It's that time of year again: The Open Enrollment Period (OEP) for Medicare. Barring special circumstances, there are only a few times per year when individuals 65 and older or those with disabilities can apply for this government-owned health insurance. That is why it is important to research in advance to see what Medicare options may be best for you.
Medicare offers a variety of coverage options, which are divided into parts A, B, C, and D. Broken down, Part A covers hospital visits, Part B covers medical visits, and Part D covers prescriptions. Part C (also known as Medicare Advantage) is special coverage that bundles all of the above. Of course, each has its own costs and advantages. You can find more information on Parts A and B on the Medicare.gov website. This article from AARP covers what Parts C and D include.
Now that you have an idea of what you need to research, let's talk about what Medicare Open Enrollment is, who can apply during this time, what you can do if you miss Open Enrollment, and important information for first time Medicare enrollees.
What is Medicare Open Enrollment?
In a nutshell, Medicare Open Enrollment is the time of year that you can join, switch plans, or drop one of the Medicare health care plans. This is only one of two main times per year that you can join Medicare.
So, when does Medicare Open Enrollment start and end? Also called the Fall Open Enrollment Period, this Medicare enrollment period runs from October 15th through December 7th each year. It is best to apply as soon as possible so that your coverage will begin on January 1st of the following year. If you send your request near the end date, you could experience a delay in coverage.
Even if you are not enrolling for the first time, this open enrollment period is the perfect time to make any changes to your current plans and coverage. For example, you can opt to switch from Original Medicare to an Advantage Plan (or vice versa) or switch to one that covers prescription drugs (or vice versa). Or, you can choose to drop a Medicare plan altogether.
We mentioned that there are two main enrollment periods each year. You may be wondering what the difference between open enrollment and annual enrollment Medicare is. The short answer is, there is none. It's just another name for the same Medicare enrollment period.
However, there is a difference between Medicare Open Enrollment and General Enrollment. The GEP begins January 1st and ends March 31st. You can also sign up for Medicare for the first time during this period if you missed your Initial Enrollment Period (IEP). However, coverage does not begin until July 1st of that year and you will likely receive a penalty for delaying your enrollment.
Who Can Apply During Open Enrollment?
In general, individuals age 65 and older can apply for Medicare during the OEP. You must be a U.S. citizen or alien that is working towards permanent residence and have been living in the U.S. for at least 5 years before filing your Medicare application.
There are special exceptions for some individuals under the age of 65. People with certain disabilities and permanent kidney failure are also eligible to apply for Medicare during the Open Enrollment Period.
It is also important to note that income comes into play as well. To qualify, an individual's income cannot exceed $1,010 per month and $1,355 for married couples.
You may be wondering if you can have Medicare and open enrollment at the same time. The answer is “yes”. Again, this enrollment period is for those signing up for the first time or those wishing to make changes to their current plans.
What if I Miss Medicare Open Enrollment?
If, for whatever reason, you miss the Medicare Open Enrollment Period, you have a few other options. As stated earlier, the General Enrollment Period begins January 1st. You can do many of the same things during this time as you can during the Open Enrollment Period. But, remember that it will take longer for your coverage to begin if you sign up during this period. You can also sign up for Medicare Advantage (Part C) during this time if you're looking to add extra coverage to your plan.
Numerous extenuating circumstances can also allow you a Special Enrollment Period (SEP). These include, but are not limited to, the following:
- Moving out of your plan's service area.
- Moving into or out of a skilled nursing facility.
- You're no longer eligible for Medicaid.
- You no longer receive employer-based or union-based health insurance.
These are just a few examples. If major changes are made to your plan, coverage, or your own health, it never hurts to ask if you qualify for a Special Enrollment Period (SEP).
You might also look into Medigap coverage. This is supplemental insurance that can be used in conjunction with Medicare. Enrollment timeframes for Medigap vary for each individual. However, you can only apply for this if you are 65 and older AND are already signed up for Medicare Part B.
Initial Medicare Enrollment Period (First Time Medicare)
If you are just coming upon your 65th birthday and are beginning to research your Medicare options, let's talk about the Initial Enrollment Period (IEP). This is the 7-month period in which you are first able to sign up for Medicare around the time you turn 65. This timeframe begins 3 months before, the month of, and 3 months after your birthday.
If you are eligible for Medicare due to disability, your IEP starts 3 months before the 25th month of continuous disability payments.
You are not automatically enrolled when you turn 65 unless you are already receiving Social Security or Railroad Retirement Board benefits. Sign up as soon as possible so your coverage is not delayed. People who enroll outside of their IEP may receive penalties for delayed enrollment. Another good reason to sign up asap.
Researching Medicare options and coverage is an important endeavor for anyone of retirement age. It will likely be your sole source of health insurance during your golden years. Such an important decision can feel daunting to many, especially with all of the ins and outs of each Plan and even the variations within each.
Benefit and Financial Strategies wants you to be as knowledgeable as possible and feel confident about your enrollment in Medicare. We have been serving the needs of the Flagstaff, Arizona community and beyond for over 30 years. We work with both businesses and individuals to ensure bright futures for all of our clients. To learn more about all of our services, including insurance plans, we invite you to head over to our Financial Services for Families and Individuals page. Whether it's a phone call or an email, please don't hesitate to contact us with any questions you may have about your Medicare enrollment.