Medicare Enrollment 

  1. Enrolling into Medicare – How Do I Know If I Am Eligible?

When seeking out understanding for if you’ll be, or currently are, eligible for Medicare, you must first consider a few features about yourself, including medical status, your tax history, and lifestyle factors (like your place of living) – after all, the path to Medicare coverage typically builds on reasonable reflections of one’s need for it, taking into account the person’s individual input into the system (and how much it is ultimately worth.) So, when discerning your eligibility to enroll into the several different parts of Medicare, how do you qualify yourself before making a move? What makes being eligible for Original Medicare different from being eligible for an alternative like a Medicare Part C advantage plan, or a Medigap supplement policy?

Medicare Part A and B:

Representing Original Medicare, the entry point of Medicare coverage, it is understandable that its eligibility can be considered somewhat straight-forward excluding special circumstances – if you’re considered a legal US citizen, either through birth or permanent residence (for over 5 years,) this alone may allow you to qualify.  Medicare is a healthcare program overseen by the federal government as investment towards the regular senior citizens, and therefore, can be quite flexible for how it applies its eligibility. In most circumstances, majority of Medicare beneficiaries will additionally fall into a category below:

  • You’re 65 or over and currently receive, or can receive, Social Security benefits.
  • You are disabled and have been receiving disability for about, or over, 2 years.
  • You have ESRD and likely require consistent medical attention, including dialysis or a potential transplant.
  • You’ve been diagnosed with ALS and have, or will receive, disability benefits because of it.

The immediacy of eligibility can vary between the lines of these reasons, with some allowing automatic enrollment, and others placing the responsibility to enroll onto your shoulders. Generally, in any circumstance other than turning 65 with applicable tax credits, you’ll be required to manually enroll – however, Part B enrollment, in every eligibility, is always voluntary.

Both Part A and B may have premiums, but Part A will only be necessary in the event where you, or your spouse, failed to properly pay Medicare taxes for 10 years – Part B, however, will always charge a monthly premium for its coverage appropriately, based on your income as well if you file your taxes with another individual, and so on.

Medicare Part C and D:

The viability to enroll into a Medicare Part C advantage plan, with or without drug coverage, or a stand-alone Part D prescription drug plan, is only based on the pre-requisite coverage you currently have – simply put, you’ll only be required to have, and keep, your Medicare Part A and B, as well as live in the appropriate service area for the plan’s use. 

As Medicare Part C advantage plans are realistically “alternatives” to the coverage of Original Medicare, it is reasonable to believe that all one would really need to qualify is Medicare Part A and B – remember, when enrolled into Medicare Part C, you’ll continue to pay your Part B premium, along with the costs required by your alternative primary policy (like the plan’s own premium, copays, and otherwise.)

A MAPD, Medicare Advantage Plan with Prescription Drug Coverage, follows the same formula; individual drug plans through Part D additionally only require you to have your Original Medicare, so logically, a Part C plan with drug coverage wouldn’t expect any different.

  1. When Can I Enroll – Applicable Enrollment Periods for Part A, B, C, and D

Each part of Medicare has certain available periods of time, or applicable reasons, that will open the doors towards enrollment to you; signing up, for many parts of Medicare, is not an annual consideration and your flexibility can feel limited without a proper understanding of the potential openings open to you. While some may run on a reoccurring annual stretch of time, others are specific, brief, and may require a bit of internal and external questioning to reach – additionally, your choice to enroll at certain times will affect how quickly you’ll be given a coverage you may desperately require, making enrollment period awareness a high priority.

Now, each period only applies to certain types of Medicare, and within those applications lay rules necessary to making sure your enrollment is valid and complete; in many circumstances, the ability to enroll in certain parts may intersect with limited chances to leave or alter another. In the following, you’ll see a brief listing of information surrounding each enrollment period, including some rules, considerations, and outcomes:

The Initial Enrollment Period (IEP):

  • Eligible to join Medicare Part A, B, C, and D during this period
  • Lasts from the 3 months before, the month during, and the 3 months after your 65th birthday
  • If enrolling into Part B, coverage almost always begins no earlier than your birth month – however, depending on when you choose to enroll, coverage may start much later.
    • If you enroll 3 months before your 65th birthday, your Part B begins the 1st of your birth month.
    • If you enroll during your birth month, your Part B begins the 1st of the month following your birth month.
    • If you enroll in the 3 months after your birth month, the amount of time until your coverage comes into effect greatly increases – 3 months for the 1st month after, 5 months for the 2nd month, and 6 months for the 3rd and final month.
  • Part D, much like Part B, also has certain delays on coverage based on time of enrollment during the period – if completed within the first 3 months, the coverage begins right when your birth month begins, but if enrollment is done during your birth month, it will be the month after. In the 2-3 months following, the coverage will be based on this element, beginning the first day of the month following the enrollment month.

The General Enrollment Period (GEP):

  • An open opportunity to enroll given to everyone who may have missed their initial enrollment period, occurring every year during the same three months (Jan 1st to March 31st.) 
  • Eligible to join Medicare Part A and B during this period.
  • Enrollment completed at any point during this stretch of time will start coverage at the beginning of July the same year.

The Annual Enrollment Period (AEP):

  • A free-for-all period involving many options to change or enroll into alternative plan options, allowing a heavy amount of freedom and ability to survey the competition before the next year – period runs from October 15th to December 7th, every year.
  • Eligibility to join and change reaches only a few selections, including:
    • Those with Medicare Part A and B (Original Medicare) can enroll into Part C.
    • Those with Part C advantage plans may leave them for Original Medicare.
    • Original Medicare holders can join, leave, or change their Part D prescription drug coverage.
    • You may freely switch from Part C advantage plan to another.
  • You are free to enroll, or disenroll, from as many plans and as many times as you like during the period – the coverage you have come Jan 1st will be the coverage you keep.

The Open Enrollment Period (OEP):

  • Runs from January 1st to March 31st, much like the General Enrollment Period, but is very limited in purpose and ability to make changes comparatively. 
  • Eligible to only switch from one Part C advantage plan to another, or switch from a Part C advantage plan to Original Medicare.
  • Only allowed one change during the entire period.

Special Enrollment Periods (SEPs):

  • Special reasons based on personal and life circumstance that may allow small windows of enrollment possibility to the individual affected – these reasons greatly range in severity and flexibility of use, but there are many.
  • You may be able to enroll during a uniquely tailored SEP for Original Medicare (Part A and B) if:
    • You were or are covered by an employer, through a group health plan or union, and had to delay your coverage because of it.
    • You are within 8 months after you’ve lost coverage through your employer.
    • You are disabled, but still working.
  • On the other hand, you may be able to enroll using a SEP for Part C or D if:
    • You chose to not apply for an advantage plan or stand-alone drug coverage because of the coverage through your employer, much like the SEP for Original Medicare.
    • You are a Medicaid beneficiary and/or receive a level of Extra Help from the government for prescription drugs.
    • You enter, are in, or recently have left a greater-care institution, such as a skilled nursing facility, nursing home, or otherwise.
    • Either you have moved, making your plan no longer applicable to yourself, or your plan has drastically changed recently, making its coverage no longer a viable option.
    • You will, at some point soon, no longer be eligible for Medicaid or Extra Help.
    • You’re currently enrolled into, or lose enrollment, from a State Pharmaceutical Assistance Program (known commonly as an SPAP.)

The Open Enrollment Period (Medigap):

  • Unique enrollment that allows you to enroll into a Medigap supplement plan without medical underwriting, taking place between the first month you’re 65 (or older) and enrolled into Medicare Part B – this means that period may be delayed based on enrollment into Part B.
  • Supplement coverage enrolled into during this period cannot be denied or risen in price based on age, health status, location, and so on.
  • Certain pre-existing conditions may still be considered.
  • Unlike other enrollment periods, you may enroll into a Medigap supplement plan year-round – this period exists primarily to avoid medical underwriting and provide a single chance to enroll free of all potential future inclusions.
  1. How Do I Properly Enroll?

While all parts of Medicare are federally regulated, their processes for enrollment go through different means – Part C and D, for example, are privatized and operate through individual healthcare institutions, rather than direct public entity, meaning you won’t have to communicate an intent to enroll through Social Security like you would for Original Medicare. In most examples, when turning 65, a person will likely be automatically enrolled into Medicare Part A and B, sent a letter shortly after detailing their new coverage as well as providing their card, as well as their opportunity to mail back a requested decline of Medicare Part B; however, if manual enrollment happens to be required, where does the communication need to begin during an available enrollment period?

There is a variety of three ways you can adequately communicate your intent to enroll for Original Medicare, of which all include speaking to the Social Security Administration (the overseers of your eligibility to enroll into Medicare Part A and B):

  • You may complete your enrollment entirely on the Social Security government website.
  • You can call the national hotline for the Social Security Administration and mention your interest to enroll.
  • Or, you may simply visit the Social Security office building most convenient for you.

Now, comparatively, Medicare Part C and Part D plans take a bit more consideration – remember, there are many competitors across every nook and cranny in the United States, and every plan has its own perks, costs, and rulesets that will greatly define how you’ll receive your coverage! The communication of your interests and values during this process will be crucial, and can be completed in also one of three ways:

  • Many healthcare providers have their own individual sites for plan listings and information, including what plans of theirs may be available in your area and how to enroll into them; you may be able to also find a website that adequately places provider’s options against one another for a more convenient and close-up comparison.
  • Insurance agents, brokerages, and the plan provider’s themselves will have phone numbers available to be called for telephone assistance, and potentially, complete enrollment.
  • All providers are inclined to offer an option for physical enrollment forms to be requested, if so your preference – as such, you may be given all proper enrollment forms via mail to fill out in-person.

References Used:

https://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-eligibility.html
https://www.ehealthmedicare.com/medicare-enrollment-articles/medicare-eligibility/
https://www.mymedicarematters.org/enrollment/when-can-i-enroll/?SID=5c740995bc03f205
https://www.ehealthmedicare.com/medicare-enrollment-articles/medicare-enrollment/
https://www.mymedicarematters.org/enrollment/how-do-i-enroll/?SID=5c740995bc03f205
https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf