What Is the Medicare General Enrollment Period?

The Medicare program includes various enrollment windows, among which the General Enrollment Period (GEP) is often forgotten. As a brokerage specializing in Medicare, we possess comprehensive expertise in guiding clients through all enrollment stages, including the GEP.

The GEP presents an opportunity to sign up for Medicare Parts A and B for those who did not enroll during their Initial Enrollment Period. This period runs annually from January 1 to March 31.

It's important to note that enrolling during the GEP, after missing the Initial Enrollment Period, may result in late enrollment penalties. This aspect of Medicare is important to understand when considering enrollment timing.

Who Needs the General Enrollment Period?

The Medicare General Enrollment Period (GEP) serves as an essential enrollment phase for a specific group of individuals. This period becomes particularly relevant for those who find themselves in the following circumstances:

Missing the Initial Enrollment Period: The Initial Enrollment Period (IEP) is when individuals first become eligible for Medicare. Those who do not enroll in Medicare Part A and Part B during this initial phase will need to look toward the General Enrollment Period.

Ineligibility for a Special Enrollment Period: Special Enrollment Periods (SEPs) are granted under certain conditions, such as employment or life changes, allowing for late enrollment without penalties. However, if an individual does not meet the criteria for a Special Enrollment Period, the General Enrollment Period becomes their next available option for enrolling in Medicare.

The General Enrollment Period thus serves as a safety net for those who, for various reasons, missed their Initial Enrollment Period and are not eligible for any Special Enrollment Periods. It ensures that these individuals still have access to essential Medicare coverage, albeit with different timing and potential implications like late enrollment penalties. Let’s take a little closer look at the IEP and SEP options.

Initial Enrollment Period (IEP)

The Initial Enrollment Period for Medicare is tailored to each individual based on their 65th birthday. This period spans seven months, offering a specific time frame for enrollment in Medicare. For instance, if you turn 65 on June 15, your Initial Enrollment Period would start from March 1 and extend until September 30.

An additional benefit applies to those whose birthdays fall on the 1st of any month. In these cases, the Initial Enrollment Period is extended by an additional month at the beginning. Taking the example of a 65th birthday on June 1, the enrollment window in this scenario would open earlier, beginning on February 1, and would still close on September 30. This extended window provides additional flexibility and time for those eligible to make informed decisions about their Medicare enrollment.

Special Enrollment Period (SEP)

The Special Enrollment Period (SEP) is a window of time reserved for those who lose their active employer-based health coverage. This period grants an eight-month window for enrollment, beginning from the date of loss of employer coverage or the end of employment, whichever occurs earlier.

For example, if your active employer health coverage ceases on October 31, you have a deadline of June 30 of the following year to enroll in Medicare Parts A and B. This timely enrollment is essential to avoid incurring late penalties and experiencing delays in obtaining coverage. Missing the Special Enrollment Period means having to wait for the General Enrollment Period to enroll in Medicare.

It's important to note that COBRA coverage does not equate to active employer coverage. Therefore, if you opt for COBRA immediately after the cessation of your employment, you must still enroll in Medicare Parts A and B within the first eight months of your COBRA coverage to avoid potential penalties and coverage gaps. This distinction is critical for understanding your Medicare enrollment options and timelines.

Late Enrollment Penalties

Choosing to enroll in Medicare during the General Enrollment Period (GEP) rather than the initial or special enrollment periods can lead to significant late enrollment penalties. Starting in 2023, enrolling during the GEP means that your Medicare benefits will activate on the first day of the month following your application submission.

Medicare Part A: Late penalties for Part A are rare since most individuals qualify for premium-free Part A. A late penalty is applicable only if you need to pay a premium for Part A, which is not common for most enrollees.

Medicare Part B: The penalty for late enrollment in Part B is more substantial. It involves an increase of 10% of your premium for each full 12-month period you were eligible but didn’t enroll. This additional amount is permanently added to your monthly premium. For instance, if the Part B premium is $174.70 in 2024 and you delay enrollment by three years, your adjusted premium would be approximately $227.11. It's worth noting that if the delay is less than one year, there's no penalty.

Medicare Part D: The late penalty for Part D is calculated by taking 1% of the national average premium ($34.70 in 2024) and multiplying it by the number of months you delayed enrollment. This penalty is then added to your monthly Part D premium. For example, a 36-month delay would lead to an added penalty of about $12.49 per month.

Exception for Creditable Coverage

It's important to remember that if you had creditable coverage (coverage that is at least as good as Medicare’s standard coverage) during the period you delayed enrolling in Medicare, you would not incur these late penalties. This is often the case for those who have employer-sponsored health insurance past the age of 65.

Applying for Medicare During the General Enrollment Period

Enrolling in Medicare Parts A and B can be done through various methods: online, in-person at a Social Security office, or by phone. The online method is often the most convenient. However, if you're already enrolled in Part A and need to apply for Part B, you'll have to manually complete a specific form.

After enrolling in Parts A and B, it's important to consider additional coverage options. You might want to explore either a Medicare Advantage plan or a Medicare Supplement plan. When opting for a Medicare Supplement plan, you have a six-month window starting from the effective date of your Part B enrollment to sign up without undergoing medical underwriting.

If you're eligible for a Special Enrollment Period for enrolling in a Medicare Advantage or Part D plan, this period begins the day you lose employer coverage and lasts for two months. Conversely, if you're enrolling in both Part A and Part B during the GEP, you get a more extended window: three months before, the month of, and three months after your Part A effective date to enroll in a Part D or Medicare Advantage plan.