Medicare Enrollment Periods Explained

There are numerous Medicare enrollment periods that affect how and when you can get coverage under the Medicare program. Some of the terms, such as “Open Enrollment,” can actually apply to many different aspects of Medicare coverage. This can bring confusion into the mix. Medicare is already complex enough without this added cross-reference complexity.

How the Various Medicare Enrollment Periods Work

We will take a look at each of the Medicare enrollment periods and how they affect you. Some periods refer to your enrollment and qualification into the Medicare program itself. Original Medicare consists of Part A (inpatient care) and Part B (doctor and outpatient care). Other enrollment periods refer to how you qualify for insurance plans to work alongside or in place of your Medicare coverage. This includes Medicare Part C (Medicare Advantage) and Part D (Prescription Drugs).

If you are still confused by the various parts and plans of Medicare, watch this YouTube video that helps alleviate the confusion about the Parts and Plans of Medicare. The article continues below.

Open Enrollment?

The term “Open Enrollment” is likely the single most misused term when it comes to Medicare coverage. It is used to refer to your qualification into a Medicare supplement, or Medigap, plan. Open Enrollment can refer to the General Enrollment Period at the beginning of the year for those who did not enroll into Part A and Part B when they were first eligible. The fall enrollment period for Obamacare, or ACA, plans is also known as Open Enrollment.

medicare enrollment periods

Open Enrollment is most often used to refer to the enrollment period in the fall when you can make changes to your Medicare Part C and Part D coverage. The fall Medicare enrollment period is actually called the Annual Election Period, or AEP. It is not Open Enrollment. Yet, even the federal Centers for Medicare and Medicaid Services (CMS) has begun referring to it as Open Enrollment in the last few years.

The use of the term, Open Enrollment, concerning the fall enrollment period is the single largest area of confusion we have to address almost daily at Integrity Senior Solutions. Many people assume it refers to all types of Medicare coverage. It only refers to Part C (Medicare Advantage) and Part D (prescription drug plans). The Annual Election Period (AEP) each fall does not affect Medigap coverage at all. We will address this more in the next section.

The reason for this confusion is that from 1991 when Congress standardized all the Medigap plans with a letter designation (Plan A, Plan F, etc.), Open Enrollment referred to a person’s ability to enroll in a Medigap plan of their choosing when first enrolling into Medicare Part B without underwriting. There were no Part C and Part D plans for over a decade, so Open Enrollment only referred to this one situation. Today, it is used for many different aspects of Medicare. This is where the confusion has set in for many people. Let’s help clarify some of this confusion for you.

 

Election Periods for Insurance Plans

Annual Election Period (AEP)

If you did not enroll in a Medicare Advantage (Part C) or Medicare Prescription Drug Plan (Part D) when you were first eligible or need to make changes to your current Part C or Part D coverage, you can do so from October 15 to December 7 of each year. This is the Annual Election Period.

If you currently have Original Medicare, (Part A and Part B) with a stand-alone Prescription Drug Plan, you can make the following changes during AEP:

  • Enroll in a stand-alone Medicare Prescription Drug Plan that works alongside Original Medicare and your Medigap plan.
  • Switch to a different Medicare Prescription Drug Plan.
  • Disenroll from your Medicare Prescription Drug Plan.
  • Switch from Original Medicare to a Medicare Advantage plan.

If you currently have a Medicare Advantage plan, you can make the following changes during AEP:

  • Switch to a different Medicare Advantage plan.
  • Move from a Medicare Advantage plan that does not include prescription drug coverage to one that does (and vice versa).
  • Leave your Medicare Advantage plan and return to Original Medicare.

It is important to note that if you plan to leave your Medicare Advantage plan for original Medicare, you will not automatically qualify for a Medigap plan to supplement your Medicare coverage. Unless you are in an Open Enrollment situation such as turning 65 or enrolling into Part B, or a Guaranteed Issue situation, you must pass medical underwriting to enroll in Medigap coverage. More on your Guaranteed Issue options in the Special Enrollment Period section below.

It is best to apply for Medigap first before disenrolling from a Medicare Advantage plan. Once you are approved for Medicare supplement coverage, you can disenroll from your Medicare Advantage plan.

AEP Does Not Affect Medigap Coverage

Because of all the ads and media attention that AEP gets each year, it can cause some confusion for those with Medigap coverage. Medigap plans are not affected by the Medicare Enrollment Periods.

Many people assume that because it is “Open Enrollment” that they can make changes to their Medigap coverage without medical underwriting. Medigap plans are much more comprehensive in coverage than their Medicare Advantage counterparts. With Medicare supplement coverage, you can go to any doctor, specialist, or hospital in the US that accepts Medicare. There are no referrals needed. There are no networks to consider. But Medigap plans usually carry a higher monthly premium for this comprehensive coverage.

We go into a detailed comparison between Medigap and Medicare supplement coverage in this video:

 

Medigap Plans Are Guaranteed Renewable

Medigap coverage renews every month. And you can change your Medigap plan any time of year. Your coverage under a Medigap plan is contractually guaranteed and cannot be changed year to year. But to take advantage of the better coverage, you have to qualify medically to get a Medicare supplement. A reminder – if you are in your Open Enrollment period (within 6 months of enrolling in Part B) or a Guaranteed Issue situation – such as leaving an employer plan or a Special Election Period (covered below) – you do not have to qualify medically.

If you are considering changing your Medigap plan, you can call us at 1-888-228-6119 or use the contact form on this page to reach out to us. We can go over your Medigap options and see if you would qualify for a better premium for your coverage. You can make that change year-round. If you are in fairly good health, there is a good chance we can find coverage for you. We won’t know until we check your individual situation.

 

Initial Enrollment Period for Part D

If you are on Medicare and want prescription drug coverage (Medicare Part D), you have two choices. First, you can elect to enroll in a stand-alone Medicare Prescription Drug Plan that works alongside your Original Medicare and Medigap coverage.  Your second option is to enroll in a Medicare Advantage plan that covers prescription drugs.

You are first eligible for Part D when:

  • You have Medicare Part A and/or Part B.
  • You live in the service area of a Medicare plan that covers prescription drugs.

You can enroll for prescription drug coverage during your Initial Enrollment Period for Part D.  This Part D enrollment period generally occurs at the same time that you’re first eligible for Medicare Part A and Part B. If you qualify for Medicare because of turning 65, this period runs concurrently with your Initial Enrollment Period for Medicare Part A and/or Part B.  The enrollment period begins three months before you’re first eligible for Medicare, includes the month you become eligible, and ends after three months.

It is important to note that if you delay enrolling in Part B because of group employer or retiree coverage, your IEP actually starts based on your first eligibility for Medicare. That is actually triggered by eligibility for Part A which typically starts when you turn 65. If you delay your Part B enrollment in this situation, there are a couple of situations that could affect your enrollment into Part D:

  • If you have creditable prescription coverage under your employer or retiree coverage, you can qualify for a Special Enrollment Period, or SEP (more on this below), when that coverage ends. This will allow you to enroll in a Part D plan within the two months after your coverage ends. Make sure to keep a copy of your termination of coverage from the employer plan. Medicare will want a copy as proof of your eligibility for an SEP.
  • If you do not have creditable prescription coverage, your enrollment into Part B does not constitute an automatic open enrollment into a Part D drug plan. If you were eligible for Part A when you turned 65, that is when your Initial Enrollment Period began. Without prior creditable coverage through an employer or retiree plan, you would have to wait for the Annual Election Period. That period runs from October 15 – December 7 of each year.

If you become eligible for Medicare retroactively, your Initial Enrollment Period for Part D begins the month you receive notification that you are eligible for Medicare. It will continue for an additional three months.

 

Initial Coverage Election Period

As we have discussed, Medicare Part C is another way to get your Medicare Part A and Part B coverage. Medicare Part C refers to Medicare Advantage plans. These plans replace your Medicare Part A and Part B (and usually Part D) with coverage from a private insurance company. So, instead of getting your Medicare coverage through the government-run program, your coverage decisions are made entirely by the insurance company.

You’re eligible to enroll in a Medicare Advantage plan if:

  • You have Medicare Part A and Part B.
  • You live in the service area of a Medicare Advantage plan.
  • You do not have end-stage renal disease (with some exceptions).

Your first chance to enroll in a Medicare Advantage plan is during your Initial Coverage Election Period (ICEP). For the majority of people going onto Medicare, this enrollment period occurs at the same time as their Initial Enrollment Period for Part B. We cover the Initial Enrollment Period in more detail below.

The Initial Coverage Election Period (ICEP) is a period of time that starts three months immediately before you are entitled to Medicare Part A and enrolled in Part B. ICEP ends either the last day of the month before you are entitled to Part A and enrolled in Part B, or three months after the month of your 65th birthday, or the 25th month of receiving Social Security Disability Insurance (SSDI) benefits. If you choose to join a Medicare Advantage Plan during this period, the plan must accept you, unless it has reached its member limit.

 

Medigap Open Enrollment Period (OEP)

Medicare Supplement plans, also known as Medigap, have an Open Enrollment Period that runs concurrently with the Initial Election Period. This Open Enrollment Period, as it has long been known, lasts for 13 months. It begins 6 months before your 65 birthday, includes the month of your 65 birthday, and continues for 6 months after your 65 birthday.

This Open Enrollment period also occurs if you delay your enrollment in Medicare Part B because you stayed on an employer plan. In this case, it gives you guaranteed acceptance that lasts until 6 months after your Part B effective date. During the Medicare Supplement OEP, you can apply for a Medicare Supplement plan without having to go through medical underwriting. This is your one chance to go with any company and any plan that you choose. In other words, you cannot be denied acceptance into a Medigap plan of your choosing based on your health conditions.

 

Starting in 2019, the Annual Disenrollment plan has been replaced with the Open Election Periods listed below

Annual Disenrollment Period

The Medicare Advantage Disenrollment Period happens annually from January 1st to February 14th. During this period, people who discovered their Medicare Advantage coverage wasn’t as good as it was presented to them can return to Original Medicare.

Medicare Advantage plans have many restrictions such as specific networks you must use They also copayments and coinsurance anytime you utilize a service.  Many outpatient services such as chemotherapy and radiation cost you 20% out of pocket in most plans. Medicare Advantage works very differently than original Medicare with a Medigap plan. Once you enroll in a Medicare Advantage plan, you are locked into that plan for the full calendar year unless very specific circumstances allow you to get out.

When Medicare Advantage plans first came onto the market, many Medicare beneficiaries enrolled without realizing how limited the coverage is. Often, they didn’t understand the plans had a limited provider network.

Imagine their dismay when they would learn in January or February – after they were locked into the plan for the year – that their doctor was not in the network. How about a cancer patient learning that the oncologist they had been getting treatments from was not in their network? Or that their plan did not include their important medications. They would be stuck in that plan for the whole year. For those especially dealing with serious health situation, this created stress and anxiety.

This is one example of why Medicare put the annual Medicare Advantage Disenrollment Period into place. Plan members can leave their Medicare Advantage plan and return to original Medicare.

Medicare Disenrollment Period Guidelines

The disenrollment period can only be used for one thing – to disenroll from a Medicare Advantage plan. You cannot move from one Medicare Advantage plan to another one. Beneficiaries should use the Annual Election Period in the fall to change plans.

Your only option is to return to original Medicare. This will also trigger a Special Enrollment Period where you can enroll in a Part D drug plan. This is because most Advantage plans include drug coverage. You will be allowed to choose a Part D drug plan that is available in your area.

Your coverage under Medicare Part A and Part B will resume on the first day of the month following your disenrollment. For example, if you disenroll on January 20, your return to original Medicare will take place on February 1.

 

Open Election Period (OEP)

The 45-day annual disenrollment period from Medicare Advantage – referred to as the Medicare Advantage Disenrollment Period (MADP) – is eliminated for plan year 2019. Beneficiaries will now be eligible for the OEP.

OEP occurs annually from January through March 31. Beneficiaries, enrolled in an MA-only or MAPD plan, may use the Open Election Period to switch to:

  1. Another MAPD plan (Medicare Advantage with drug plan included)
  2. An MA-only plan (with no drug benefit)
  3. Original Medicare with or without a Part D drug plan.

The Open Election Period Does NOT Guarantee Acceptance to a Medigap Plan

It is very important to note that using OEP for option 3 above only moves you back to original Medicare. There is no guarantee that you will be approved for coverage under a Medigap plan. Like most people, you will probably want to get a Medigap plan to fill the gaps in Medicare. In order to get coverage, you will have to go through medical underwriting.

The best method for completing this process is to apply for coverage under a Medigap plan first. Once your approval is in place, disenrolling from a Medicare Advantage plan is the easy part. We can help walk you through the entire process.

There is one scenario where you can leave a Medicare Advantage plan and move to a Medigap plan without underwriting. This is called your Trial Right exception. We will cover this in detail in a later section if you want to scroll there now. But this Trial Right Period allows you to leave your Medicare Advantage plan if you have been on it for less than 12 months. You can only use this provision if it is your first time on a Medicare Advantage plan. This provision can also be used at any time of the calendar year as long as it is within your first 12 months of coverage. However, many people use it during the Open Election Period for the guarantee of moving into a Medigap plan without medical underwriting.

How to Disenroll From Your Medicare Advantage Plan

The simplest way to leave your Medicare Advantage coverage is to simply enroll in a stand-alone Part D plan. When CMS receives your enrollment in a drug plan, they will automatically disenroll you from your Medicare Advantage plan. CMS will not allow you to carry a Part C and Part D plan at the same time. Enrolling in one disenrolls you from the other automatically.

Be sure to confirm that the Medicare Advantage company has disenrolled you. Your agent is not able to do this for you. You will need to follow up with your Medicare Advantage company yourself to verify this. Their customer service number is on your coverage card.

You may also disenroll from your Medicare Advantage plan by contacting the plan in writing. You should have received an Evidence of Coverage booklet when you enrolled. It will have the information you need to contact the plan for disenrollment.

A third option is to contact CMS directly by calling 1-800-MEDICARE. CMS can help you disenroll. They can also help you find a suitable Part D prescription drug plan based on your current needs. As mentioned, enrolling in a drug plan will disenroll you from Medicare Advantage, as well.

 

Open Election Period for Newly Eligible Individuals (OEPNEW)

A newly Medicare Advantage eligible individual who is enrolled in an MA plan may change his or her election once during the period that begins the month the individual is entitled to both Part A and Part B. It ends on the last day of the third month of the entitlement.

An individual who chooses to exercise this election may also choose to enroll or disenroll from a Part D plan.

It is important to note that OEPNEW does not allow for Part D changes for those enrolled in original Medicare. This includes those enrolled in stand-alone Part D plans.

 

Open Election Period for Institutionalized Individuals (OEPI)

The Open Election Period for Institutionalized Individuals is continuous for Medicare beneficiaries who move into, reside in, or move out of an institution. OEPI ends two months after the month a beneficiary moves out of the institution. For example, if a person moves out during the month of February, their OEPI ends at the end of April.

 

Special Enrollment Period (SEP)

After the Annual Election Period is over, there are very few options to make changes to your Part C (Medicare Advantage) and Part D (prescription drug coverage) plans. There are some special circumstances that may trigger a different enrollment option. This is known as a Special Enrollment Period, or SEP.

Here are a few examples of special circumstances that may trigger an SEP for you:

  • You move out of your Medicare plan’s service area.
  • You’re eligible for Medicaid coverage – or you lose your eligibility.
  • You get Extra Help (also known as the Low-Income Subsidy) with your Medicare prescription drug costs.
  • Your Medicare plan leaves the Medicare program.
  • You live in, just moved into, or just moved out of a nursing facility or other institution.

In most cases, when you inform your current plan of your intent to use a Special Enrollment Period, you have a limited time to change plans. The time frame generally consists of the current month and the following two months after you tell your plan.

For the full list of events that can qualify you for a Special Election Period, you can visit Medicare.gov. If you believe that you may qualify for an SEP, you can call us to get your Medicare questions answered. You can use the contact form on the right side of this page or call us at 1-888-228-6119.

 

Trial Right Period

We briefly covered the Trial Right option above. If you have been in a Medicare Advantage plan for less than a year, you may have an option to leave under the Trial Right provision. If you qualify for Trial Right, you can move onto original Medicare and have the option to guaranteed acceptance into certain Medigap plans.

The Trial Right can be used anytime during the year. This special Medicare enrollment period only applies in limited situations. Here are the two situations you can use it in:

1 – You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.

If this is your situation, you can enroll in any Medigap plan of your choice.

You can/must apply for a Medigap policy:

  • As early as 60 calendar days before the date your coverage will end
  • No later than 63 calendar days after your coverage ends

2 – You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.

Your situation is a little different than the first scenario.

You have the right to buy:

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it.

If your former Medigap policy isn’t available, you can buy a Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

You can/must apply for a Medigap policy:

  • As early as 60 calendar days before the date your coverage will end
  • No later than 63 calendar days after your coverage ends

Medicare Enrollment Periods For Medicare Part A and B

The previous sections covered the Medicare enrollment periods that deal with your coverage for Part C or Part D and with Medigap plans. This section will deal with your enrollment into Part A and Part B of Medicare. These Medicare enrollment periods are for enrolling in Medicare itself, not your additional coverages beyond original Medicare.

 

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) refers to the first time an eligible person can enroll in the federal Medicare program. It is best to enroll in Medicare during your IEP. This will help to avoid any late-enrollment penalties.

You may join Medicare Parts A, B, C and D, or enroll in a Medigap plan during this time:

  • The 3 months before your 65th birthday,
  • The month of your birthday, and
  • The 3 months after your birthday.

Medigap plans will actually allow you to enroll for coverage 6 months before your first month of Part B eligibility when you are turning 65. We recommend taking advantage of this opportunity. Your Medigap rate is locked in for the first 12 months of coverage. So enrolling 6 months ahead actually gives a rate lock of 18 months.

Most people are enrolled in Medicare Part A and Part B automatically ahead of their 65th birthday. If you are already receiving Social Security or Railroad benefits, you will automatically be enrolled in Part B.  The IEP is the first time people may enroll manually if necessary. You also have the option of enrolling in a stand-alone Part D Medicare Prescription Drug Plan during this Medicare enrollment period, as long as you are entitled to Medicare Part A or enrolled in Part B.

If you are NOT receiving Social Security benefits at age 65, you will not be automatically enrolled in Medicare Part A or Part B. You must sign up for Part A yourself. When you enroll in  Medicare Part A after your 65th birthday, your enrollment will be backdated 6 months and will be effective no earlier than the first day of your 65th birth month.

If you have a Healthcare Savings Account (HSA), it is important to stop your contributions to correlate with your Part A effective date. This is because enrollment in Part A disqualifies you from contributing to an HSA. If you have already made contributions to the HSA up to the time you enroll in  Medicare Part A (after turning 65), you will need to contact the HSA Administrator to back those funds out of the account. Otherwise, you could face tax and excess contribution penalties.

 

General Election Period (GEP)

Sometimes people miss the opportunity to enroll in Medicare during the Initial Enrollment Period or Special Enrollment Period. Doing so will put you at risk of paying a late enrollment penalty. This is why we recommend enrolling in Medicare during your IEP.

If you missed it, all is not lost. The last of our Medicare Enrollment Periods is the General Election Period, or GEP. During this period, which occurs from January 1 to March 31 each year, you can enroll in Medicare Part A and Part B.

Unlike Part A where your enrollment is back-dated 6 months, your Part B enrollment will be effective the following July 1 after you enroll. So if you enroll in Part A and Part B in January, your Part A effective date would for July 1 of the previous year and your Part B effective date would be July 1 of the current year. Confusing? Somewhat, even for agents who work with Medicare every day. But we have the experience to help you navigate it all here at Integrity Senior Solutions.

Keep in mind that you may have to pay a late-enrollment penalty for Part B if you didn’t sign up for Medicare when you were first eligible. If you aren’t eligible for premium-free Part A, you may owe a late-enrollment penalty for Part A, as well. You are entitled to Part A coverage for free if you have worked at least 40 quarters (10 years) in your lifetime and paid Medicare taxes.

 

We Are Here to Help

If you have any questions about these Medicare Enrollment Periods and how they may affect you, please reach out to our office. We can help you find the best coverage for your situation. Best of all, there is no charge or fee for our service!

The phone number is 1-888-228-6119. You can also use the contact form to the right to reach us.