Medicare Enrollment Periods for 2020

There are several enrollment periods for various parts of Medicare. It can be a bit confusing and overwhelming if you’re not familiar with the requirements that apply to your particular situation.

General Medicare eligibility requirements

Before you can enroll, you need to make sure you meet the general requirements for Medicare eligibility. They include:

• You’re 65 or older and a US citizen. You also are eligible if you’re a permanent legal resident, and you have lived in the United States for at least five consecutive years.

• You are already receiving Social Security retirement or Railroad Retirement Board benefits.

• You’re disabled and receiving Social Security Disability Insurance or Railroad Retirement disability insurance benefits. In most cases, there is a two-year waiting period when you first start receiving disability benefits.

• You have end-stage renal disease (ESRD) at any age, and your kidneys no longer work, you need regular dialysis, or you have had a kidney transplant. You’re also eligible if you have ESRD, and you worked the required amount of time as a government employee, under Social Security or the Railroad Retirement Board. You also qualify if you’re the spouse or dependent child who meets any of these requirements as well.

• You suffer from amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS). If you suffer from ALS, there is no waiting period. Medicare benefits kick in when your SSDI benefits begin.

NOTE: If you or your spouse didn’t pay Medicare taxes while you worked, you may still be eligible for Medicare benefits if you pay a monthly premium. Most people who paid Medicare taxes for at least 40 quarters (10 years) will not have to pay a premium for Part A Medicare.

When can I enroll, change my Medicare plan, or apply for additional coverage?

You have several opportunities throughout the year to enroll, switch plans, or add Medicare coverage. Let’s take a closer look at how and when you can do each of these.

If you have a qualifying event, such as a job change or job loss, a change in insurance coverage, or other similar situations, you may be able to obtain coverage at any time throughout the year through a Special Enrollment Period.

In some cases, you won’t have to do anything to enroll. You will automatically be enrolled in Medicare when you turn 65 if you’re receiving Social Security or Railroad Retirement benefits.

You can’t always enroll in all parts of Medicare during each of the periods, so you need to pay attention to what you can and cannot do to avoid going without coverage for an extended time.

However, you only need to sign up for Medicare once. After you’re enrolled, your coverage is permanent as long as you pay any required premiums.

What are the Medicare enrollment periods?

Initial Enrollment Period (IEP)

For most people, the first time they will enroll in Medicare is when they turn 65. Your Initial Enrollment Period (IEP) is a seven-month window that begins three months before the month you turn 65, includes the month you turn 65, and the three months afterward. Actual enrollment takes place on the first day of the month you turn 65.

If you’re already getting Social Security benefits at 65, then you’re automatically enrolled in Part A and Part B Medicare. A Medicare card will be mailed to you about three months before you turn 65. If not, then you’ll have to enroll on your own.

Because there is a premium associated with Part B, you will be given the option to decline coverage. You can also decline Part A, but there is no downside since it’s free in the vast majority of cases.

If you don’t qualify for free Part A coverage, you can still sign up during your IEP, but you will probably have to pay a premium, which will vary depending on how long you worked and paid Medicare taxes.

Also, if you don’t enroll during your IEP, you may have to pay a premium penalty if you decide to enroll later on. You could also end up with a gap in coverage if you don’t enroll during this period as well.

You can also enroll in Part C Medicare Advantage coverage and Part D Prescription drug coverage during your IEP as long as you also enroll in Part A and Part B coverage.

People who already have Medicare before 65 due to a disability have another Part D IEP for when they turn 65 years old.

And, you can enroll in Medicare before 65 with other certain qualifying conditions. For example, if you have ALS, you can enroll in Medicare the first month you get SSDI benefits.

With end-stage renal disease and you need dialysis or a kidney transplant, you can get Part A and Part B benefits within three months of your first dialysis treatment.

Special Enrollment Period (SEP)

If you have delayed enrolling in Part B because you already have employer group coverage, either through you or your spouse, you can enroll in Part B during a Special Enrollment Period (SEP). You also qualify for a SEP if your current Medicare plan when you stop working or your employer no longer covers you.

The SEP can take place at any time throughout the year and is the 8-month period following the end of your employment or your employer’s group coverage, including COBRA, whichever is earlier.

If you are able to enroll during your SEP, you don’t have to pay a late enrollment penalty that might otherwise be due if you did not sign up during your IEP.

If you’re younger than 65, and you become eligible for Medicare because you are disabled, but you also have coverage through you or your spouse’s employer, you can also delay enrollment in Part B.

It should be noted that if you have ESRD, you will not have the same SEP. Different rules will apply.

For Part C and Part D coverage, there are several circumstances when a SEP will apply. Some of the more common scenarios include:

• If you move and you have different insurance options, you have an SEP that allows you to either change plans or revert back to Original Medicare.

• If coverage ends through your employer or your union group health plan, you have a 2 month SEP that starts the month after your coverage ends.

• If you’re eligible for Medicaid benefits, you have an open-ended SEP that allows you to enroll or change Part C or Part D plans.

• If you lose your Medicaid benefits, you have a 3 month SEP to switch to a Part C and Part D plan starting with the month you’re notified that you’re losing Medicaid eligibility.

• If you qualify for Extra Help (low-income subsidies), you have an open-ended SEP for as long as you qualify for Extra Help.

• If you no longer qualify for Extra Help, you have a 3-month SEP beginning with the month you’re notified you are losing your low-income subsidy.

• If you live in an area with a Part C or Part D plan that has an overall plan performance rating of 5 stars, you can join that plan from December 8 through November 30.

There are other instances that allow you to use SEPs to enroll in Part C and Part D coverage. Contact Medicare directly if you have questions about whether you qualify or not.

Lifelong SEPs let you change plans once every quarter for the first three quarters each year. Circumstantial SEPs let you change plans one time following a particular event.

General Enrollment Period (GEP)

If you miss your IEP, you can still sign up for Medicare Part A and Part B during the General Enrollment Period (GEP). The GEP runs from January 1 through March 31 annually.

When you enroll during the GEP, your coverage begins the following July 1.

Also, if you enroll during the GEP, you might have to pay late enrollment penalties. For Part A, these penalties could increase by 10% for twice the number of years you could have been enrolled but chose not to do so.

For example, if you delay signing up for Part A by three years, you would have to pay a Part A late enrollment penalty for six years.

Your Part B premium could also go up 10% for every 12-month period you were eligible but did not sign up. If you delayed Part B enrollment for three years, you would pay a 30% enrollment penalty for as long as you’re enrolled in Part B from that point on.

Medicare Advantage Open Enrollment Period (OEP)

Starting in 2019, Medicare beneficiaries were able to take advantage of the Medicare Advantage Open Enrollment Period (OEP). The OEP runs January 1 through March 31 annually.

The OEP allows people already enrolled in a Medicare Advantage Part C plan to make a one-time change. During this period, you can switch from one Part C plan to another Part C plan, or you can disenroll from a Part C Plan and return to Original Medicare (Part A and Part B) with or without a Part D prescription drug plan.

The OEP was reintroduced because administration officials found that beneficiaries were often confused about Medicare Advantage plans, and overlooked important elements when signing up for a plan. Many did not realize that Part C plans had networks, or that certain drugs might not be covered under a plan’s formulary, or that co-pays might be required.

Other reasons people might want to change their Part C plan is if they discovered that their doctor was leaving their network or their network became more restrictive.

Medicare Supplement Insurance (Medigap) Open Enrollment Period

You will get more choices and better prices if you buy a Medigap policy when you’re first eligible during your 6-month Medigap Open Enrollment Period. In fact, you can buy any policy sold in your state during this time.

One of the big advantages of buying during your open enrollment period is that you can’t be denied coverage, even if you have health issues. This is known as a guaranteed issue right. If you apply after your open enrollment period, an insurance company is not required to sell you a Medigap policy if you don’t meet underwriting requirements, except for a few specific situations.

Even if you are able to buy one, it could cost more due to past or present health conditions. However, during the open enrollment, you can buy any policy that a company sells for the same price as people who are in good health.

If you’re 65 or older, your Medigap open enrollment period starts the first day of the month, and you’re enrolled in Part B. Most times, it makes sense to enroll in Part B when you’re first eligible, so you avoid any premium penalty costs.

If you’re under 65, some states may require Medigap insurers to sell you a policy. However, federal law does not require insurers to sell you a Medigap policy if you’re under 65. Again, it’s best to check with the particular laws in your state.

If you’re covered through an employer’s group insurance, then you can enroll in Part B at a later date without an enrollment penalty. Your open enrollment period to buy a Medigap policy would start at that time.

Some states do have additional Medigap open enrollment periods, so it’s best to check and see what the specific regulations are for your jurisdiction. Some states may also allow you to buy a Medigap policy called Medicare SELECT.

This type of policy requires you to use in-network hospitals and, in some cases, in-network doctors to enjoy full benefits.

Part D Enrollment Periods

There are several times a year that you can enroll in a Medicare Part D prescription drug plan.

The first is during your Initial Enrollment Period when you turn 65. You’ll have a 7-month window to do so, and you must also enroll in Part A and Part B at that time.

Every year, you can also enroll, make changes, or drop your Part D plan during the Annual Enrollment Period. This runs October 15 through December 7.

You can also enroll during a Special Enrollment Period, which can take place at any time of the year, as long as you have a qualifying event. This can include things like losing a job with health coverage, you moved out of the service area for your current Part D plan, or your current plan is ending their contract with Medicare, you were recently incarcerated, among others.

You can also enroll in a Part D plan any time you qualify for Medicare Extra Help. This helps low income and limited asset people pay for prescription drugs.

Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP) runs October 15 through December 7 each year. During this time, you can change, drop, or add Medicare Part C and Part D coverage for the coming year.

If you didn’t sign up for one of these plans during your IEP, the AEP is when you have the chance to make changes unless you qualify for a SEP.

In September, you’ll get an Annual Notice of Change letter so that you will know how your coverage is going to be different. With this letter in hand, you have accurate information that you can use to determine if the plan you have still best fits your needs.

• Change to or from a Medicare Part C plan from Original Medicare, Part A, and Part B.
• Change from one Medicare Advantage plan to another.
• Add a Medicare Supplement Plan.
• Enroll in a Part D prescription drug plan.
• Change from one Medicare Part D plans to another.
• End Medicare Part D coverage completely.

Changes made during the AEP go into effect on January 1 of the following year.

Also, if you make more than one change during the AEP, your last change received during that period is the one that applies.

How to enroll in Medicare

For general information on Medicare and how to enroll, visit the Medicare website.

Part A and Part B

If you’re over 65 or you’re turning 65 within the next three months, you can enroll in Part A and/or Part B online through Social Security.

You can also call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 am to 7 pm.

You can also apply in person at your local Social Security office.

If you worked at a railroad, you can enroll by calling the Railroad Retirement Board at 1-877-772-5772 (TTY users 1-312-751-4701). Assistance is available Monday through Friday, from 9 am to 3:30 pm.

Part C and Part D

You will need to compare plans and shop for the one that best meets your particular situation. There are several online resources to help you, or you can work with an expert agent who will provide the guidance you need to make the right choices.

Medicare also offers a Medicare eligibility and enrollment calculator. You can access it here.

How do I know if I should change Medicare plans?

Your general health and health insurance needs can change from year to year. You have options and opportunities to update your Medicare coverage so that it protects you in a way best suited for you.

You can do some of the legwork yourself, but it also helps to consult with an experienced Medicare insurance agent or with Medicare directly to make sure all of your questions are answered.

The difference between doing your homework and not doing your homework can cost you thousands of dollars in uncovered expenses if you’re not careful.

Qualifying for financial assistance with Medicare costs

Medicare Savings Programs (MSP) are administered by states and can help you pay for premiums, copays, deductibles, and coinsurance costs if you have limited income and assets.

There are three MSPs that help you pay for Original Medicare and Part B costs. They include:

• Qualified Medicare Beneficiary Program (QMB)
• Specified Low-Income Medicare Beneficiary Program (SLMB)
• Qualified Individual Program (QI)

Each of these has its own asset and income limits. Those limits are different in Alaska and Hawaii.

If you receive Medicare benefits and you meet the specific Medicaid eligibility requirements for your state, you may qualify for both programs. This is known as being dual-eligible.

If you qualify for any of the MSPs, then you also automatically qualify for Extra Help, which assists you in paying for your prescription drugs. Extra Help is also referred to as Part D Low Income Subsidy (LIS).