Medicare is a health insurance program provided to eligible individuals who are age 65 or older, as well as younger people with certain disabilities and those with end-stage renal disease. For many, this coverage plays a key role in providing access to necessary healthcare.
Medicare Parts A and B are often referred to as Original Medicare. This coverage is provided through the federal government. Medicare Part A covers the cost of a hospital or nursing home stay but does not cover long-term care or the costs of the treatments you receive while in the hospital.
Medicare Part B covers doctor visits, medically necessary services, and preventative services. This includes supplies, tests, and other services needed to diagnose a medical condition as well as health care required to detect and treat medical conditions early on.
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Since Medicare Parts A and B don’t cover all medical expenses, many individuals choose to enhance their coverage with either Medicare Part C, also called a Medicare Advantage Plan, or Medicare supplemental insurance, also called Medigap. These are 2 distinctive forms of coverage, and you cannot have both simultaneously.
A Medicare Advantage plan typically replaces Part A and Part B coverage while also providing additional benefits, like dental and vision care. Medigap is purchased as a supplement to Medicare Parts A and B to cover the “gaps” in Original Medicare.
Generally, you can only enroll, switch plans, or drop a plan at certain times of the year. This makes it critical to understand the Medicare enrollment periods associated with each coverage type. The following guide provides an overview of the basics you need to know.
First-time Enrollment: Initial Enrollment Period
- When: Varies depending on your birthday
- Coverage Begins: Varies depending on when you enroll
- What You Can Do: Enroll in Medicare Parts A and B, a Medicare Prescription Drug Plan (Part D), or a Medicare Advantage Plan (Part C)
For the majority of Americans, the first opportunity to sign up for Medicare begins 3 months prior to the month in which you turn 65 years old. The Medicare initial enrollment period also includes your birthday month and the 3 months following, for a total of 7 months. Individuals with certain disabilities and specific medical conditions may be eligible for coverage sooner.
If you’re already receiving Social Security or Railroad Retirement Board benefits and you’re a U.S. resident, the federal government automatically enrolls you in both Medicare Part A and Medicare Part B at age 65. You receive your Medicare card in the mail about 3 months before you turn 65, and your coverage takes effect the first of the month in which you turn 65.
If you’re not automatically enrolled, you can sign yourself up during your 7-month initial enrollment period. It’s important to note that if you don’t sign up for Parts A, B, or D coverage when you’re first eligible, you may have to pay penalties in the form of higher premiums should you enroll later on.
Initial Medicare coverage begins on the first of the month. The month when your coverage begins depends on whether you’re eligible for premium-free coverage and the date you enroll.
If you’re eligible for premium-free Part A, your coverage begins on the first of the month in which you turn 65 – unless your birthday is on the first, in which case, it begins the month before you turn 65. For Part B and Part A with a premium, coverage begins as follows:
- If you sign up the month before you turn 65, coverage begins the month you turn 65
- If you sign up the month you turn 65, coverage begins the next month
- If you sign up 1 month after you turn 65, coverage begins 2 months after you sign up
- If you sign up 2 or 3 months after you turn 65, coverage begins 3 months after you sign up
After your Medicare initial enrollment period ends, if you haven’t yet signed up, you must wait for another enrollment period before you may be able to sign up for Part B and Premium Part A.
If you want to supplement your Original Medicare coverage with a Medicare Supplement plan, the enrollment period begins the first day of the month you turn 65 and continues for 6 months, as long as you have signed up for Medicare Part B.
If you fail to sign up for a Medicare Supplement plan during this 6-month period, you may find that you’re unable to buy a plan or that you are required to answer medical questions in order to get coverage.
Open Enrollment Period
- When: January 1 to March 31 each year
- Coverage Begins: The first day of the month following the month in which you make a change
- What You Can Do: If already enrolled in a Medicare Advantage plan, you can make a one-time election to switch to a different Medicare Advantage Plan or switch to Original Medicare (and also enroll in a Part D plan).
While this is often referred to as Medicare open enrollment periods, or Medicare OEP, it does not actually apply to Original Medicare. Instead, this open enrollment period is only for individuals who are already enrolled in a Medicare Advantage plan. You cannot enroll in Medicare Part A or Medicare Part B during the open enrollment period.
Depending on your circumstances, access to a Medigap plan during the open enrollment period might require medical underwriting.
General Enrollment Period
- When: January 1 to March 31 each year
- Coverage Begins: July 1
- What You Can Do: Sign up for Medicare Part A and/or Medicare Part B if you didn’t sign up when you were first eligible and you aren’t eligible for a special enrollment period
If you didn’t sign up for Medicare Part B when you were first eligible during the initial enrollment period, you might be subject to a late-enrollment penalty. In some cases, your monthly premium may increase by 10% for each 12-month period you could’ve had Part B but didn’t sign up. The longer you go without Part B coverage, the more the penalty may increase, and the penalty typically remains for as long as you have Part B.
Annual Enrollment Period
- When: October 15 to December 7 each year
- Coverage Begins: January 1
- What You Can Do: Reevaluate your current coverage and make changes or purchase new policies
The Annual Enrollment Period for 2022 is happening soon. Take this time to make changes to your current enrollment to ensure you have the plan you want in 2023. During the Medicare annual enrollment period, also called Medicare AEP, Medicare enrollees can make the following changes:
- Switch from Original Medicare to Medicare Advantage (if you meet the requirements)
- Switch from Medicare Advantage to Original Medicare (could also add Medicare Part D and a Medigap plan)
- Switch from one Medicare Part D plan to another
- Enroll in or drop a Medicare Part D plan
- Switch from one Medicare Advantage plan to another
Note that if you’ve reviewed your current plan and you’re happy with it, there is no requirement to make a change. In many cases, your current plan automatically renews as-is on January 1.
There are also some things you cannot do during the Medicare annual enrollment period. For example, if you did not sign up for Medicare Parts A and B when you were first eligible, you cannot sign up during this fall enrollment period. Instead, you must wait for the Medicare general enrollment period.
This annual enrollment period also does not apply to Medigap plans. In many cases, these plans are only guaranteed-issue during your initial enrollment period and during special enrollment periods.
Special Enrollment Periods
- When: Varies, depending on your circumstances
- Coverage Begins: Varies
- What You Can Do: Enroll in Medicare Part B and Premium Part A and/or join, drop, or switch a Medicare Advantage, Medigap, or prescription drug plan (when certain circumstances occur)
Some scenarios that may allow for changes during the Special Enrollment Periods (SEP) include:
- Moving back to the U.S. after living abroad: You can join a Medicare Advantage plan or Medicare Part D within 2 months of moving back.
- Moving out of your plan’s service area: You can switch to a new Medicare Advantage plan or Medicare Part D plan. The special enrollment period would begin either the month before your move or the month that you tell your plan you are moving, whichever is later. Then, your special enrollment period would last an additional 2 full months.
- Moving into or out of a skilled nursing facility, long-term care facility, rehab hospital, or psychiatric facility: You can make a variety of changes to your coverage for this event, including joining, switching, or dropping plans. This opportunity lasts for as long as you are in the institution and 2 full additional months after you leave.
- The end of your employment or an employer-provided plan: You can join a Medicare Advantage plan or Medicare Part D plan for 2 full months after your employer-provided coverage ends.
What You’ll Need to Enroll in Medicare
Signing up for Medicare requires you to provide some basic information, including:
- Your contact information, including home address and phone number
- Your Social Security number
- Identification documents, such as your birth certificate, driver’s license, or passport
- Proof of citizenship if you were not born in the U.S.
- Permanent resident card number if you are not a citizen
You can enroll in a Medicare plan online, in person at your local Social Security Office, or over the telephone. If you plan to enroll in person, be sure to contact your local Social Security Office for details on appointment availability.