Enrollment Periods

 

Medicare Part A & Part B are available to you when you first turn 65, or earlier if you’ve been receiving Social Security Disability Income benefits for two years.  Most people accept the Part A benefit as soon as it is available, since those who have worked 40 quarters or more (and paid into the Medicare System) will not be charged a premium.  Part B will cost at least $135.50/mo for newly enrolling individuals (see the details on Part B for additional premiums for those with higher incomes).  You may enroll during the three months prior to your 65th birthday, the month of, and the three months following your 65th birthday.  If you enroll prior to your birthday, coverage will be the first of the month in which you turn 65.  If you enroll the month of your birthday, coverage will begin 1 month after you sign up.  If you enroll 1 month after your birthday, coverage starts 2 months after you sign up; enroll 2 or 3 months after your birthday and coverage will start 3 months after you sign up.

In addition to the initial enrollment opportunity, you may also enroll in Parts A & B during the General Enrollment Period between January 1 and March 31 each year.  In that case, your coverage will start on July 1 and you may need to pay a higher premium for “late” enrollment.

If you’re working at age 65 and still covered by your employer’s group health insurance (or your spouse’s group health plan), or have other “qualifying events”, you may enroll at a later date without incurring any penalty.  (Note, this must be ACTIVE coverage, not COBRA coverage).  You will need to furnish written confirmation that your other coverage is ending, Employer Verification Form CMS L564E and you’ll need to enroll in Parts A & B within 8 months of losing your group insurance.  For more information, see the Medicare.gov website:  

https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html

Medicare Part C (Medicare Advantage) is initially available at the same time as Parts A & B, and requires that you be enrolled in Parts A & B of original medicare in order to be eligible.  You will also have a special enrollment period if you lose your group insurance (through your employer or your spouse’s employer), lose your current coverage due to a move, lose or gain eligibility in Medi-Cal, etc.

Medicare Part D (Prescription Drug Coverage) is initially available at the same time as Parts A & B. You must be enrolled in A or B in order to be eligible for this coverage.  Extra premiums are charged for those beneficiaries with higher incomes (See our page on Part D for details). You will also have a special enrollment period if you lose your group insurance (through your employer or your spouse’s employer), lose your current coverage due to a move, lose or gain eligibility in Medi-Cal, etc.  To avoid the penalties, do not have a gap in prescription coverage longer than 63 days. 

There is an Annual Election Period from October 15 – December 7 for Parts C & D each year, during which time you may enroll in a Medicare Advantage (HMO) plan or change plans.

Coverage will be effective January 1 of the following year and will run through that calendar year.  We strongly recommend re-evaluating your Part D plan selection each year, since the insurance companies change their lists of covered medications, their copayments, etc., and you may have made changes in the prescriptions you take.  

For more information on enrollment periods for Parts C & D, see the Medicare.gov website:

https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3192 

Medicare Supplements are available on a “guaranteed issue” basis if purchased within 6 months of your Part B effective date, or within 6 months of ending your active group insurance, or if you lose your Medicare Advantage plan (due to the plan no longer being offered in your county, for example).  If you originally start with a Medicare Supplement or “Medigap” plan, leave for a year or less to “try” a Medicare Advantage plan, and then disenroll from that Medicare Advantage program, you may be able to re-enroll in a Medicare Supplement without answering medical questions.  Other than those time windows, these plans are underwritten, which means answering medical questions and possibly being turned down for coverage. You may purchase them at any time, if you’re healthy.

In California there’s a special opportunity to change insurance companies for the same level (or a lesser plan) during the month of your birthday.  This is called the “Birthday Rule” and is not available in all states.  Application time periods vary, so call us for details if you’d like to make a move.

For more information you may want to see the Medicare.gov website:  

https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html

Or call us at 831-335-8200.