can also be penalties if you don’t enroll in Original Medicare or Part D when you are first eligible, so make sure you enroll when you are first eligible. It is important to talk with an experienced independent agent to determine which Medicare program(s) are right for you. Give us a call at 877-885-3484 for any assistance and questions.

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Medicare Enrollment Timelines

Initial Enrollment Period- Turning 65

When you turn 65, you enter your Initial Enrollment Period (IEP) for Medicare enrollment. This IEP begins 3 months prior to your 65th birthday month, includes the month of your 65th birthday, and ends 3 months after your 65th birthday. If you are already collecting benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Original Medicare to begin the month you turn 65. If you are not yet collecting benefits, you will need to complete an application for both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) yourself if you are going to be using Medicare as your primary health insurance, as you will not be enrolled in Medicare automatically. 

If you have to sign up, below are the various ways you can enroll:

  • Apply through the Social Security website. If you begin an online application, you will be given a re-entry number so you can go back to Social Security to finish your application if you can’t do it all at once.
  • Go to your local Social Security office but check to make sure they do not have limitations or require appointments due to the Covid-19 pandemic.
  • Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
  • If you worked for a railroad, call the RRB at 1-877-772-5772.

If you enroll in Medicare Parts A and B during your Initial Enrollment Period, your Medicare Part B start date will begin based on when you submit your application-

Medicare Initial Enrollment Periods

Medicare Program

When can you enroll?

Medicare Part A

You can enroll in Part A anytime after you are 64 and 9 months old or if you become eligible for Medicare for another reason. You will be automatically enrolled if you are receiving Social Security benefits; otherwise, you will need to enroll through the Social Security Administration yourself.

Medicare Part B

Most people can enroll in Part B during the 7 month Initial Enrollment Period, which starts three months before your 65th birthday, includes the month of your 65th birthday, and the three months after your 65th birthday.

Medicare Advantage (Part C)

Most people can enroll in a Medicare Advantage plan during the 7 month Initial Enrollment Period, which starts three months before your 65th birthday, includes the month of your 65th birthday, and the three months after your 65th birthday.

Medicare Part D Prescription Drug

Most people can enroll in a Part D prescription drug plan during the 7 month Initial Enrollment Period, which starts three months before your 65th birthday, includes the month of your 65th birthday, and the three months after your 65th birthday.

Medicare Supplement (Medigap)

When you turn 65 and are enrolled in Medicare Part B, you have a 6 month Open Enrollment Period when you can enroll in a Medicare Supplement plan with guarantee issue rights. This means you cannot be declined or charged more based on your health and any pre-existing conditions.

Do I Have to Sign Up for Medicare at 65?

If you are retired or looking to make Original Medicare your primary insurance when you are first eligible at age 65, you will want to sign-up for Medicare Parts A and B.

If you are already on Medicare disability, collecting Social Security benefits, or collecting benefits from the Railroad Retirement Board, you will be automatically enrolled in Medicare for coverage to begin the month of your 65th birthday. In this case, you will receive your red, white, and blue Medicare card about 3-4 months prior to your birthday.

If you are not already receiving benefits from Social Security or the Railroad Retirement Board, you will need to submit an application for Medicare Parts A and B. The application can be completed online through the Social Security website at www.StartPartB.com.

If you plan to continue working past age 65 and remain on your employer's health insurance plan, you do NOT want to apply for Medicare Part B when you turn 65. Rather, you will want to submit an application for Medicare Part B when you retire and leave your employer plan. This period is known as a Special Enrollment Period.

 

When Can I Enroll in Medicare?

Enrollment for Medicare must occur during an appropriate enrollment period. For enrollment in Original Medicare (Part A and Part B) there are three enrollment periods:

  • Initial Enrollment Period (IEP): Your IEP is a 7-month window surrounding your 65th birthday. This period begins 3 months prior to your 65th birthday, includes the month of your 65th birthday, and ends 3 months after your 65th birthday. This is your first opportunity to enroll into Medicare, other than qualifying for Medicare disability under age 65.
  • Special Enrollment Period (SEP): You may qualify for an SEP if you defer your Medicare enrollment at age 65 because either you or your spouse continue to work and remain on your employer-sponsored health insurance. Once you or your spouse decide to retire, you can request a Special Enrollment Period to enroll in Medicare (Part B or Parts A and B). To qualify for an SEP, your employer will need to complete the employer coverage form L-564, which will be attached to your Medicare application.
  • General Enrollment Period (GEP): The GEP in the enrollment period for someone who delayed their Medicare enrollment at age 65 without another form of creditable health insurance. The General Enrollment Period occurs every year from January 1st-March 31st, with coverage beginning July 1st. If you are required to apply for Medicare during the GEP, you will also likely face a late enrollment penalty for the length of time you delayed your Part B enrollment. 
Can I Enroll in Medicare While Working?

You can choose to make Original Medicare your primary health insurance, even if you plan to continue working. If Medicare has better benefits than the plan offered by your employer, it is worth it to consider making Medicare your primary insurance. You will want to, however, make sure you choose one or the other. You do NOT want to enroll in Medicare Part B while remaining on your employer's health insurance. You will need to decide to either remain on the group plan, or transition into Medicare completely with either a Medicare Supplement/ Medigap plan, or a Medicare Advantage plan. You can, however, remain on your employer plan and enroll in Medicare Part A. 

Medicare Enrollment If You Are Still Working

It is a little different to get started with Medicare for those who will be continuing to work after age 65 and have health insurance coverage through your employer. If you continue to remain under employer coverage past your Initial Enrollment Period, you will have different enrollment options when you decide to retire and transition into Medicare. 

One factor to determining whether you can delay your Medicare enrollment and continue on your employer-sponsored health insurance is the size of your current company. Your employer’s size will determine if you can delay Part A and Part B when you turn 65 without having to pay the penalty if you enroll later. Below are the two scenarios based on your employer’s size:

  1. If your employer has less than 20 employees, you should sign up for Part A and Part B when you first become eligible. You have to do this because with employers of this size, Medicare pays claims first (is primary) before your employer group coverage kicks in. If you don’t enroll when you’re first eligible, you could end up paying a Part B late enrollment penalty and have a gap in coverage if you decide you want Part B later.
  2. If your employer has 20 or more employees, you may be able to delay enrolling in Part A and Part B and not have to worry about the late enrollment penalty if you enroll later.

It is essential to talk with a Medicare expert and your company HR representative to ensure you are taking the correct action given your employer’s size and your individual situation.

If you decide to remain on your employer’s health insurance plan past after age 65, you will likely qualify for a Special Enrollment Period (SEP) when you initiate your retirement. This SEP gives you the option to enroll in Medicare Part B and Part D upon retirement to avoid any gaps in coverage.

Medicare Enrollment Periods and Timelines

Annual Medicare Enrollment Periods (Past Age 65)

Medicare Program

When can you enroll?

Medicare Part A & B

General Medicare Enrollment Period: If you miss your Initial Enrollment Period, you can sign up during Medicare’s General Enrollment Period (January 1–March 31), and your coverage will start July 1.

Medicare Advantage (Part C) & Medicare Part D Prescription Drug

The Medicare Annual Enrollment Period (October 15–December 7) allows you to enroll in,  drop or switch your plan coverage.

Medicare Advantage (Part C) & Medicare Part D Prescription Drug

Special Enrollment Periods: You may have the chance to sign up for or change your Medicare plan during a Special Enrollment Period if you have special circumstances. For example, if you move and the plan you have is not available in the area you move to.

Medicare Advantage (Part C) & Medicare Part D Prescription Drug

If you’re enrolled in a Medicare Advantage Plan and want to change your health plan, the Medicare Advantage Open Enrollment Period (January 1 – March 31) allows you to:

·         Switch to a different Medicare Advantage Plan with or without drug coverage

·         Go back to Original Medicare and, if needed, also join a Medicare Prescription Drug Plan  

Hopefully you found this Medicare overview helpful and now understand the different enrollment periods. We are always here to help with any questions. Just give us a call 877-885-3484.

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