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Medicare General Enrollment vs Medicare Advantage Open Enrollment

Medicare General Enrollment vs Medicare Advantage Open Enrollment: What’s the Difference?

January 1 marks the beginning of two Medicare sign-up periods: General Enrollment and Medicare Advantage Open Enrollment. However, even though they start and end on the same days (January 1 through March 31), the guidelines for each enrollment period are very different. In this post, we describe what you can do during Medicare General Enrollment vs Medicare Advantage Open Enrollment, as well as when your changes will take effect.

What Is Medicare General Enrollment?

You can sign up during the Medicare General Enrollment Period if you meet all of the following criteria:

  • You have never signed up for Medicare (Part A, Part B, or both)
  • Your Initial Enrollment Period (IEP) is over
  • You do not qualify for a Special Enrollment Period (SEP)

If this is your first time enrolling in Medicare, please note that you do this through Social Security. Your coverage will begin July 1.

Is There a Late Penalty for Signing Up During General Enrollment?

You may face late penalties if you did not enroll during your IEP and don’t qualify for a Special Enrollment Period. Much depends on how much time passes from when you could have signed up for Medicare to when you actually do. If a full 12 months pass, you’ll likely face late penalties.

The Medicare Part A late penalty is 10 percent of your premium for twice the number of years you could have registered but did not. So, if a full 12 months pass, you pay the penalty for 24 months. Of course, if your premium is zero, then you have no late penalty for Part A, since 10 percent of zero is zero.

Medicare Part A Late Penalty

Unfortunately, Medicare Part B late penalties are paid for the entire time you have Medicare. In this instance, you pay an extra 10 percent for every year you delay enrollment without qualifying for an SEP. So, 12 months is 10 percent, 24 months is 20 percent, and so on. This is why we advise signing up for Medicare as soon as you qualify.

Medicare Part B Late Penalty

What Is the Medicare Advantage Open Enrollment Period?

The Medicare Advantage Open Enrollment Period (OEP) is for anyone who currently has a Medicare Advantage (MA) plan. It lasts from January 1 through March 31 and allows you to switch to a different MA plan OR switch back to Original Medicare. For those choosing to return to Original Medicare, you may also enroll in a Part D plan.

You may only make one change during the Medicare Advantage OEP. Any changes you make take effect the month after the plan receives your request.

What You Can’t Do During Medicare Advantage Open Enrollment

Unlike the Annual Enrollment Period, you can only make changes during MA Open Enrollment if you have an MA plan. That means that you cannot leave Original Medicare to join an MA plan. In addition, you can’t join a Prescription Drug plan (Medicare Part D), or change to a new one, if you have Original Medicare. Again, this enrollment period is only for people who currently have a Medicare Advantage plan.

What If You Don’t Qualify for Either One?

If you don’t qualify for either Medicare General Enrollment of Medicare Advantage Open Enrollment, then one of the following must be true:

Medicare General Enrollment vs Medicare Advantage Open Enrollment

If you have Original Medicare, you don’t need to do anything. Your current coverage simply continues in 2019. If you’re in your Initial Enrollment Period, then welcome to Medicare! We have a plethora of educational articles available, but we suggest starting with our Medicare 101 post. It explains the Medicare basics to help you understand your options. There’s also our guide for people turning 65 this year. Both are easy to read and offer great tips for making the most of your Medicare coverage.

The third item is often the most difficult to ascertain, as there are numerous situations that qualify you for an SEP. Actually, the Centers for Medicare Rights (CMR) identifies 20, with numerous examples and qualifying situations listed for each. The most common are:

  • Losing creditable drug coverage through no fault of your own, meaning you didn’t stop paying your premiums
  • Joining or leaving employer-provided coverage
  • Being institutionalized, i.e. moving into or out of a nursing home or skilled nursing facility
  • Gaining or losing Extra Help, Medicaid, or MSP eligibility

Find full details, including how long the SEP lasts, on CMR’s SEP chart.

Get Help from a Medicare Expert

Understanding Medicare’s many enrollment periods can be extremely confusing. The licensed agents at Medicare Solutions have the training and expertise to answer all of your Medicare questions. Just call us toll-free at 855-350-8101 (TTY 711) to get started.

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