Approaching your “Medicare years” can be an anxious time. When exactly do you need to enroll? What happens if you miss the enrollment window? Are you even eligible?
Here’s a guide through the whole process, showing you everything you need to get on board so you can start taking advantage of the program’s benefits with the right plan for future health and wellness.
Enrollment that’s automatic
There are a few ways to be signed up automatically:
If you’re under 65 with a disability, you qualify automatically after 24 months of Social Security or RRB disability benefits. Part A is premium free for everyone who qualifies for automatic enrollment.
Enrollment you need to sign up for
For those who don’t qualify, Part A can be purchased for $506/month in 2023. If you are married and didn’t meet the work requirement, you are automatically eligible as long as your spouse worked for at least 10 years.
When do I first enroll for Medicare?
Everyone is given a generous amount of time to sign up for Medicare Part A, Part B, Part C, and Part D. It’s called your Initial Enrollment Period, or the first time you can sign up for Medicare.
To give you an example of how this works, say your birthday is in June — your Initial Enrollment Period will begin March 1st and end on September 31st. The sooner you need coverage, the sooner you should enroll. Signing up 3 months prior to your 65th birthday means your Medicare plan will be activated the first day of your birthday month. If you wait three months past your birthday to enroll, you won’t have coverage until 6 months after you turn 65.
Is there a second chance to enroll?
If you miss your Initial Enrollment Period, you get a reprieve with the General Enrollment Period. This allows you to sign up for Medicare Part A and Part B between January 1st and March 31st; your Medicare coverage will begin on July 1st of the same year. Be aware that if you elect to buy Part A at this time, you must also enroll in Part B.
Special enrollment for special cases
Part A and B
If you had health care when you turned 65, you could skip signing up for Medicare Part A and/or Part B. This could be a case where you worked for a union or a company with at least 20 workers, or where you were under your spouse’s health care coverage.
You’re eligible for what’s called a Special Enrollment Period (SEP) when:
If you happen to be in the Initial Enrollment Period when your employment stops, you don’t need to wait for a Special Enrollment Period. But if you miss the SEP, you may have to pay a late enrollment penalty.
In the case where you are disabled and working, or you have coverage from relative or spouse who is working, the Special Enrollment Period applies as long as the employer has more than 100 employees.
Part C and D
The same conditions that allow you to bypass the Initial Enrollment Period for Part A and Part B, let you to wait to sign up for Part C and Part D. But here the SEP begins 63 days after the end of your employer coverage.
In both Parts C and D, you have to have Original Medicare first.
There are Special Enrollment Periods for Part D plans in the event you:
When you want to change your plan
As you can see, there are a lot of enrollment periods. This one is called The Open Enrollment Period, or the Annual Election Period, and runs each year from October 15th to December 7th. This is when:
Your coverage will start January 1 of the following year.
Medicare Advantage Open Enrollment Period
You have additional opportunities to change your Medicare Advantage (Plan C) coverage beyond the Open Enrollment Period (October 15 – December 7)..
For anyone enrolled in a Medicare Advantage plan on January 1, the Medicare Advantage Open Enrollment Period (MA OEP) is a chance to change plans — it runs from January 1 to March 31. Additionally, there’s an individualized Medicare Advantage Open Enrollment Period for new Medicare beneficiaries with both Medicare Part A and B who enroll in an MA plan during their Initial Enrollment period. There is a three-month MA OEP for these individuals to switch plans.
Individual and annual Medicare Advantage Open Enrollment Periods both allow people already in a Medicare Advantage plan a one-time election to choose between:
The MA OEP replaces the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. If you are enrolled in Original Medicare you cannot make changes to your Part D plan.
Medicare Advantage Disenrollment Period (MADP)
Every year from January 1st to February 14th, you can dis-enroll from your Medicare Advantage coverage and return to Original Medicare, regardless of how long you’ve had the MA plan. And even if you just signed up for a plan during an Annual Election Period, you can still switch back to Part A and Part B if you want to.
If your MA plan requires you to use in-network providers, you need to keep an eye on when your MA disenrollment becomes official. Going to an out-of-network doctor before you’re dis-enrolled could mean your costs are not covered.
The MADP is flexible about prescription drug coverage. You can join a stand-alone drug plan when you dis-enroll — even if your MA plan covered medications. If that’s the case, you’re automatically dis-enrolled from your MA prescription drug plan simply by joining a stand-alone plan.
Here are some caveats about the MADP:
You can’t change your Medicare Advantage plan unless you’re eligible for the Special Election Period, which is when you’re allowed to dis-enroll from MA or switch to a different plan. This happens only under specific circumstances, such as you’ve moved to a new service area or were misled by your plans’ marketing claims.
Medigap Open Enrollment
There’s no enrollment period more important to get right than the Medigap Open Enrollment. It goes for 6 months and starts on the first day of your 65th (or older) birthday, and requires that you be enrolled in Part B. During this time, any health care insurance sold under Medigap in your state can’t use medical underwriting, which means they cannot:
The exception to this is a pre-existing condition. Under the “pre-existing condition waiting period,” an insurance company can delay you up to 6 months for out-of-pocket cost coverage for a pre-existing condition. Coverage can be denied only if the condition was diagnosed or treated within 6 months before coverage started.
If you’re thinking of switching to a Medicare Advantage (Plan C) plan when you currently have Part A and Part B plans and a Medigap policy, be sure you know the consequences. You may not be able to get a Medigap plan again if you want one in the future.
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If you are already receiving Social Security or Railroad Retirement Board benefits, you’ll be enrolled automatically when you turn 65. The other way this happens is if you have worked on the books for at least 10 years (40 quarters) in the U.S.
If you miss your IEP, the General Enrollment Period allows you to sign up for Medicare Part A and Part B between January 1st and March 31st; your Medicare coverage will begin on July 1st of the same year.
Yes, the Medicare Advantage Open Enrollment Period (MA OEP) is a chance to change plans — it runs from January 1 to March 31. Plus, you have an individualized Medicare Advantage Open Enrollment Period for new Medicare beneficiaries with both Medicare Part A and B who enroll in an MA plan during their Initial Enrollment period. There is a three-month MA OEP for these individuals to switch plans.
If you enroll in a Medigap plan during your Medicare Supplement Open Enrollment, which runs for 6 months from the first day of your 65th-birthday month, you are protected from being denied coverage for a health condition or injury.
- Best overall Medicare supplement for new enrollees: Plan G.
- Best overall Medicare supplement before 2020: Plan F.
- Best low cost Medicare supplement: Plan K.
- Best alternative to Plan G Medicare supplement: Plan N.
Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.
Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.
The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.
Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.
For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.
It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.
Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.
Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.
- Plan F$128–$342
- Plan F (high deductible)$22–$88
- Plan G$106–$325
- Plan G (high deductible)$29–$58
Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.
The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.
The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.
Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.
It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.
Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.