Arm Yourself with Medicare Enrollment Knowledge

Read on to learn more about Medicare eligibility, Medicare enrollment periods, the different parts of Medicare, and how to enroll.

Key Takeaways

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The Initial Enrollment Period for Medicare occurs in the three months before, the month of, and the three months after someone’s 65th birthday.

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If you miss your Initial Enrollment Period, sign up during the General Enrollment Period each January - March.

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Medicare Advantage and Part D plans from private insurers provide additional coverage on top of Original Medicare.

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Whether you’re an experienced Medicare policyholder or don’t know your Part A from your Part B, this resource will provide all the information you need to know about Medicare plans, enrollment, and eligibility. 

The technical terms and similar names of plans, enrollment periods (Annual Enrollment Period and Open Enrollment Period are often confused but entirely different, for example), and qualifications can be confusing. At Healthcareplans.com, we aim to make learning about Medicare simpler, using terms anyone can understand, so you can begin or continue your Medicare journey with ease.

When am I eligible to enroll in Medicare?

The majority of Medicare enrollees become eligible for Medicare enrollment by age, with most Americans reaching Medicare eligibility at age 65. There are some exceptions, however—certain conditions may allow you to enroll in Medicare coverage before you reach 65. Below are the qualifications required for Medicare enrollment by age or by qualifying condition:

  • Qualifying by Age. If you are a citizen of the United States who has been living in the U.S. for the previous 5 years and are 65 years of age (or nearing your 65th birthday), you are eligible for Medicare Parts A & B, sometimes referred to as Original Medicare. You may qualify for premium-free Medicare Part A if:
    • you or your spouse have worked and paid Medicare taxes for 10 years before your age 65 year, or
    • you or your spouse collect Social Security or Railroad Retirement Board benefits.
  • Qualifying Conditions. Some disabilities may qualify you for Medicare benefits even if you haven’t yet turned 65. If you are disabled and have received Social Security benefits for at least 24 consecutive months, you may be Medicare-eligible. In addition, you qualify for early benefits if:
    • you suffer from kidney failure, also known as End-Stage Renal Disease (ESRD), and have had a kidney transplant or been on dialysis for 3 months, or
    • you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

When can I enroll in Medicare?

Medicare enrollment periods infographicMedicare enrollment periods infographic

When you qualify for Medicare by age, there are times of the year when you can sign up for Medicare, known as enrollment periods. There are five distinct enrollment periods, explained in detail below.

  • Initial Enrollment Period (IEP). The Initial Enrollment Period begins 3 months before the month of your 65th birthday and continues through your birthday month and for 3 months after, a total of 7 months. During IEP, you can enroll in Medicare for the first time.

  • Annual Enrollment Period (AEP). The Annual Enrollment Period runs the same time every year, from October 15 through December 7. During AEP, Medicare plan holders can enroll in new Medicare plans, make changes to existing coverage, or cancel policies. Any changes made during this period take effect on January 1 of the following year.

  • Medicare Advantage Open Enrollment Period (MAOEP). The Medicare Advantage Open Enrollment Period is for those who have already enrolled in Medicare Advantage coverage. During MAOEP, which runs from January 1 through March 31 each year, policyholders can add prescription drug coverage (Medicare Part D) or make one more Medicare Advantage policy change. 

  • General Enrollment Period (GEP). The General Enrollment Period runs from January 1 to March 31 each year. Though it runs at the same time as MAOEP, these two periods should not be confused, as they serve separate purposes. During GEP, you can enroll in Medicare coverage if you missed your Initial Enrollment Period. Enrolling after your initial period of eligibility may result in late fees, and your coverage will begin July 1 of that year.

  • Special Enrollment Period (SEP). Special Enrollment Periods are triggered by certain life events—for example, moving out of the coverage area for your current plan or losing Medicaid eligibility. Moving into a long-term care facility may also trigger a Special Enrollment Period.

  • For a complete list of SEP-triggering events, visit Medicare.gov.

How do I enroll in Medicare?

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The first step to enrolling in Medicare is understanding the different parts of Medicare coverage available and your coverage eligibility. The generic term “Medicare” can mean many different things, and encompasses a wide array of policy and coverage options. The following is a breakdown of when and how you can enroll in Medicare’s different parts.

  • Medicare Parts A & B (Original Medicare). What is often referred to as “Original Medicare” comprises two parts, Medicare Part A hospital and hospice coverage and Medicare Part B medical insurance and preventative care. Original Medicare coverage is provided by the federal government.
    • Medicare Part A signup. Whether you plan to continue working and using employer-provided health insurance or not, you must enroll in Medicare Part A coverage during the Initial Enrollment Period surrounding your 65th birthday detailed above, or you may face late fees and higher premiums upon later enrollment.
    • Medicare Part B signup. When you retire, enroll in Medicare Part B to complete your Original Medicare coverage one of the following ways:
      • By phone at 1-800-772-1213
      • At your local Social Security office

  • Medicare Part C (Medicare Advantage). Medicare Part C, sometimes referred to as Medicare Advantage, is additional private-sector coverage that ensures you receive all the benefits of Medicare Parts A & B, along with additional benefits which may include vision coverage, dental coverage, health and wellness programs, or gym memberships. You can enroll in a Medicare Advantage plan:
    • during the Initial Enrollment Period surrounding your 65th birthday if you qualify for both parts of Original Medicare,
    • during the Annual Enrollment Period each year from October 15 through December 7, or
    • during a Special Enrollment Period triggered by a move outside your current coverage area or other qualifying event.

  • Medicare Supplement (Medigap). Medicare Supplement policies or Medigap policies offer additional coverage for out-of-pocket Medicare costs. You must have Original Medicare to enroll in a Medigap policy, and your enrollment period lasts for six months after enrolling in Original Medicare for the first time. Medigap policies are offered by private insurance companies to supplement the governmental coverage provided by Original Medicare.

  • Medicare Part D (Prescription Drug Coverage). Medicare prescription drug coverage is only available through private insurer health plans purchased in addition to Original Medicare and/or a Medicare Advantage plan. You can enroll in or change a Part D plan:
    • during your Initial Enrollment Period after signing up for both Medicare Parts A & B,
    • during the Annual Enrollment Period each year from October 15 through December 7, or
    • during the Medicare Advantage Open Enrollment Period running from January 1 through March 31 each year.

For Medicare Part C (Advantage Plans), Medigap, or Part D prescription drug coverage, you’ll need to work with a private insurance provider or an insurance agency like ours that works with multiple providers to connect Americans with the plans that fit them best. Here are just a few of the benefits of working with our agency to secure your Medicare coverage:

  • Our agents are all U.S.-based and U.S.-licensed, providing quality customer service on every call.
  • Our licensed agents are medicare experts armed with the knowledge to answer a wide array of questions and help nail down the best possible coverage for you.
  • We offer policies from more than 6 national insurance providers, so we can help find the best plan for you without bias toward one particular company’s plans.
  • We offer convenient and transparent online enrollment, so you can compare plans and complete the process yourself online without having to wait in lengthy phone queues.

If you still have questions about Medicare enrollment periods or if you qualify for an enrollment period, call us at 1-855-200-9406 to speak to a U.S.-based agent.

Helpful resources

https://www.medicare.gov/basics/get-started-with-medicarehttps://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periodshttps://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-enrollment/when-to-enroll-in-part-d https://www.cms.gov/medicare/health-drug-plans/medigap
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