Medicare Enrollment Periods: What You Need to Know

Whether you are just enrolling in Medicare or need to change your plan, Medicare offers an enrollment period for every situation. The trick is knowing when and how those enrollment periods apply to you.

“Think about your Medicare coverage before it’s time to enroll or make a change,” says Terry Meshanko, senior sales executive with Highmark. “Read up and do research to understand medicare, but really evaluate your current needs and situation.” Working with an insurance agent to sift through the available Medicare options and enrollment periods will save you headaches and penalties for enrollment.

We’ll help you to understand how each Medicare enrollment period might apply to you:

Medicare Initial Enrollment Period (IEP)

If you receive Social Security benefits before you turn 65, you’ll be automatically enrolled in Original Medicare (Part A and Part B). For everyone else, this 7-month enrollment period is the time to join Medicare without a penalty. You can also sign up for a Medicare Advantage Plan (Part C) and/or a Medicare Prescription Drug Plan (Part D) during the IEP.

Details for using this enrollment period include:

• Who: Anyone close to the age of 65 who needs to sign up for Medicare coverage including Part A, Part B, Part C, and/or Part D can use the IEP. 
• Why: Enrolling in Medicare during the IEP protects you from late enrollment penalties.
• When: The IEP is available for seven months, beginning three months before your 65th birthday month and ending three full months after your birthday month.

Medicare Annual Enrollment Period (AEP)

Since needs and financial situations change, Medicare allows every member to make plan changes during the AEP. “That’s when you can upgrade, downgrade, evaluate what is best for you,” Meshanko says. “Look at what benefits you used the previous year and what medical needs you expect in the near future.”

Details for using this enrollment period include:

• Who: Any Medicare member can use the AEP. 
• Why: The AEP is used to change from Original Medicare to Medicare Advantage (or vice versa), join a prescription drug plan, change plans, or drop coverage.
• When: It’s available October 15 through December 7 each year, with coverage changes effective January 1.

Medicare Advantage Open Enrollment Period (OEP)

The OEP offers the chance for Medicare members who have Medicare Advantage plans to make changes to their coverage. “Look at the plans each year,” Meshanko says. “You are not locked into the initial Medicare Advantage plan you select, but take note of when those changes can be made.”

Details for using this enrollment period include:

• Who: Medicare members with Medicare Advantage can use the OEP.
• Why: Use the OEP to switch from one Medicare Advantage plan to another or return to Original Medicare (plus Part D). 
• When: It’s available January 1 through March 31 each year, with changes effective the following month.

Medicare Special Enrollment Periods (SEP)

Medicare recognizes that working past 65 and other special circumstances may require a late enrollment or unexpected changes to your coverage. Medicare offers a number of SEPs that each address specific situations and have their own restrictions.

If you or your spouse are not planning to retire at age 65, there is an SEP to help you avoid penalties or a lapse in coverage. Be sure to check the guidelines for working past 65 and Medicare.

Other SEPs allow you to change your coverage during special circumstances that include moving, losing your current coverage, and qualifying for a special needs plan. “If you need a last-minute special enrollment, you’ll need to act fast,” Meshanko said. “This is where an insurance agent can really come into play.”

Details for using this type of enrollment period include:

• Who: Medicare members who are working past 65 (with coverage under an employer plan), moving, losing current coverage, enrolling in other coverage, or in other approved situations can use an SEP. 
• Why: Use these SEPs to make plan changes without penalty or a lapse in coverage during emergency or special circumstances. 
• When: The availability varies according to each SEP.