Medicare Enrollment Periods - What and When Are They?

Medicare, like other forms of Health Insurance, has specific times throughout the year that you can sign up. These are called Enrollment Periods and with Medicare, there are 3 different types; Initial, General, and Special. We’re going to highlight each one and the timeframes associated with each.

Initial Enrollment Period

Your Initial Enrollment Period (IEP) with Medicare is pretty straightforward. This is a 7-month period and your first opportunity to sign up for Medicare Parts A + B and any Supplemental Insurance. Your IEP begins 3 months before the month of your 65th Birthday and extends to 3 months after your 65th Birth month. For example, if you were born in April, your IEP would start on Jan 1st and end on July 31st.

Your Medicare start date changes based on which month you sign up during your IEP.

If you sign up during the 3-month period before your 65th birthday, you’re Medicare will start on the first of the month in your birth month. For example, if your birthday is May 17th, you could sign up between February-April and your Medicare would become active for May 1st.

If you sign up during your birth month, or during the 3-month period after your 65th birthday, your Medicare will start on the first of the following month. Using the same example above, if your Birthday is May 17th, and you sign up for Medicare in May, it would become active on June 1st.

Depending on your situation you may not want to sign up for Medicare during this time. The most common reason to not sign up during your IEP would be if you or a spouse were going to continue working past 65 and be covered by an employer group plan. In these cases, most people sign up for Part A only(unless you actively contribute to a Health Savings Account), since there is typically no monthly cost. When you’re ready to retire and going to be losing employer group coverage you will have another opportunity to sign up for Part B and any Supplemental Insurance as well.

General Enrollment Period

The General Enrollment Period with Medicare begins on January 1st and ends on March 31st. If you sign up for Medicare during this period your effective date would be the first of the following month. Typically, people will sign up during this period if they missed the opportunity to sign up during their IEP and don’t have the option to enroll through a Special Election Period.

Special Election Periods

If you don’t sign up for Medicare during your IEP or during the GEP, you may have other opportunities to enroll or switch plans based on special situations. Special Election Periods generally fall under 5 different categories: You change where you live, you lose your current coverage, you have a chance to get other coverage, your plan changes its contract with Medicare, and Other Special Situations. There are multiple, more specific situations under each of these categories. Typically, if you sign up during a Special Election period your coverage will begin 1 or 2 months after the month you sign up.

The most common Special Election Period is losing creditable employer coverage. This election period applies to people who are working past 65 and still covered by their employers or a spouse’s employers group plan. Once you lose your Employer Coverage you have an 8-month window to sign up for Part B. However, your window to sign up for a Medicare Advantage Plan or a Part D plan is only 2 months after coverage ends. Most people time their Medicare to start the month after their employer coverage ends to avoid lapses in coverage.

Another common Special Election Period is moving to a new address outside of your current plans service area. This applies to people who move to a new state, change their primary residence, or in some larger states move to a new county. The timing of this election period has to do with when you tell your plan you are moving. If you tell them before you move, you have a chance to switch plans the month before you move and continue for 2 full months after you move. If you are moving on June 7th, you would have a chance to change plans from May-August. If you tell your plan you moved after you actually move, you have the month of your move and 2 full months after. Using the same example if you moved on June 7th you would have June-August to switch.

For a full list of all the Special Election Periods with Medicare, you can visit this link: https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances-special-enrollment-periods

5-Star Special Election Period

Centers for Medicare and Medicaid Services (CMS) rates every Medicare Advantage and Part D plan with a 1–5 Star rating. 1 being the lowest, 5 being the highest. The ratings consider satisfaction surveys from members and providers among a few other factors. Plans that are rated 5 stars have a Special Election Period all their own. If you have Medicare Parts A + B you can enroll into a 5-Star rated plan from December 8th-November 30th. You can only make the change once per year during that time and a 5-star plan must be available in your area. Your coverage would begin the first of the month after the month you enroll. The 5 Star Special Election Period isn’t a chance to sign up for Medicare Part B.

Annual Enrollment Period

The Annual Enrollment Period with Medicare runs from October 15 to December 7th. This is not a period when you can sign up for Medicare Part B. Instead, plan changes for Medicare Advantage and Part D plans are released for the next year during this time. You can review the changes, if any, made to your plan and decide if you would like to stay or switch to a new Advantage or Part D plan. If you do make a change to your plan during this time it will be active for Jan 1st.

Medicare has many different moving pieces and timelines that come into play. We’re happy to help sort through these situations and determine if you would be eligible to switch into a new plan. If you’re looking to get started on the right foot with Medicare, we’re happy to help take the guesswork out of the process. Feel free to reach out to us and see how Doctor’s Choice can help you with your Medicare needs. Thanks for reading!