Understanding Medicare Enrollment Periods

Medicare Insurance can be very complex for the average Joe to understand. You think trying to understand all of the insurance elements is difficult? How about understanding when you can change from your current Medicare Insurance plan. That is a common topic that has been arising more often these days and we want to address this issue.
Medicare Enrollment Period
Let’s start from the beginning. Your Initial Enrollment Period (IEP) starts at age 65 and you can enroll as early as 3 months prior to your birthday month and it ends 3 months after your birthday month. So if your birthday is in April, you can start enrolling in Part A & B in January and you would have until July to have something in place. If you enroll in the 3 months after your birthday month, your Medicare coverage will start the 1st of the following month that you enrolled.

The next and most common period is the Annual Open Enrollment. (AEP) which we have previously discussed. In a nutshell, it’s the time of year when you can change your Medicare Advantage plan to another Medicare Advantage plan of equal or lesser value. More often than not, you will change to a plan that has better benefits or maybe your current plan is no longer going to be offering services in your region.

The most difficult to understand is the Special Enrollment Period (SEP). There are multiple qualifying events that would qualify you for a Special Enrollment Period if:
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  • You lost your creditable drug coverage due to no fault of your own
  • You drop employer/union health and/or drug coverage from current or former employer
  • You are institutionalized
  • You are enrolled in a qualified State Pharmaceutical Assistance Program (SPAP) or lose eligibility
  • You have Extra Help (State Medicad or SSI benefits)
  • You want to disenroll from the FIRST Medicare Advantage plan you ever enrolled in
  • You enroll or disenroll from PACE
  • You permanently move (Your coverage may not be available)
  • You join or lose eligibility for a Special Needs Plan (SNP)
  • You have had Medicare eligibility issues (retroactive enrollment)
  • There was Contract violations, misleading marketing or enrollment errors from your current carrier
  • You current Medicare private health or drug plan no longer offers it in your area
  • You disenroll from your current Medicare Advantage plan from Jan 1-Feb 14
  • You experience a n “exceptional experience” by request to CMS only
  • You qualify for a new Medicare Part D Initial Enrollment Period at age 65

These events will allow you to make the necessary changes to your Medicare Health plan. However, some of these Special Enrollment Periods only last for a specific amount of time so do not procrastinate! For more information on Medicare Insurance please talk to one of our insurance professionals for updates, news, quotes and online applications.

2 thoughts on “Understanding Medicare Enrollment Periods”

  1. I just found out I am losing my Medicare Advantage coverage so does this mean I can enroll in another plan even with my current health conditions?

    1. Good Question Betty! Since you are losing coverage to no fault of your own, than Yes you can switch to any other plan in your area on a Guaranteed Issue basis. Regardless of your medical history or conditions you can switch to a Medicare Supplement and/or another Medicare Advantage plan.

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