Get more from your Medicare plan

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Like the people they cover, Medicare plans can change each year. Whether this is your first time enrolling or you already have a plan and are thinking about renewing it, be sure to explore your options! 

1. Fall Open Enrollment occurs each year from October 15 through December 7.

• Any change you make during Fall Open Enrollment will take effect January 1^st of the following year.
• In most cases, Fall Open Enrollment is the only time you can pick a new Medicare Advantage or Part D plan.
• If you have Medicare Advantage, you can also switch to Original Medicare. To get drug coverage, you should also join a Part D plan.
• Depending on where you live, you may be able to buy a Medigap policy, which helps pay Original Medicare costs. Limitations apply as to who can buy a Medigap and when.

Review your current Medicare health and drug coverage. If you are dissatisfied with your coverage for next year, make changes during Fall Open Enrollment.

• If you have Original Medicare, take a look at next year’s Medicare & You handbook to know your Medicare costs and benefits for the upcoming year.
• If you have a Medicare Advantage Plan or a Part D plan, you should receive an Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) from your plan. These notices are sent out annually to existing members and must be received in home before October 1 of each year. Review these notices for any changes in the plan’s costs, benefits, and/or rules for the upcoming year.
• Even if you are satisfied with your current Medicare coverage, look at other Medicare options in your area that may better suit your individual needs in the upcoming year. For example, check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price. Research shows that people with Part D could lower their costs by shopping among plans each year. There could be another Part D plan in your area that covers the drugs you take with fewer restrictions and/or lower prices.

2. If you are dissatisfied with a Medicare Advantage Plan you choose during Fall Open Enrollment, you can change your plan during the Medicare Advantage Open Enrollment Period (MA OEP).

• The MA OEP occurs each year from January 1 through March 31, with changes taking effect on the first of the month following the month you enroll. During this time, you can switch from one Medicare Advantage Plan to another, or switch from a Medicare Advantage Plan to Original Medicare with or without a Part D prescription drug plan.

3. Understand the difference between Fall Open Enrollment and Open Enrollment for the state or federal Marketplaces.

• The federal Marketplaces (also known as Exchanges) offer annual open enrollment periods for uninsured and underinsured Americans. This enrollment period may overlap with Fall Open Enrollment. The Marketplaces are typically not meant for people with or eligible for Medicare.
• If you have or are eligible for Medicare, you should only use the Fall Open Enrollment Period (October 15 through December 7) to make changes to your Medicare coverage.

4. Initial enrollment period (IEP) for Medicare at age 65

This is the time frame for most people to sign up for Medicare. It runs seven months, starting three months before the month in which you turn 65 and ending three months after that month. (For example, if your birthday is in May, your IEP begins Feb. 1 and ends Aug. 31.)

Use this period to enroll in Part A (hospital insurance) even if you do not intend to enroll in Part B.

Use this period to enroll in Part B (which covers doctor’s services, outpatient care and medical equipment) if:

• You have no other health insurance.
• You still have health benefits from a former employer, but you have retired or stopped working or plan to stop shortly.
• You still have health benefits from the former employer of your spouse who has retired or stopped working or plans to do so shortly.
• You are covered by COBRA insurance that extended employer health benefits after you (or your spouse) stopped working.
• You have group health insurance from an employer with fewer than 20 workers, or your health plan (such as the TriCare program for active or retired military personnel) requires you to enroll in Part B on turning 65.
• You have individual health insurance you have purchased yourself.
• You do not qualify for Part A and have no other health insurance.
• You are living (but not working) outside the United States.

Be aware that if you are in any of the above situations and delay signing up for Part B beyond your IEP you may face a late penalty when you eventually sign up and — perhaps more detrimentally — you will be able to sign up only during the general open enrollment period (see below) at the beginning of each year and coverage will not begin until the following July.

But in other situations, if you continue to work beyond age 65 and have group health insurance from an employer for whom you or your spouse is still working, you may be able to delay signing up for Part B without penalty. See “Special enrollment period for Part B” below.

If you are already receiving Social Security retirement benefits when you turn 65, Social Security will automatically enroll you in Medicare Parts A and B. You have the right to decline Part B within a certain length of time if you or your spouse is still working for an employer that provides your health insurance.

You can also enroll in Part D prescription drug coverage during this initial enrollment period. But if you already have drug coverage from elsewhere — such as a former or current employer, COBRA or the Veterans Affairs health program — you may not need to sign up at this time. See “Special enrollment period for Part D” below.

5. Initial enrollment period (IEP) for Medicare through disability

If you become eligible for Medicare under age 65 because of disability, you will receive a letter from Social Security saying when your Medicare coverage will begin. It typically starts 24 months after your disability benefits were approved. Social Security will automatically enroll you in Part A and Part B. If you wish to opt out of Part B, you can if you or your spouse is still working for an employer that provides health coverage and has more than 100 workers.

When you turn 65, you’ll be entitled to a second seven-month IEP — this time based on age instead of disability. You get to start over, so if you previously paid a Part B late penalty, you won’t have to pay it any longer.

6. Special enrollment period (SEP) for Part B

This SEP allows you to enroll in Part B without penalty beyond age 65 provided that you can show you have had group health insurance from an employer (or employers) for whom you or your spouse were still working since you turned 65. The SEP runs for eight months from the date you (or your spouse) stopped working. But you can enroll before this date to ensure unbroken health coverage. Your Part B coverage begins on the first of the month after you enroll.

If you work outside the United States when you turn 65 or later, you’re entitled to the same SEP when you return to this country if you (or your spouse):

• had American-style group health insurance from an employer for whom you were working when abroad;
  
• were covered under the national health insurance program of the country you were living in while working abroad (as an employee or as a self-employed person);
  
• received health coverage from an approved organization (such as the Peace Corps) while working abroad as a volunteer.

You are not entitled to this SEP (and must therefore enroll in Part B during your initial enrollment period to avoid a late penalty) in certain situations — for example, if you work beyond age 65 for an employer that has fewer than 20 employees; or if you are covered beyond 65 by the employer insurance of a domestic partner to whom you are not married.

7. Special enrollment period (SEP) for Part D

Part D drug coverage has different rules than Part B. You can delay enrolling in Part D beyond age 65 if you continue to have “creditable” drug coverage — meaning that Medicare considers it of at least equal value to Part D. When this coverage ends, you will be entitled to this SEP and can sign up immediately and without penalty in the following circumstances:

• When drug benefits from your current employer (or from your spouse’s employer) terminate on retirement or through no fault of your own.
• When COBRA coverage terminates.
• When you lose drug benefits from a retiree health plan through no fault of your own.
• When you return from abroad to live permanently in the United States.
  
• When you are released from prison.
  

In all these cases, the special enrollment period lasts for 63 days beyond the crucial date — such as the end of drug coverage, your return to the United States or your release from prison. But your actual coverage in a Part D drug plan must have begun on or before the 63rd day to avoid a late penalty. Since coverage cannot begin until the first of the month after enrollment, it’s best to sign up no later than the end of the second calendar month after the critical date.

If you let this SEP expire before enrolling in a Part D drug plan, you must wait until the next annual enrollment period (see below), and you will receive a late penalty — added permanently to your plan’s premiums — for every month of delay.

8. General annual open enrollment for Medicare:

Jan. 1 through March 31

This period is specifically for people who missed signing up for Medicare Part B at the required time — either during their initial enrollment period or during a special enrollment period for Part B. If you need to sign up for Part B during this period, be aware that your coverage will not begin until July 1, and you may be required to pay a late penalty based on how many years you have delayed.

Meet with one of our Licensed Agents to learn more and to find a plan that meets your needs – (858) 391-8544

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