What Are the Different Types of Medicare Enrollment Periods?

Medicare is confusing enough, and to make it even more so, the program is littered with several different enrollment periods. Missing an important enrollment opportunity could cause you to go without coverage, or to pay more than you would have otherwise. Today, we’ll review a few of the most important enrollment periods that every Medicare beneficiary should know.

Initial Enrollment Period

The Initial Enrollment Period (IEP) is the first time you’re eligible to enroll in Medicare. It is unique to each individual as it is based on their 65th birthday. Your IEP begins three full months before you turn 65 and ends three full months after your birthday. For example, if your birthday is on October 10, your IEP runs from July 1 through January 31.

As long as you enroll prior to your birthday month, coverage can begin as early as the first day of the month of your 65th birthday. The only exception to this is if you are born on the first day of the month. In that case, your coverage may start one month sooner. If your birthday is on October 1, your coverage can begin on September 1.

During you IEP, you may enroll in Original Medicare (Parts A and B), as well as any other supplemental plans like Medigap, Medicare Advantage, and Part D prescription drug plans.

It is important that you don’t miss your IEP. Doing so will cause you to go without coverage until the General Enrollment Period, which we’ll discuss next. However, you can skip your IEP and delay Medicare enrollment if you have creditable health insurance in place. Typically, this comes in the form of an employer’s group health plan.

General Enrollment Period

The General Enrollment Period (GEP) occurs at the same time every year. It runs from January 1 through March 31. Anyone who did not enroll in Medicare during their IEP may enroll during the GEP. Until 2023, anyone who enrolled during the GEP would not have their coverage begin until July 1. However, since the BENES Act was passed, coverage begins much sooner. Starting in 2023, if you enroll in Medicare during the GEP, your coverage will begin the month after you enroll. You can also use this time to enroll in Medigap, Medicare Advantage, and Part D.

If you use the GEP to enroll, there is a high chance that you will have incurred late enrollment penalties. You may pay a penalty for Part B and Part D, unless you had other creditable health coverage.

Special Enrollment Period

Special Enrollment Periods (SEPs) are any enrollment periods that fall outside of the standard ones. They can apply to Original Medicare, Medicare Advantage, and Medicare Part D. You must have gone through a qualifying life event in order to be eligible for an SEP. 

SEP for Original Medicare

The most common occurrence of qualifying for an SEP to enroll in Parts A and B is when someone has chosen to continue to use creditable insurance past the age of 65 and delayed their Medicare enrollment. In this case, when that person terminates their creditable coverage, they’ll be granted an SEP during which they can enroll in Original Medicare and any ancillary products they choose. They have up to eight months to enroll in Medicare without incurring late-enrollment penalties

SEP for Medicare Advantage and Part D

There are quite a few circumstances that might allow a beneficiary to change their current Medicare Advantage or Medicare Part D plan. Depending on which situation applies, you’ll usually have about two months to choose a new Part C or Part D plan. A few qualifying events include:

• Moving from your current plan’s service area
• Moving into or out of a medical institution
• Losing or gaining Medicaid eligibility
• Moving back to the U.S. after living outside the country
• Changing residences inside your plan’s service area, but with the option of additional plans
• Gaining the option of a 5-star plan
• Enrolling or disenrolling from the Program of All-Inclusive Care for the Elderly (PACE)
• Dropping Part C to move back to a Medigap plan within the first 12 months of changing (Trial Right)

This is not a comprehensive list of things that could qualify you to change your Part C or Part D plans. If you feel you’ve had a significant life event, talk to a local Medicare advisor to determine your options.

Annual Enrollment Period

The Annual Enrollment Period (AEP) happens every fall, starting on October 15 and ending on December 7. During this time, beneficiaries have several opportunities. They can:

• Change from one Part D plan to another
• Change from one Part C plan to another
• Change from Part C back to Original Medicare
• Change from Original Medicare to Part C

AEP is important to every person on Medicare. In almost all cases a person is enrolled in either Part C or Part D, sometimes both. These plans operate on annual contracts, which means they can choose to change their benefits every year. They could change the premium, deductible, cost-sharing amounts, included benefits, and drug formulary. What is working well for someone now may not work as well in the upcoming year.

If your plans are not reviewed during AEP, they will be automatically renewed for the following year. However, you may have missed the opportunity to increase your coverage and save money if you elect not to review your plan and look at any new ones on the market. Insurance carriers are always competing with one another to offer the “best” plans, so beneficiaries could greatly benefit by taking a few minutes to look at their coverage options.

Medicare Advantage Open Enrollment Period

The MA OEP is the last enrollment period we need to discuss. It happens every year from January 1 through March 31. During this time, any beneficiary currently enrolled in a Medicare Advantage plan can make a one-time change to their plan. That could mean choosing a different Medicare Advantage plan or moving back to Original Medicare with a Part D prescription drug plan

Any changes made during this period will go into effect the following month. So, if you decide to change your plan on February 2, the change will begin on March 1. This is a great opportunity to change your plan if you decide the benefits aren’t what you desire. The independent insurance agents at Local Medicare Specialists can help you compare your current plans to others in your area to make sure you have the coverage you need.