If you have ever wondered about health insurance and enrollment periods, you are not alone. The time of the year when you can get yourself into a health insurance program varies from place to place and even between the kinds of insurances you might want or need. When it comes to enrolling in Medicare, it is not as straightforward or simple as most of us would prefer. In this collection of Medicare facts, we are going to go over the basics of the enrollment periods and help you plot out a calendar or plan for when you must get your applications completed and your proverbial ducks in a row.
Why does it matter? There are a few reasons that Medicare facts about enrollment periods matter, and before we go into specifics about those enrollment periods, we should look at just why they are significant.
The Importance of Planning for Enrollment
Some of the most financially valuable Medicare facts relate to enrollment periods and requirements. Just consider:
- The Social Security Administration says that “You can apply online for Medicare even if you are not ready to retire,” and this can allow you to adequately prepare for and even begin coverage without also dealing with the financial aspect of beginning to collect retirement funds; and
- Medicare explains that you may face a “Part B late enrollment penalty that applies if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% of the standard premium for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (January 1 through March) to enroll in Part B. Coverage will start on July 1 of that year…Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.”
It just makes sense to take the time to look at what you can and must do as you prepare for retirement or using Medicare.
The next thing to do is to know what Medicare coverage you require. These basic Medicare facts explain the fundamental options open to anyone eligible to enroll in and receive Medicare coverage:
- Part A – This is hospital insurance and “covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.”
- Part B – This is medical insurance and “covers certain doctors’ services, outpatient care, medical supplies, and preventive services”
- Part C , or Medicare Advantage Plans – Combines Part A and Part B with other coverage, such as prescription drug costs, and more. Medicare Advantage is usually through a plan such as a Medicare HMO or PPO, a Medicare Special Needs plan, a Medicare Private Fee-for-Service plan, or MSA (Medicare Savings Account). This means having both Part A and Part B coverage and will require you to pay the Part B premiums. It may include prescription drug coverage, too.
- Part D – This is prescription drug coverage and works alongside of Original Medicare, some Medicare Cost Plans, some Medicare Private-fee-for-service plans, and Medicare Medical Savings Account Plans.
- Medicare Supplement Insurance plans (Medigap) typically helps cover some of the health care costs that your Original Medicare does not cover.
- Other Medicare Health Plans:
- Medicare Cost Plans – These are not available to all but allow you to join if you have only Part B coverage. Also, if you have both A and B but go to a non-network provider it enables you to join or leave at any time. It also provides drug coverage or allows for joining Part D of Medicare.
- Demonstration/Pilot programs: Known as “research studies,” they are (as medicare.gov explains): “special projects that test improvements in Medicare coverage, payment, and quality of care. They usually operate only for a limited time for a specific group of people and/or are offered only in specific areas.”
- PACE (Program of All-inclusive Care for the Elderly) is a Medicare/Medicaid program that helps people meet health care needs in the community.
These are the options for Medicare, and some come with additional premiums, and so it is to your benefit to take the time to map out the kinds of equipment, treatments, medications, and other therapies you might require. Only then can you determine if you would benefit more from one sort of coverage over another. Yet, it also helps you to determine the various enrollment periods you must honor.
Specific Medicare Facts about Enrollments and Programs
The next set of Medicare facts, then, is the specifics about the enrollment periods.
- Initial Enrollment Period or IEP – This is the first time you can sign up for Medicare and may opt for Parts A-D at that time. This is a seven-month window that includes three months prior to the 65th birthday, the month of the birthday and three months afterward. Coverage begins no earlier than the birthday month.
- Special Enrollment Period or SEP – This applies if you delay enrollment in Parts A-D and will only be effective if you have coverage from an employer; OR within the eight months after coverage via Parts A and B end; OR 63 days after coverage ends for Parts C and D
- General Enrollment Period – If you did not sign up during the Initial Enrollment Period when you were first eligible or you are not eligible for a Special Enrollment period, you can sign up for your Part A and/or Part B coverage. This is the window of time running January 1 through March 31, but coverage will not begin until July 1 of that year.
- Fall Open Enrollment – This is frequently called the Annual Election Period and begins on October 15 each year and ends December 7. During this window, you can switch to a Medicare Advantage plan (Part C) from Original Medicare (Part A & Part B); You can switch back to Original Medicare from a Medicare Advantage plan (Part C); you can drop, add or switch to a different Medicare Prescription Drug Plan (Part D) if you have Part A & Part B; and you can switch from one Medicare Advantage Plan to another. Coverage begins January 1 of the following year.
Medicare Advantage Open Enrollment Period (OEP) –The Medicare Advantage Open Enrollment Period goes from January 1 through March 31 every year. You can switch from an existing Medicare Advantage plan to a different one or drop your Medicare Advantage plan and return to Original Medicare (Part A and Part B).
- Medicare Supplement Insurance (Medigap) enrollment – This could be an area of confusion that may require a separate set of Medicare facts around enrollment periods. For one thing, the best time to purchase a Medigap policy is during YOUR open enrollment period. At this point, the insurance company must sell you the policy at their best rate regardless of health issues and are unable to deny coverage. Another set of Medicare facts that few know about includes the following: You can use your guaranteed issue right (Those 65 or older have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage) to get the best rate. Outside of the enrollment periods can prove problematic because you can be denied coverage, get much higher premiums, face a waiting period, and more.
If you know which approach to your Medicare coverage you intend to use, it makes it far easier to achieve the best outcomes for you with Medicare facts such as those listed above. You may also want to take the time to weigh the various options or routes to coverage open to you. Before we finish up, let’s take a few moments to evaluate those options and find what works for you.
No matter what your circumstances, the basic Medicare facts apply, and you can choose several pathways to coverage. They are:
- Original Medicare –This is Medicare Part A Hospital Insurance) and Part B (Medical Insurance) coverage
- Original Medicare Plus Add-Ons – This is Original Medicare (Part A and Part B) when eligible and then signing up for Medicare Prescription Drug (Part D) when applicable and/or a Medicare Supplement Insurance Plan (Medigap)
- Medicare Part C – Also known as a Medicare Advantage plan that rolls everything into a single plan, and usually includes prescription drug coverage and extra benefits. It may mean lower premiums and more.
In this collection of Medicare facts and details about enrollment periods, you may have learned all that you need to know to begin comparison shopping and finding out which approaches work for you. Even better, these Medicare facts let you know when you can enroll and could spare you any headaches, lapses in coverage or penalties for failing to enroll when eligible or required.