Confused on when you can enroll in Medicare? You are not alone!
Medicare is the health insurance plan for qualifying seniors. It is often confused with Social Security which is retirement income received after contributing to Social Security through w2 payroll taxes and work credit.
Medicare Part B We will review HOW you can elect in greater detail below near the end section. A quick simplified version of HOW to get started on Medicare Part B is:
- Enroll online at www.medicare.gov
- Call Social Security/CMS at 1-800-MEDICARE
- Visit a local county Social Security Office found here.
We get these two questions with every applicant: WHEN & HOW?
If you are turning age 65, (sometimes you'll see it called T65 in the Medicare literature) and retired your path and timing is typically going to be simple.
But, there are many other situations where you may delay your enrollment if you are enrolled on an Employer plan, or even enroll early if you are disabled for example.
Feel free to jump ahead to any section when you may enroll or delay your Medicare coverage, or different parts: Part B, Part D Prescription etc. :
First we'll talk about the WHEN.
There are actually potentially many times when someone might end up enrolling in Medicare in some cases. It's NOT the same for everyone. For others, there is just the initial eligibility period and the limited open enrollments. You have to be careful and make the right Medicare enrollment decision for your situation.
It can have huge effects long term on both your rates and access to medical care.
Make sure you talk with an experienced Medicare insurance products agency like ours to understand the best options for you.
For most people the first time they are eligible for Medicare enrollment is when they turn 65. The election window is 7 months in total.
This means you can enroll in Original Medicare or Medicare Advantage beginning three months before your 65th birthday, your birthday month, and the three months after.
Enrolling at IEP when you turn 65 with Medicare as the single insurance plan assumes you don't have another group health plan option in place. Some examples of alternate creditable group coverage are:
- Employer Sponsored Group Coverage
- Retirement Group Health Coverage
- Spousal Employer Coverage
Enrollment in Medicare Part A Hospital plan is typically automatic as you qualify over your lifetime through w2 payroll quarter credits.
Sometimes! If you elected Social Security early, enrolled in pre-65 disability Medicare already, or happen to be a Railroaid Retiree beneficiary then your enrollment in both Part A & Part B is automatic.
The id cards will arrive in the mail!
Each year from October 15th to December 7th effective dates January 1st the AEP allows existing Medicare enrollees to change plans. During AEP you can make changes to your Medicare enrollment such as:
- -Medicare Advantage plan members can change Medicare Advantage plans at same carrier or another insurance carrier
- -Cancel Medicare Advantage insurance coverage to switch to Original Medicare
- -Switch off Original Medicare to enroll in Medicare Advantage plan at carrier of your choice
- -Terminate your Medicare Part D RX plan coverage
- -Switch Medicare Part D plan at same carrier or another
- -Add Medicare Part D prescription plan coverage
All of these changes submitted during AEP are effective January 1st. Keeps it simple!
How will you know if you need to change plans?
It's not always obvious. You may be happy with your current plan but each year you will receive a Annual Notice of Change Letter, or ANOC in industry parlance.
Medicare requires the insurance carriers to mail out the Annual Notice of Change, or ANOC every year by September 30th. If you have not received your ANOC by September 30th then contact your insurance carrier to request a copy.
What if you missed the Annual Election Period AEP?? Although they are extremely different types of election periods there's one more chance for Medicare Advantage enrollees to make changes... OEP.
OEP spans from January 31st to March 31st with effective dates July 1st of each year.
During OEP Medicare Advantage enrolless only can make the following changes:
- Change Medicare Advantage plans
- Cancel Medicare Advantage and enroll in Original Medicare (no Medicare Supplement Guarantee)
- Apply for Medicare Part D prescription coverage (if separate policy not bundled in Medicare Advantage plan)
- Cancel Medicare Part D prescription coverage (if separate policy not bundled in Medicare Advantage plan)
Be careful with the Medicare Part D plan! This enrollment period a get out of jail free card if you are unhappy. It's not flexible. Here's why..
Almost all Medicare Advantage plans bundle Medicare Part D. This means you cannot drop it from your Medicare Advantage plan and enroll independently into a new Medicare Part D plan on a standalone basis.
In most situations if you need a prescription drug plan switch you simply change the Medicare Advantage plan which bundles a different Medicare Part D Prescription plan.
There is only one change allowed between the AEP & OEP open enrollment periods so make sure to talk it over with an experienced insurance agency first so you get it right and understand your decision.
Beyond the Initial Enrollment Period and the AEP/OEP open enrollment there are other times you may qualify to enroll in Medicare.
It's crucial to understand if you have rights to a SEP or Special Enrollment Period which MAY allow you to delay Medicare Part B and Medicare Part D RX until a later time when it's needed.
Examples of some SEP Special Enrollment Period Qualifying events are:
- Employer sponsored group health insurance coverage which will remain active (via self or spouse's employer)
- Lost or became inelgibile for Medicaid
- Move to a new region or state which causes a loss of prior coverage.
- Switch from Medicare Advantage to Original Medicare within the first 12 months of initial eligibility enrollment.
- If permanently disabled, you may qualify for Medicare Part A&B even before you reach age 65
- Medicare contract termination with an Insurance Carrier
- Eligible for both Medicare and Medicaid
- If you have qualifying chronic condition or special needs there may be a SNP 'Special Needs Plan' in your area.
- Errors made by the insurance carrier or agency in plan benefit description, misleading marketing, or enrollment
- A significant drop in contracted provider(s) on the Medicare Advantage Plan. For example, sometimes a Medicare Advantage plan has a single major General Hospital contracted to support the plan members.
The Hospital has an affilliated Physician network which would drop from the Medicare Advantage plan provider contract as well, resulting in inadequate number and speciality of Physicians to support the Medicare Advantage plan.
A 5 Star Rated Medicare Advantage plan rating is received by an alternate insurance carrier
What is the Qualifying Event Window to elect coverage?
After each of these SEP Special Enrollment Period events there is a window of time where you can enroll or disenroll. These windows can range between:
- Two Months
- Three Months
- Initial 12 Months
*other There can be very unusual or specific election periods or windows depending on the event. So, don't count on the timeframes of election periods above.
There are EVEN more SEP events to choose from which are not listed because they are a bit more rarely used so make sure to talk your situation through by contacting us. Or, email is firstname.lastname@example.org.
You may be able to use a different qualifying event to your advantage.
Okay, you've taken the first steps and gotten your Medicare Part A & Part B elected when you turn 65 years old. Congratulations!! You are well on your way.
When can you enroll in a Medicare Supplement 'guaranteed issued'?
It depends on your prior health coverage situation.
If you have no other coverage than Medicare as prior/current as you turn 65 you can apply for your Medicare Supplement plan and be guaranteed to be approved for the first 6 months from the point of Medicare Part B election.
If you stay on Employer Sponsored group insurance after age 65 the election window is 63 days from the time you cancel the Employer group coverage.
You also have the 63 day election window after many types of events like the ones listed above such as Medicare Advantage plan or insurance carrier plan cancellations which are non-voluntary.
*Plan cancellation due to non premium payment is not a voluntary cancellation and does not qualify.
Have a pre-existing condition or medical issue and worried about getting Medicare approved?
Let's talk about when pre-existing conditions matter and when they do not.
Medicare 'Guaranteed Issue' means you are applying during one of the periods listed above when the insurance carrier cannot refuse to approve you based on medical history or condition.
Got hospitalizations, surgeries, prescription, or chronic medical conditions?
Doesn't matter! No waiting periods for treatment either if you've had prior creditable health coverage.
In essence, you are protected during the election window and protected from 'medical underwriting'.
Earlier, you remember a time in life when a health insurance carrier could use your or pre-existing conditions against you when applying for an individual health plan.
The insurance carrier could previously decline to issue you an insurance policy on individual plans prior to the ACA bill.
Can you apply anytime later for a Medicare Supplement if you've missed your Guaranteed Issue election window?
Yes, but then the insurance carrier can consider your health history and pre-existing conditions are factored. This system is called medical underwriting. You CAN still apply and potentially receive an approval if your health is favorable enough.
Contact Us to ask questions regarding your individual case and whether or not you should try applying. Toll free 1-866-486-6551.
The Medicare Part D prescription plan has the same initial enrollment period as Medicare Supplements. You get 7 months to elect: 3 months before your 65th birthday, your birthday month, and the 3 months after.
Effective date is 1st day of the birthday month if you elect prior...but not retroactive if you if you elect after your birthday month.
A special enrollment period is allowed for Medicare Part D enrollees who didn't elect Part D because they stayed on an employer plan, or other creditable group coverage until that coverage terminates. This is just like the Medicare Supplement SEP window.
There is a penalty for late enrollment into Medicare Part D so be sure to contact us with any questions on whether or not you need to purchase the coverage at this time.
Next, we talk HOW...to enroll in Medicare Part A & B
First step, is to make sure you have Medicare A&B in place. There are several ways to do this:
-Call Medicare at 1-800-MEDICARE
-Online by visiting the website at www.medicare.gov to register your account, apply, & enroll
-In person at a local county Social Security office. You can find yours located here.
Now it's time to find the right Medicare Supplement plan. Instant quotes are here:
Medicare Supplement applications can be faxed to us directly at fx# 916 200 0425.
If you prefer to use the U.S. Postal service our mailing address for application submissions is:
1420 E. Roseville Pkwy
Roseville, CA 95661