As John Lennon sang, life is what happens when you’re making other plans. Throughout our lives we experience changes, and they’re often unplanned and sudden. You move, you change jobs, you lose your insurance, anything can (and will) happen.
Usually, those life changes don’t fall conveniently within Medicare’s Annual Enrollment Period. Luckily, Medicare offers its beneficiaries numerous enrollment periods throughout the year. And, they have Special Enrollment Periods that allow you to make changes if you meet certain criteria. In this post, we explain each enrollment period and qualifying special circumstances.
When Is the Initial Enrollment Period?
The Initial Enrollment Period (IEP) occurs during the seven months surrounding your 65th birthday. This includes the three months before your birthday, the month of your birthday, and the three months following your birthday. So, if your birthday is June 15, your IEP begins on March 1 and ends on September 30.
If you sign up during the three months before your birthday, Part B coverage begins the first day of the month of your birthday (June 1 in our example). The same is true if you sign up for Part D.
What Is the Special Enrollment Period?
The Special Enrollment Period (SEP) applies to those who waited to sign up for Medicare because they had existing coverage through either their or their spouse’s employer or union.
You may enroll for Parts A and/or B through the SEP at any point while still employed or while still covered through your spouse’s employment. The SEP continues for eight months after either your coverage or employment ends, whichever comes first.
You may also qualify for and SEP if you have a health savings account (HSA) with a high deductible health plan (HDHP) based on you or your spouse’s employment.
Please note that COBRA and retiree health plans do not qualify for SEP according to Medicare.
SEP and Medicare Parts C and D
If you waited to sign up for Medicare Part C (Medicare Advantage) or Part D (Medicare Drug Plan) due to having coverage through your or your spouse’s employment, you have 63 days to sign up after the loss of that coverage.
What Is the General Enrollment Period?
Medicare offers the General Enrollment Period (GEP) for those who did not sign up for Medicare when they first became eligible AND are not eligible for SEP.
GEP runs from January 1 to March 31 and allows you to sign up for Medicare Parts A and B. Coverage begins July 1 and requires paying premiums for Part A and/or Part B. You may also face higher premiums due to enrolling late.
What Is the Annual Enrollment Period?
The Annual Enrollment Period (AEP) is Medicare’s annual opportunity to switch from Parts A and B to a Medicare Advantage (MA) plan (or to switch back). You can also choose a new MA plan. This is also the time when you can add, drop, or change your Medicare Part D Drug Plan.
AEP begins October 15 and ends December 7. Coverage begins January 1 of the following year.
When Can You Enroll in Medigap?
Medigap policies help you pay the costs not covered by Original Medicare. Unlike other Medicare plans, private insurers underwrite these policies. This means that you can be denied a Medigap policy if you do not meet the underwriting requirements. However, if you buy a policy during Medigap open enrollment, you cannot be denied.
Medigap open enrollment begins the month you are both 65 and enrolled in Part B. It lasts for six months.
What Are the Other Special Enrollment Periods?
Medicare offers numerous Special Enrollment Periods besides the SEP mentioned above. These are similar to the change of life exceptions offered by many employer-sponsored insurance plans. If you meet one of these special circumstances, you may make changes to your Medicare coverage.
Qualifying circumstances, as of January 2021, include:
- You are eligible for or lose eligibility for a Special Needs Plan
- You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program
- You are institutionalized
- You disenroll from your MA plan during the MA disenrollment period
- You enroll in or disenroll from Program of All-Inclusive Care for the Elderly (PACE)
- You experience an exceptional circumstance
- You experience enrollment errors or contract violations
- You experience issues with Medicare eligibility
- You have a permanent change in your home address
- You have Medicaid, a Medicare Savings Program, or Extra Help
- You join or drop health or drug coverage offered by an employer, including retiree plans
- You lose creditable drug coverage through no fault of your own
- You qualify for a new Part D IEP
- You want to enroll in a 5-star Part C or Part D plan
- You wish to disenroll from your first MA plan
- Your MA or Part D plan no longer offers Medicare coverage
- Your MA plan stops contracting with many of its providers
- Your Part C or Part D plan is consistently low-performing
In most cases, if you qualify for an SEP, you have 63 days after the qualifying circumstance occurs to make changes to your Medicare coverage.
Final Thoughts on Medicare’s Enrollment Periods
Medicare offers beneficiaries numerous opportunities to enroll for coverage, starting with your Initial Enrollment Period on through to the Special Enrollment Period if you meet certain qualifications.
