Despite the deluge of mail and near-constant advertisements, many Medicare beneficiaries miss the Medicare Annual Enrollment deadline. Life has a habit of interrupting even the best intentions. If you missed Annual Enrollment this year, you do have a few options to make changes to your Medicare coverage for 2019. In this post, we describe those options and when changes would take effect.
Do You Qualify for the Initial Enrollment Period?
If you qualify for the Initial Enrollment Period, or IEP, you don’t need to wait for any of the other Medicare enrollment periods. Your IEP begins three months before your birth month and lasts for three months after your birth month (seven total months).
If you sign up during IEP, your coverage start date depends on when you enrolled.
- During the first three months: The first day of the month you turn 65 OR the month before your birthday if you were born on the 1st day of the month
- The month you turn 65: One month after you sign up
- Month five: Two months after you sign up
- Months six and seven: Three months after you sign up
Please note that, if you want a Medicare Advantage (also known as Part C and MA) plan, you must first enroll in Original Medicare (Parts A and B).
The Medicare General Enrollment Period
The General Enrollment Period is available to anyone who has never signed up for Medicare (Part A, B, or both) AND is not eligible for a Special Enrollment Period (SEP).
Depending on your unique circumstances, you may have a late penalty for not enrolling during your IEP. If a full 12 months pass between becoming eligible and enrolling AND you don’t qualify for an SEP, you typically pay a penalty.
Medicare Part A only has a penalty if you do not qualify for premium-free Part A. If that describes you, the penalty is 10 percent of your monthly premium for twice the number of years you could have had Medicare but did not.
If you delayed enrolling in Part B and do not qualify for a Special Enrollment Period, the penalty is 10 percent for every full 12-month period that you could have enrolled in Part B but did not. So, 12 months equals 10 percent, 24 months equals 20 percent, and so on. You pay this penalty for the entire time you have Medicare.
Please note that you apply for Medicare through Social Security. This page has all of the information you need to apply for Medicare. When you sign up during General Enrollment, coverage begins on July 1.
The Medicare Advantage Open Enrollment Period
If you have a Medicare Advantage plan, you may make the following changes between January 1 and March 31:
- Switch to a different Medicare Advantage plan (with or without drug coverage)
- Leave your MA plan and return to Original Medicare
If you’re changing back to Original Medicare, you may also enroll in a Medicare Part D plan at the same time.
During the Medicare Advantage Open Enrollment Period, you may NOT do any of the following:
- Leave Original Medicare to join an MA plan
- Join a Prescription Drug Plan if you have Original Medicare
- Switch to a different Prescription Drug Plan if you have Original Medicare
You may only make one change during MA Open Enrollment. Once the plan receives your request, all changes take effect on the first of the following month.
Do You Qualify for a Special Enrollment Period?
Some beneficiaries delay enrolling in Medicare because they have coverage through either their employer or their spouse’s employer. If this describes you, you qualify for an SEP as long as you or your spouse is still employed AND you have group plan coverage based on that employment. Once employment or the coverage ends (whichever comes first), you have eight months to enroll in Part A and/or Part B.
Enrolling in Medicare during an SEP typically means you do not have to pay a penalty for late enrollment. Please note that COBRA and retirement health plans do not qualify for an SEP as they are not based on current employment.
You may also qualify for a Special Enrollment Period if you experience certain life events. Qualifications vary according to the type of event. Find the full details of what you can do, how long you have to act, and when coverage begins here.
Changes in where you live
This life event covers five difference scenarios:
- Moving to a new address outside your plan’s service area
- Moving to a new address within your plan’s service area, but you also have new plan options
- Returning to the United States after living in another country
- Moving into or out of, or currently living in, an institution, such as a long-term care hospital or skilled nursing facility
- Being released from jail
Typically, you have two full months to make changes after you move.
Losing your current coverage
Many people who qualify for Medicare delay enrollment because they already have coverage through a group health plan, Medicaid, or similar programs. Qualifying scenarios include:
- Losing Medicaid eligibility
- Discovering you no longer qualify for Extra Help
- Leaving coverage through an employer or union
- Losing creditable drug coverage involuntarily OR your creditable drug coverage changes and is no longer creditable
- Leaving a Medicare Cost Plan that provided drug coverage
- Leaving a Program of All-inclusive Care for the Elderly (PACE) plan
Each of these scenarios gives you at least two months to make changes without penalty.
Again, there are literally dozens of scenarios that qualify you for a Special Enrollment Period. If you have any questions about your Medicare coverage or enrollment, call us toll-free at 855-350-8101. One of our licensed agents can answer all of your questions.