Qualifying for a Special Enrollment Period:
If you miss signing up for Medicare during your Initial Enrollment Period (IEP), you can still sign up for Original Medicare (Parts A and B) during the General Enrollment Period (GEP). This period runs from January 1 to March 31 every year, with coverage starting on July 1 for those who enroll during this time.
What If You Don't Sign Up for Medicare at 65?
Most people’s IEP takes place around their 65th birthday and spans seven months—three months before, the month of, and three months after their birthday. Failing to enroll during this time may result in late enrollment penalties unless you qualify for a Special Enrollment Period (SEP), such as having employer-provided insurance
How the General Enrollment Period Works
While the GEP provides another chance to enroll, late enrollment penalties may apply. For Medicare Part A, a 10% penalty can be added for twice the number of years you delayed enrollment. If you waited two years, you could pay this penalty for four years.
For Medicare Part B, the penalty increases by 10% for every 12-month period you were eligible but didn't enroll. This penalty applies for as long as you're enrolled in Part B.
Can You Delay Signing Up for Medicare Part B?
You can choose to delay signing up for Part B, but unless you qualify for an SEP or financial assistance, you may face a higher premium. The longer the delay, the greater the penalty.
Enrolling in Medicare Advantage (Part C) During the GEP
Although the GEP doesn't include Medicare Advantage (Part C), you can sign up for a Medicare Advantage Plan after enrolling in Parts A and B during this period. Medicare Advantage enrollment is allowed during specific times, such as the Initial Enrollment Period or the Annual Open Enrollment Period from October 15 to December 7.
If you qualify for a Special Enrollment Period, you can enroll or make changes to your Medicare Advantage plan at any time. For instance, individuals with End-Stage Renal Disease (ESRD) can enroll in a Special Needs Plan that accepts those with ESRD.
Enrolling in a Prescription Drug Plan (Part D)
You can join a Prescription Drug Plan either as a standalone option or alongside a Medicare Advantage Plan. If you enroll in Part A or B during the GEP, you can enroll in a Part D plan between April 1 and June 30, with coverage starting on July 1. Otherwise, you can sign up during your IEP or an SEP.
Medigap Policies and the General Enrollment Period
If you enroll in Medicare Part B during the GEP, you may also be eligible to purchase a Medigap policy, though premiums may be higher due to your health status if you wait beyond your Medigap Open Enrollment Period, which starts when you first sign up for Part B.
Medicare Savings Programs
Medicare Savings Programs (MSPs) help cover costs like premiums, deductibles, and co-pays for those with limited income and resources. MSPs include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) programs. If you qualify for an MSP, you're also eligible for Extra Help with prescription drug costs.
Key Medicare Enrollment Periods
- Initial Enrollment Period (IEP): A 7-month window around your 65th birthday for signing up for Medicare Parts A and B.
- Special Enrollment Period (SEP): Allows enrollment outside standard windows if you have qualifying circumstances, such as losing other health coverage.
- Medicare Advantage Open Enrollment Period (OEP): Runs from January 1 to March 31 for switching Medicare Advantage plans or returning to Original Medicare.
- Annual Enrollment Period (AEP): October 15 to December 7, where you can make changes to your Medicare Advantage and Prescription Drug Plans.
- Medigap Open Enrollment Period: A 6-month period starting when you enroll in Part B, allowing the purchase of any Medigap policy without underwriting restrictions.
How to Change Medicare Plans
You can make changes during specific enrollment periods based on your needs, such as switching from one plan to another or enrolling in a different type of coverage. Major life events, like retirement or job loss, may qualify you for a Special Enrollment Period to make changes.
Medicare Eligibility Requirements
To qualify for Medicare, you generally need to be 65 or older, or under 65 with a qualifying disability or medical condition like ESRD or ALS. U.S. citizens or permanent legal residents who have lived in the U.S. for five consecutive years are also eligible. Most individuals will receive free Part A benefits if they or their spouse worked and paid Medicare taxes for at least 10 years.
If you have limited income and resources, you may qualify for programs like Medicare Savings Programs or Extra Help, which assist in covering Medicare premiums, deductibles, and other costs.
Ready to explore your Medicare options on your own terms? With our easy-to-use platform, you can compare all available plans and enroll whenever it’s convenient for you.
Empower yourself with the information you need to make the best choice for your healthcare. Click the button below to start comparing plans and enroll today!
Do you want to work with an Agent?
Let’s find a medicare plan based on your Fit Score.
Are you looking for personalized guidance in navigating your Medicare options? Discover the perfect plan tailored to your unique needs through your Fit Score!
At Green Apple, our dedicated team of Career Healthcare Advisors is here to offer you year-round concierge services focused solely on your Medicare requirements. With our exclusive “Green Apple Difference” approach, we’ll connect you with the best solutions to achieve your healthcare goals.
Start your journey toward the right Medicare plan today! Click the button below to get started.