Last Updated On: June 27, 2023

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Helping You Understand Open Enrollment For Medicare

Medicare open enrollment period, also known as the annual election period, happens in the period between October 15 and December 7 when a current Medicare user can upgrade parts of their plans to Medicare Advantage and/or Part D plan. The revised coverage for the user will begin on January 1.

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It’s Time to Think About Medicare Open Enrollment

At every stage of your life, you want to make sure you’re putting your health first, and this sentiment holds especially true for people who are approaching the age they become eligible for Medicare—the US federal government’s health insurance program. 

Medicare can help you enjoy your life without worrying about how you’ll make ends meet if confronted with unexpected medical bills.

Buying a Medicare plan that fits your medical and financial needs is an excellent way to get this preventative protection. To get the best coverage and corresponding premiums, you’ll need to find the ideal Medicare plan for you so that come the Fall Open Enrollment period, all you have to do is apply.

Initial Enrollment Period (IEP)

If this is the year you turn 65, you’re more than likely auto-enrolled for original Medicare (Plan A and Plan B). Your coverage begins three months before your birthday and will continue another three months after your 65th birthday, giving you a chance to enroll in a Medicare coverage plan.

If you want to secure your plan at a better premium and you’re planning on using Medigap to get guaranteed best price acceptance, then you’ll also want to make sure you enroll before your actual birthday.

When Is The Fall Medicare Open Enrollment?

During the annual Fall Medicare Open Enrollment period that runs from October 15 until December 7, you can buy a Medicare policy or alter your existing Medicare coverage. These are some of the options available to you:
  • Enroll in Medicare
  • Purchase Plan D or Prescription Drug Coverage
  • Change from Original Medicare to Medicare Advantage — if you have Plan A and B coverage
  • Switch to a different Medicare Advantage Plan

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Medicare Special Enrollment Period (SEP)

There is a special extension for those afflicted by FEMA – declared emergencies, disasters, or if you lose your job or health plan coverage provided by a spouse’s job. These unforeseen circumstances directly affect your ability to apply for Medicare on time. This means any incidents occurring between August 1 and December 7 could qualify for SEP — check with your provider to make sure.

This special window is called the Medicare Special Election Period (SEP). How it works is when the disaster/emergency/special circumstance happened, let’s say it was in October, you have four months starting the month after the event to complete your Medicare enrollment.

What Happens If I Miss Fall Enrollment?

If you miss the Fall Open Enrollment, you can still get Medicare coverage. Your next window of opportunity to enroll is during the General Medicare Enrollment period that runs from January 1 through to March 31. However, if you miss the Fall Enrollment Period without good reason, like SEP preventing your application, these are the catches:
  • You’ll likely pay higher premiums
  • You’re subject to medical underwriter
  • You could get denied certain coverages
  • There will be a delay or gap in your coverage
  • You’ll pay late enrollment fees

Who Can Apply To Medicare?

To qualify for Medicare, you must be:
  • 65 or older
  • An American citizen that’s lived on US soil for the past 5 years
  • You’re currently receiving or worked long enough to be eligible for Social Security or railroad retirement benefits
  • A current or former government employee that’s paid Medicare taxes while working
For individuals not yet 65, you can enroll in Medicare if you:
  • Are on Social Security disability benefits for 24 months
  • Receive disability pension and meet certain criteria from Railroad Retirement Board
  • You have ALS or kidney failure

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How To Enroll?

Enrolling in Medicare depends on the coverage you choose:

  1. Original Medicare: As an American already receiving Social Security or railroad retirement benefits, you’re auto-enrolled in Plan A and Plan B Original Medicare three months before your 65th birthday. After your birthday, Plan B premiums will be automatically deducted from your Social Security or railroad retirement benefits.
    • Not receiving Social Security: If you’re 65 and not receiving Social Security or railroad retirement benefits, then you have 7 months to apply — 3 months before your birthday, your 65th birthday month, and 3 months after. For coverage beginning on your birthday, you’ll need to enroll prior to your birthday.
    • Disabled: If you’ve been on disability for 24 months, on the 25th month, it converts to Original Medicare.
    • End-Stage Renal Disease: You do not have to wait 24 months to receive Medicare; contact Social Security to determine your next steps.
  2. Medicare Advantage: If you’re currently paying into original Medicare (Plan A and Plan B) and reside in a state that offers Medicare Advantage, you can upgrade your policy to Medicare Advantage, also called Medicare Part or Plan C. Medicare Advantage is the most comprehensive coverage that bundles Plan A, B, and D into one policy. However, you’ll still pay your Plan B premium to the government.

  3. Prescription Drug Coverage (Plan D): First-time enrollees can create a policy that includes Plan D coverage. If, however, you already have Plan A and Plan B (original or Advantage Medicare), you can add prescription drug coverage through the Fall Open Enrollment period.

  4. Medigap: To get the best premiums guaranteed — no matter your health — you’ll want to sign up for Medigap coverage during your IEP. On your 65th birthday, you then have 6 months to enroll for Medigap for the best rates; otherwise, you face higher premiums.

Original Medicare vs. Medicare Advantage

Unfortunately, there is no one-size-fits-all policy. The main factors you may want to weigh are how much you can afford to pay monthly, your age and overall health, and your risk threshold — are you proactive or reactive when it comes to your health? Whether you opt for Original Medicare and Supplemental Coverage (Plan D and Medigap) or Medicare Advantage, these are some additional considerations you can use to help you determine which Medicare Plan is best for you:
  • Medical Conditions: If you qualify for Medicare Advantage Special Needs Plan (institutionalized, certain conditions or Medicaid dual eligibility).
  • Disability: If you’re under 65 and eligible for Medicare, you may not qualify for Medigap coverage, making Medicare Advantage a better choice.
  • More Extras: Original Medicare and supplemental plans cover your basic needs, while some participating Medicare Advantage Plans offer dental, hearing and vision benefits.
  • Premium Costs: Original Medicare (Plan A and B) will be the cheapest coverage unless you add supplemental coverage (Plan D and Medigap), in which case, on average, your premiums will exceed that of Medicare Advantage.
  • Out-of-Pocket Cap: Medicare Advantage you’re on the hook for copay, coinsurance and out-of-pocket expenses that can be in part or entirely avoided with Original Medicare and supplemental Medigap coverage. Some Medigap policies will even pay the cost upfront.
  • Travel Coverage: Original Medicare with Medigap coverage and Medicare Advantage both offer medical coverage while traveling outside the states.
  • Network Size: Typically, original Medicare with supplemental coverage will offer you a broader network of doctors while Medicare Advantage is more limited.
  • Switching Plans Flexibility: If you want the ability to switch coverage after your Initial Enrollment Period, it’s much easier for Medicare Advantage Plan enrollees.

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Open Enrollment Doesn’t Cover Medigap Plans

The Fall Open Enrollment period is for enrolling or changing your Medicare coverage. However, if you missed your initial enrollment (IEP) at 65, you can enroll during the Medicare General Enrollment Period that runs from January 1 to March 31.

Open Enrollment is excellent for first-time enrollees who wish to buy Medigap because they’re guaranteed the best premiums, no questions asked. If you miss this window, you will be subject to medical underwriting—which means higher premiums or refusal. Otherwise, there is no specific Medigap enrollment window.

Medicare Open Enrollment

You can’t put a premium on good health. As you enter your 65th year, it’s time to finalize your Medicare Plan, so you don’t have to compromise your health in the event of unexpected medical bills.

Do your research so that you know without question the best Medicare Plan for you, so once Fall Open Enrollment rolls around, all you have to do is call, enroll and then relax knowing your health is taken care of.

We can help. Request a free Medicare quote today and we’ll pair you with one of our top providers who is matched specifically with your unique needs, and your budget.

FAQ

The details of medicare health and drugs can change significantly every year, including details such as costs, what comes under the coverage, and which pharmacies belong to their network. Every year between October 15 and December 7.

Good question. Since part of Medicare can come from Medicare-approved insurance agencies, the best thing to do is call your current or local insurers and ask about their Medicare Plans. Or, of course, save yourself considerable time and get a fast and free Medicare quote from us.

Yes, but you’ll face higher premiums and your coverage will be delayed. If you miss the Fall Enrollment, your next opportunity is January 1 — March 31.

If you want to switch your plan to a new Medicare Advantage plan and have missed the Medicare Open Enrollment period, just change it to your desired plan during any of the enrollment periods. When the coverage period of the new plan begins, your old plan will be discontinued.
The Medicare Open Enrollment Period is for those who want to make any changes to their Medicare plan. If you do not wish to make any changes to your existing Medicare plan, you do not need to take any actions in this period. Automatically, your existing coverage will continue into the next year.

No, it doesn’t. As long as you enroll for your coverage before the Medicare Open Enrollment Period ends on December 7, your new plan should take effect from January 1.

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