Medicare Enrollment

Initial Enrollment

American seniors become eligible for Medicare when they turn 65. Their first opportunity to enroll begins three months before their birthday month and extends for the following three months. This is called the Initial Enrollment Period. During this time, you can sign up for Part A and Part B, which are your hospital and medical insurance. As long as you live within the plan’s coverage area, you can also sign up for a Medicare Advantage plan.

If you sign up for Medicare in the three months before you turn 65, your coverage will begin on the first day of the month of your 65th birthday. If you sign up during your birthday month, your coverage will begin the first day of the following month. If you sign up in the three months after you turn 65, your coverage will begin the first day of the month after you ask to join the plan.

Individuals with disabilities who are under age 65 are enrolled in Medicare after they have received 24 months of disability benefits from Social Security or the Railroad Retirement Board. They will receive their red, white, and blue Medicare card in the mail three months before the 25th month of receiving disability benefits.

People with Amyotrophic Lateral Sclerosis (ALS) automatically receive Part A and Part B the month their disability benefits begin. They will receive their red, white, and blue Medicare card in the mail the month that coverage begins.

People with End-Stage Renal Disease (ESRD) can sign up for Part A and Part B by visiting their local Social Security office or by contacting Social Security. Coverage is retroactive up to 12 months prior to your enrollment date, starting when you became eligible for Medicare due to ESRD.

Special Enrollment

You can enroll in a Medicare plan after certain changes happen in your life or if you lose coverage. Changes to your living situation that qualify are as follows:

You moved outside of your plan’s coverage area
You moved to a new address and have new plan options, even if you still live within your plan’s service area
You moved back to the U.S. after living in a foreign country
You moved into, live in, or moved out of an institution
You just got released from prison

If you have moved, you have two months from the time you tell your plan to enroll in a new Medicare Advantage plan or prescription drug plan. You will be automatically enrolled in Original Medicare if you make no changes. After you have moved back to the U.S. from another country, you have two months to enroll in a Medicare Advantage plan or Medicare prescription drug plan. If you live in an institution, you have the option to join, drop, or switch Medicare Advantage or prescription drug plans while you live in the institution and for two months after you move out. If you have been released from jail, you have two months after the month you are released to enroll in a Medicare Advantage or prescription drug plan.

Special Enrollment Periods are also available if you lose your coverage, as with the following:

You are no longer eligible for Medicaid
You left employer or union coverage
You lost non-Medicare creditable drug coverage or your coverage changes and is no longer creditable
You had drug coverage through a Medicare Cost Plan but left the plan
You dropped your coverage in a Program of All-inclusive Care for the Elderly (PACE) plan

If you are no longer dual-eligible for Medicare and Medicaid, you have three months to enroll, switch, or drop Medicare Advantage or prescription drug coverage. After leaving employer or union coverage, you have two months to join a Medicare Advantage or prescription drug plan. If you lose creditable drug coverage, you have two months to enroll in a Medicare Advantage or prescription drug plan. After leaving a Medicare Cost Plan, you have two months to enroll in a Medicare prescription drug plan. You have two months after you drop your PACE plan to enroll in a Medicare Advantage or prescription drug plan.

Having the chance to get other coverage can also qualify you for a SEP if:

You can enroll in other coverage through an employer or union
You are enrolling in other prescription drug coverage as good as Medicare Part D
You enrolled in a Program of All-inclusive Care for the Elderly (PACE) plan

In any of the above cases, you can drop your Medicare Advantage or prescription drug plan at any time.

You qualify for a SEP if your plan changes its contract with Medicare, as with the following cases:

Medicare sanctions the plan because of a problem that affects you
Medicare terminates your plan’s contract
Your plan’s contract is not renewed with Medicare

If your plan is sanctioned by Medicare, you will be notified of when you can switch. If Medicare terminates your plan’s contract, you have two months before and one month after the contract ends to find a new Medicare Advantage or prescription drug plan. If your plan is not renewed, you can find a new plan between December 8 and the last day of February.

Other special situations can make you eligible for a SEP, such as:

You are eligible for Medicare and Medicaid
You qualify for Extra Help
You are enrolled in and lose eligibility for a State Pharmaceutical Assistance Program (SPAP)
You dropped a Medicare Supplement policy the first time you joined a Medicare Advantage plan
There is a Medicare Chronic Care Special Needs Plan (C-SNP) that serves people with your chronic condition
You are in a Special Needs Plan but no longer meet the qualifications

If you are dual-eligible, you can make one change each from January-March, April-June, and July-September. When you make changes, they will be in effect the following month. If you qualify for Extra Help, you can join, switch, or drop Medicare prescription drug coverage with one change each from January-March, April-June, and July-September. After losing SPAP coverage, you can join a Medicare Advantage plan with prescription drug coverage or join a Medicare prescription drug plan once during the calendar year.

If you dropped a Medigap policy the first time you joined a Medicare Advantage plan, you have 12 months to drop the Medicare Advantage plan. You can drop the Medicare Advantage plan, enroll in Original Medicare, then buy a Medicare Supplement policy. If you qualify for a C-SNP, you can join anytime. If you no longer qualify for your Special Needs Plan, you have three months to switch to a Medicare Advantage or prescription drug plan.

Medicare Open Enrollment

Every year, beneficiaries get the chance to make changes to their plans. Open Enrollment spans from October 15 to December 7 of each calendar year. During this time, you can join, switch, or drop a plan. Coverage changes will begin on January 1. To prepare for Open Enrollment, your plan will publish its Annual Notice of Change in the fall. You do not need to sign up for Original Medicare again, but Medicare Advantage plans are contracts that need to be renewed annually.

Part B General Enrollment

You can still enroll in Part B even if you do not have Part A. You can purchase Part B during the Part B General Enrollment Period, which lasts from January 1 to March 31. You can subsequently enroll in a Medicare Advantage plan or Part D prescription drug plan between April 1 and June 30.

Not signing up for Part B when you are first eligible means you will owe a late enrollment penalty unless you have circumstances that qualify you for a Special Enrollment Period. For each 12-month period you went without signing up after you became eligible, 10% of the standard premium can be added to your monthly premium. You pay this penalty for as long as you hold coverage.

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Medicare Advantage Enrollment

Switching from Original Medicare (Part A and Part B) to Medicare Advantage (Part C) can give beneficiaries additional coverage such as prescription drug, hearing, dental, and vision benefits.

Medicare beneficiaries can switch from Original Medicare to a Medicare Advantage plan if they are 65 or older and live within the plan’s coverage area. There used to be restrictions against people with End-Stage Renal Disease, but these were lifted in 2021. You can switch during the Open Enrollment Period, which extends from October 15 to December 7.

During Open Enrollment, you also have a number of options available. This is the time to switch from Medicare Advantage back to Original Medicare. You can also switch from one Medicare Advantage plan to another, such as to one that has a more beneficial prescription drug plan or from a plan with drug coverage to a plan without drug coverage.

The other important time range to keep track of for Medicare Advantage plans is from January 1 to March 31. This is known as the Medicare Advantage Open Enrollment Period, and during this time you can switch from one Medicare Advantage plan to another regardless of the drug coverage. You can also drop your Medicare Advantage plan and return to Original Medicare; you can also add a prescription drug plan to maintain a similar level of benefits.

Medicare Part D Enrollment

If you have Original Medicare, the time to add a Part D prescription drug plan is between October 15 and January 7. During this time, you can also switch from one drug plan to another drug plan or drop your Medicare drug coverage completely.

Medicare will add 1% of the base premium amount for each month you went without creditable prescription drug coverage before signing up for Part D. This is known as the Part D late enrollment penalty.

Medicare Supplement Enrollment

Once you are 65 or older and enrolled in Part B, you have six months to sign up for a Medicare Supplement plan. You cannot be turned away because of your health during this time because you are not subject to medical underwriting during these six months. You can add a Medicare Supplement plan after this enrollment period ends but will be subject to medical underwriting.

Medicare Supplement Guaranteed Issue Rights

In certain situations, insurance companies must offer you a Medicare Supplement policy. They also have to cover your pre-existing conditions and are not allowed to charge you more for the policy because of past or current health problems.

Some of these situations include:

You have a Medicare Advantage plan but are moving out of the plan’s coverage area, your plan is leaving Medicare, or it stops providing coverage
You have Original Medicare and secondary employer or union coverage, and that secondary plan is ending
You have Original Medicare and a Medicare SELECT policy but are moving out of the SELECT policy’s service area
You joined a Medicare Advantage or PACE program during your initial enrollment, and within the first year of joining decide you want to switch back to Original Medicare
You dropped a Medicare Supplement policy to join a Medicare Advantage or SELECT policy, and within the first year decide you want to switch back
You lose your Medicare Supplement policy coverage due to your plan going bankrupt or through no fault of your own
You leave a Medicare Advantage plan or Medicare Supplement policy because they misled you or did not follow the rules

If you qualify to buy a Medicare Supplement policy because you have guaranteed issue rights, you can buy one of the following plans: A, B, C, D, F, G, K, L, M, or N. Plans C and F are only available to people who became eligible for Medicare before January 1, 2020.

You must apply for a Medicare Supplement policy no later than 63 days after the date your coverage ends, the date on the notice telling you that coverage is ending, or the date on a claim denial (if this is the first notice you get that your coverage is ending), whichever of these dates is the latest.

There are several enrollment periods to sign up for Medicare plans. Talk with a licensed agent from Medicare Peace of Mind to take advantage of your enrollment opportunities.

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