Medicare Enrollment Guide

The Medicare Enrollment Guide* is designed to help navigate the world of Medicare, which can be complex, but understanding enrollment options is crucial for securing the healthcare coverage one may need. This guide helps individuals walk through the various enrollment periods and eligibility criteria for Medicare plans, including Medicare Advantage, Prescription Drug Plans (PDP), and Medicare Supplement (Medigap) policies. Whether someone is approaching 65 or looking to switch plans, our goal is to provide clear, comprehensive information to help one make informed decisions about Medicare coverage. Explore and learn about Initial Enrollment Periods, Annual Enrollment Periods, Special Enrollment Periods, and more. 

To join a Medicare Advantage Plan, beneficiaries must first be enrolled in both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Enrollment in these plans is only allowed during specific "election periods," which are designated times when changes to Medicare coverage can be made.

The Initial Enrollment Period (IEP) is the first opportunity for eligible individuals to enroll in Medicare. It lasts for seven months:

• Starts: Three months before the month you turn 65.
• Ends: Three months after the month you turn 65.

During this period, beneficiaries can sign up for Medicare Part A, Part B, and a Medicare Advantage plan.

The Initial Coverage Election Period (ICEP) is specifically for those who are enrolling in a Medicare Advantage plan for the first time. The ICEP coincides with the IEP for individuals who are new to Medicare, meaning it also lasts for seven months:

• Starts: Three months before the month you turn 65.
• Ends: Three months after the month you turn 65.

During the ICEP, beneficiaries can choose a Medicare Advantage plan, which is an alternative to Original Medicare (Part A and Part B).

Additionally, during the IEP, individuals can also enroll in a Prescription Drug Plan (PDP). A PDP provides coverage for prescription medications and can be added to Original Medicare (Part A and Part B) or some Medicare Advantage plans that do not include drug coverage. This ensures that beneficiaries have comprehensive coverage for their healthcare needs, including medications.

The Annual Enrollment Period occurs every year from October 15 to December 7. During this time, beneficiaries can:

• Switch from Original Medicare to a Medicare Advantage Plan.
• Switch from one Medicare Advantage Plan to another.
• Enroll in or change Prescription Drug Plans (PDPs).
• Drop a Medicare Advantage Plan and return to Original Medicare.

Changes made during this period take effect on January 1 of the following year.

Special Enrollment Periods allow beneficiaries to make changes to their Medicare coverage outside of the standard enrollment periods. SEPs can be triggered by certain life events, such as:

• Moving to a new area that offers different plan options.
• Losing current coverage (e.g., due to leaving an employer plan).
• Gaining eligibility for Medicaid.
• Qualifying for Extra Help with prescription drug costs.

The specific timing and duration of an SEP depend on the qualifying event.

• Requirements: Enrolled in both Medicare Part A and Part B.
• Location: Must live in the plan’s service area.
• Exceptions: Beneficiaries with End-Stage Renal Disease (ESRD) are generally not eligible unless enrolling in a special plan designed for ESRD patients.

• Eligibility: Must have Medicare Part A and/or Part B.
• Enrollment Periods:
  • Initial Enrollment Period for Part D (IEP for Part D): Same as the IEP for Medicare.
  • Annual Enrollment Period (AEP): October15 to December 7.
  • Special Enrollment Periods (SEPs): Similar to SEPs for Medicare Advantage.

• Eligibility: Must have Medicare Part A and Part B.
• Open Enrollment Period:
  • Lasts for six months, starting the first day of the month you are 65 or older and enrolled in Part B.
  • During this period, you can buy any Medigap policy sold in your state, regardless of health conditions.
• Guaranteed Issue Rights:
  • In certain situations, you have the right to buy a Medigap policy without medical underwriting. Examples include losing other health coverage or having a Medicare Advantage Plan that is leaving the Medicare program.
• Trial Right in Medigap and Medicare:
  • The "Trial Right" allows you to switch from Medicare Advantage (Part C) to Original Medicare (Parts A and B) with a Medigap policy within 12 months.
  • First-Time Enrollees: At age 65, join Medicare Advantage and have 12 months to switch back to Original Medicare and get a Medigap policy.
  • Switching from Medigap: Drop a Medigap policy for Medicare Advantage, and within 12 months, switch back to Original Medicare and reclaim or buy a new Medigap policy.

• Late Enrollment Penalties: Enrolling late in Medicare Part B or Part D can result in penalties.
• Review Plans Annually: Beneficiaries should review their Medicare plan options annually to ensure they meet their healthcare needs and budget.
• Medicare Cost Plan (MCP): A type of health plan offered by private insurance companies, combining Medicare Part A and Part B coverage and often additional benefits. You can see any doctor that accepts Medicare, with Original Medicare covering out-of-network services.

• Medicare.gov: The official Medicare website provides detailed information and tools for comparing plans.
• Medicaid.gov: The official Medicaid website offers comprehensive resources, eligibility information, and access to state-specific programs and services.
• State Health Insurance Assistance Programs (SHIP): Offer free, personalized counseling to Medicare beneficiaries.
• Social Security Administration (SSA): Handles enrollment in Medicare and provides information on eligibility.

For further information and resources, including official Medicare booklets, guides from the U.S. Government, and more, EXPLORE here.

Click Button | Medicare Section