Everything you need to know about Your Medicare Enrollment Periods
If you are new to signing up for Medicare Part A and Part B, you will need a crash course on the different enrollment periods. Our goal is to teach you everything you need to know about Medicare enrollment periods.
You may find yourself here as a result of not completing your enrollment when you were first eligible.
Please note we recommend getting started by signing up for health care three months before your Medicare eligibility. Let’s touch on Medicare basic first and then we will jump right in.
Table of Contents
What is the Medicare and Do I have Options?
Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease. Medicare has four parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans), and Part D (Prescription Drug Coverage).
You can get Medicare coverage in two ways: Original Medicare with a Medigap plan or a Medicare Advantage Plan.
Most people who have Medicare get it through Original Medicare and buy a Medicare supplement plan. However, there is a shift towards Medicare Advantage plans due to the massive influx in television marketing.
With Original Medicare, you can see any doctor or facility that accepts Medicare. You can also buy a Medicare Supplement Insurance plan (called Medigap) to help pay your out-of-pocket costs. If you want prescription drug coverage, you must join a Medicare Part D Prescription Drug Plan.
You can also get your Medicare benefits through a Medicare Advantage Plan, like an HMO or PPO. If you have a Medicare Advantage Plan, you receive your Part A and Part B coverage from the Advantage plan.
The Medicare Advantage Plan may also offer extra coverage, like routine vision or basic dental care. You must have Medicare Parts A and B to join a Medicare Advantage Plan.
What is the Enrollment Period for Medicare:
Initial Enrollment Period (“IEP”):
You’re first eligible for Medicare when you turn 65. If you’re already receiving Social Security benefits, you’ll automatically be enrolled in Parts A and B. If not, you need to sign up for Medicare during your Initial coverage election Period. This period starts 3 months before the month you turn 65, includes the month you turn 65 and ends 3 months after the month you turn 65. -Special Enrollment Period: If you didn’t sign up for Part B when you were first eligible, you can enroll during a Special Enrollment Period. This period lasts for 8 months and begins the month after your employment or group health insurance ends, whichever comes first.
Annual Enrollment Period:
The best time to make changes to your existing coverage is during the Open Enrollment period from October 15–December 7 each year. During the open enrollment period, you can: Switch from Original Medicare to a Medicare Advantage Plan, Switch from one Medicare Advantage Plan to another Medicare Advantage Plan, you can dis-enroll from a Medicare Advantage plan and return back to Original Medicare, and make changes to your standalone Part D Prescription drug plan.
General Enrollment Period (“GEP”):
If neither of the above enrollment periods applies to you and it’s outside of open enrollment, then your next chance to sign up will be during the General Enrollment Period, which runs from January 1–March 31 each year. Medicare Beneficiaries will be required to wait until the general enrollment is available if they miss the plan during their initial enrollment period.
If you enroll during the general enrollment period, your coverage will take effect on July 1.
Medicare Advantage Special Enrollment Period (“SEP”):
If you qualify for a special enrollment period, you can switch to a Medicare Advantage Plan during this period.
The following conditions qualify for a special enrollment period:
- You move outside of your plan’s service area.
- You’re enrolled in a pilot program that’s ending.
- You lose other creditable coverage.
- You qualify for a Special Needs Plan.
- You’re released from jail or prison.
Medicare Special Enrollment Period (“SEP”):
You may be able to enroll in or change your coverage for, Parts A and/or B during a Special Enrollment Period if you meet certain conditions. For example, you may be eligible for a special enrollment period if you’re employed and have group health coverage through your employer or union, or if you have COBRA continuation coverage.
Medicare Advantage Open Enrollment Period (“AEP”) & Part D Prescription Drug Plan:
The Medicare Advantage & Part D Annual Enrollment Period is October 15–December 7 each year. During this time, you can: Enroll in a Medicare Advantage Plan Switch from one Medicare Advantage Plan to another Medicare Advantage Plan Dis-enroll from a Medicare Advantage Plan, and return back to Original Medicare Make changes to your existing stand-alone Part D Prescription Drug Plan.
Part D Initial Enrollment Period:
You’re first eligible for Medicare prescription drug coverage when you turn 65. If you’re already receiving Social Security benefits, you’ll automatically be enrolled in Part A and Part B. If not, you need to sign up for Medicare during your Initial Enrollment Period. This period starts 3 months before the month you turn 65, includes the month you turn 65 and ends 3 months after the month you turn 65.
Part D Special Enrollment Period:
You can enroll in a Medicare prescription drug plan during this period if you meet any of the following conditions:
- You’re enrolled in a Medicare Advantage Plan or other Medicare health plan that doesn’t include prescription drug coverage, and you dis-enroll from that plan.
- You have creditable prescription drug coverage (coverage that’s expected to pay at least as much as Medicare’s standard prescription drug coverage) and you lose that coverage.
- You move outside of your plan’s service area.
Medigap Open Enrollment Period:
If you’re enrolling in a Medicare Supplement (Medigap) plan, you have a 6-month window to do so, starting the first month that you have both Parts A and B. This is true even if you’re outside of your Initial Enrollment Period.
What Plan Changes can I make during the Medicare Open Enrollment Period?
During the Medicare open enrollment period, you can:
- Switch from Original Medicare to Medicare Advantage (as long as you’re enrolled in both Medicare Part A and Part B, and you live in the Medicare Advantage plan’s service area).
- Switch from a Medicare Advantage to Original Medicare (plus a Medicare Part D plan, and possibly a Medigap plan if you meet medical eligibility guidelines).
- Switch from one Medicare Advantage plan to another.
- Switch from one Medicare Part D prescription drug plan to another.
- Enroll in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare.
Medicare Sign-up: What you can't do during your Medicare Initial Enrollment Period
How to Change Medicare Plans
The annual open enrollment period for Medicare is from October 15 – December 7. During this time, you can make a variety of changes to your Medicare Advantage plan, none of which involve medical underwriting. Americans who are already enrolled in Medicare Advantage can:
- Change to another Medicare Advantage plan
- Drop their Medicare Advantage plan and return to Original Medicare
- Change from one stand-alone Part D prescription drug plan to another
- During the five-star enrollment period (December 8 – November 30), people who live in an area with a five-star Medicare Part D or Medicare Advantage plan can switch to that plan if they choose to do so.
- During the first year a person is enrolled in Medicare Advantage, they can switch to (or back to) Original Medicare and a Part D plan. And with some exceptions, they also have guaranteed-issue access to a Medigap plan.
As Medicare beneficiaries explore their benefits and compare a Medicare Advantage or Medicare supplement plan, before you switch to a new Medicare plan talk with a licensed insurance agent for assistance.
If you’re not already receiving benefits from Social Security or the Railroad Retirement Board when you turn 65, you’ll need to sign up for Medicare during your Initial Enrollment Period.
This is the seven-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.
You cannot use the fall open enrollment period to sign up for Medicare if you forget to sign up for Medicare during your initial enrollment period. You will use the Medicare general enrollment period instead.
Medicare Eligibility
Most Americans become eligible for Medicare when they turn 65. If you or your spouse have worked for at least 10 years in the United States and paid Medicare taxes during that time, you’re eligible to enroll in Medicare Part A.
You’re eligible to enroll in Medicare Part D as long as you have either Medicare Part A and/or Part B.
If you’re enrolled in both Medicare Part A and Part B (but not Medicare Advantage or Medicaid), you’re eligible to enroll in a Medigap plan to supplement your Medicare coverage.
How to Sign up for Medicare: Eligible for Medicare
If you did not sign up for Original Medicare (Parts A and B) during your Initial Enrollment Period, you can sign up during the General Enrollment Period. The General Enrollment Period is from January 1 to March 31. If you sign up during this time, your coverage will start on July 1.
You may be subject to penalties if you do not sign up by the deadline. For example, if you wait to sign up for Part B until you turn 65, you will have to pay a late enrollment penalty of 10% for every year that you delay signing up.
There are a few other things to keep in mind when signing up for Medicare. If you are already receiving benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Part A and Part B. If you are not receiving these benefits, you will need to actively sign up for Medicare.
You can sign up for Medicare online, over the phone, or in person at your local Social Security office.
Enrolling in Original Medicare
If you’re turning 65 but you’re not yet receiving Social Security or Railroad Retirement benefits, you won’t be automatically enrolled in Original Medicare. You’ll need to enroll through the Social Security Administration.
If you’re disabled and receiving Social Security Disability benefits, your Medicare coverage will start automatically in the 25th month that you’re receiving disability benefits.
How do I enroll in Medicare Advantage: Enrollment Periods for Medicare Advantage Plans
To be eligible for a Medicare Advantage plan, you must first have Original Medicare coverage Parts A and B. You will also need to live in an area where an Advantage plan is offered.
You can enroll in a Medicare Advantage plan when you’re first eligible for Medicare, or during the annual Medicare open enrollment period in the fall. If you are interested in joining a Medicare Advantage plan, you typically can only do so during specific times of the year.
The first time you may be able to enroll is during your Medicare Initial Enrollment Period.
When can I enroll in Medicare Part D?
If you’re just enrolling in Medicare Part B during the General Enrollment Period (January 1 – March 31), you’ll have to wait until the Fall Open Enrollment Period (October 15 through December 7) to sign up for a stand-alone Part D plan.
However, if you’re enrolling in Medicare Advantage during the General Enrollment Period, you can enroll in a Medicare Advantage plan (which includes Part D) between April 1 and June 30.
If you’re already enrolled in a Medicare Advantage plan and you use the Medicare Advantage Open Enrollment Period (January 1 – March 31) to switch to Original Medicare, you’ll also have the option to sign up for a Part D plan to supplement your Original Medicare coverage.
How do I enroll in a Medicare Supplement (Medigap) plan?
If you’re enrolled in Medicare Part A and Part B, you can enroll in a Medigap plan during your initial Medigap enrollment period. This period starts on the first day of the month that you’re both 65 or older and enrolled in Medicare Part B.
If you wait to enroll in a Medigap plan outside of this initial enrollment period, you may be subject to medical underwriting, which means that the insurer will take into account your health history when determining your premiums and eligibility for coverage.
Most US States, offer a guaranteed issue period during which you can purchase a Medigap plan without having to go through medical underwriting. This period typically occurs when you’re switching from one Medigap plan to another (the Birthday Rule) or when you’re moving out of state.
To find out about Medigap policies in your state, contact your State Department of Insurance or your State Health Insurance Assistance Program.
2022 Medicare Costs: New Medicare Beneficiaries
As of 2022, the average premium for stand-alone Medicare Part D coverage is $43/month. The income threshold for high-income began to be indexed as of 2020.
The Part D deductible is $445 in 2021 and increases to $480 in 2022. Part D out-of-pocket costs after deductible are capped at 25% of the cost of brand-name and generic costs.
There is no longer a donut hole in terms of the maximum amount that enrollees can be charged when they fill prescriptions.
After a beneficiary’s costs reach the catastrophic coverage threshold, additional out-of-pocket costs are capped at the greater of 5% of the cost of the drug or a copay of $3.95 for generics and $9.85 for brand-name drugs (both amounts are a slight increase from 2021).
Certain Part D plans cover a broad range of insulins for no more than $35/month as of 2021.
Medicare Part A (inpatient care)
– The Part A deductible is $1,556 in 2022.
– The Part A coinsurance is $389 per inpatient day.
– The Part A coverage covers 100% of the cost of skilled nursing facility care for the first 20 days. After the first 20 days, your skilled nursing facility coinsurance is \$194.50 per day.
Medicare Part B (outpatient care)
Medicare Part B is a federal health insurance program that covers outpatient medical care, such as doctor’s visits, laboratory tests, and durable medical equipment. The standard monthly premium for Medicare Part B in 2022 is $148.50, but it may be higher if you’re a high-income earner. You’ll also be responsible for paying the Part B deductible, which is $233 in 2022. After you’ve met your deductible, you’ll still be responsible for paying 20% of the Medicare-approved amount for most services.
If your doctor doesn’t accept Medicare assignment, they can charge you up to an additional 15% unless your state imposes a lower limit.
There are a few ways to lower your costs for Medicare Part B. For example, if you’re still working and have health insurance through your employer, you may not need to sign up for Part B. You can also delay signing up for Part B without having to pay a late enrollment penalty as long as you have other creditable coverage.
If you decide you want to enroll in Part B later on, you can do so during the general enrollment period, which runs from January 1 to March 31 each year.
Do You Need to Buy A Medicare Supplement Plan?
Medigap is a type of health insurance that is designed to supplement Original Medicare. This means that it can help pay for some of the costs that Medicare does not cover, such as co-insurance, deductibles, and co-payments.
Medigap plans are offered by private insurance companies and are regulated by the federal government. Before you can buy a Medicare supplement plan you must enroll in Medicare Part A and Medicare Part B.
There are 10 different types of Medigap plans, each with its own set of benefits. The most popular Medigap plan is Plan G, which covers the most benefits for those eligible for Medicare today.
The average cost of a Medigap Plan G policy in 2022 is $143 per month. However, the exact cost will vary depending on the insurance company and the state you live in.
You can only sign up for a Medigap plan during certain times of the year, known as Medigap Open Enrollment. This period begins on the first day of the month that you are both 65 years old and enrolled in Medicare Part B.
During the Medicare Supplement Open Enrollment period, you have a guaranteed-issue right to buy any Medigap policy that is sold in your state. This means that insurance companies cannot refuse to sell you a policy because of your health condition.
If you miss your Medigap Open Enrollment period, you may still be able to buy a policy, but you may have to go through medical underwriting. This means that the insurance company can ask you questions about your health and decide whether or not to sell you a policy.
There are also special enrollment periods that allow you to sign up for Medigap outside of the regular open enrollment period. These special enrollment periods include if you move out of the state where you bought your Medigap policy, if you go from a Medicare Advantage Plan back to Original Medicare, or if you lose your employer-sponsored health insurance.
With a Medigap plan, you do not need to change your Medicare plan as they are standardized by the government. This makes a Medigap plan a very desirable Medicare program when comparing a Medicare Advantage or Medicare with a Medigap plan.
If you have any questions about Medigap, you can contact your state’s insurance department or the Centers for Medicare & Medicaid Services.
Medicare Part C (Medicare Advantage)
Medicare Advantage plans are an alternative to traditional Medicare. You can switch between Medicare Parts A and B, Part D prescription drug plans, or a new Medicare Part C plan.
The average premium for Medicare Advantage plans is about $19/month. The maximum out-of-pocket limit for Medicare Part C (Medicare Advantage) plans is $7,550.
Medicare Advantage plans must cover everything that Original Medicare covers except for hospice care. Most plans also cover extra benefits like routine dental, vision, and wellness programs.
You can usually get your prescriptions covered through the plan too. Some plans have $0 monthly premiums, but keep in mind that you might pay other costs like copayments, coinsurance, and deductibles.
If you’re interested in a Medicare Advantage plan, you can sign up during the Annual Election Period (AEP) from October 15 to December 7 each year. You can also switch to a different Medicare Advantage plan or drop your Medicare Advantage plan and return to Original Medicare during the AEP.
Medicare Part D Prescription Drug Coverage
Medicare Part D is a prescription drug coverage plan that is available to Medicare beneficiaries. The average premium for stand-alone Medicare Part D coverage is about $43/month in 2022.
The income threshold for high-income began to be indexed as of 2020. The Part D deductible increased from $445 in 2021 to $480 in 2022.
There is no longer a donut hole in terms of the maximum amount that enrollees can be charged when they fill prescriptions.
After a beneficiary’s costs reach the catastrophic coverage threshold (this is $7,050 in 2022, up from $6,550 in 2021), additional out-of-pocket costs are capped at the greater of 5% of the cost of the drug or a copay of $3.95 for generics and $9.85 for brand-name drugs.
Medicare IRMAA
If you’re a Medicare beneficiary and your income is more than $91,000 in 2020, you’ll pay additional premiums for Medicare Part D and Part B. The income-related monthly adjustment amount (IRMAA) is a surcharge that’s added to the premiums for Medicare Part D and Part B.
The income limits apply to 2022 coverage but are based on tax returns that were filed for 2020. So, if your income has changed since you filed your 2020 taxes, you can contact Social Security to have your IRMAA re-evaluated.
You can learn more about IRMAA on Medicare’s website.
Affordable Medicare Plans
Integrity Now Insurance Brokers provides information and resources that help American consumers make informed choices about buying and keeping health coverage. Our company manages your Medigap Plans, Medicare Advantage Plans, and Medicare Part D prescription drug coverage.
It is essential to review and compare your health care benefits to ensure they remain affordable and provide the most comprehensive insurance possible.
Our Medicare insurance agents help review your changes in premiums, Doctors, medical facilities, prescription drug formulary, and changes in your preferred pharmacy, as any above changes could significantly affect how you use your Medicare coverage.
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