Medicare election period

Medicare election period

There are two types of Medicare election periods.  The first is the initial election period for Original Medicare A and B.  Second is the enrollment period for Medicare Advantage and Medicare PDP plans. There are a number of similarities between the two but also some key differences.

Medicare election period for Original Medicare A and B

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The election period for Medicare A and B is often similar to the election period for Medicare Advantage and Part D plans. They do have some differences however.  The initial election period for Medicare A and B is the first of the month a person is age 65.  If someone is 65 on June 17th, they can start Medicare A and B June 1 using their initial election period.  There are a various reasons to start your Medicare A and B enrollment.  Continue reading for information on the situation specific to you.

If you are receiving retirement benefits:

If you are already receiving Social Security payments, you will be enrolled in Medicare A and B automatically.  There is no need to do anything, both will start the first of the month you are 65.  The only exception to this is for those with a birthday on the first of the month.  They will have a first of the month before their birthday start date for Medicare A and B.

If you are receiving disability benefits:

If you are under 65 and getting Social Security Disability benefits, (SSDI) you can apply for Medicare A and B.  You will be eligible 24 months after you start SSDI.

If you don’t want Medicare Part B:

You do not have to take Medicare part B if you don’t want to.  When you are automatically enrolled in B, there are ways you can opt out of it.  If the Medicare card came in the mail and had an A and B start date on it, you can fill out the info on the back of the card and send it back to dis-enroll from part B. In the event you keep the Medicare card, you will have part B and will be charged the monthly part B premium. If you signed up for A and B online or through the Social Security office but no longer want B, you will need to call them to dis-enroll from B.

If you have health coverage through yours or your spouce’s current employer, you may want to delay or cancel part B.  Be careful with this however.  You must be actively working or getting the coverage through an actively working spouse in order waive part B.

Part B late-enrollment penalty:

If you do not sign up for Part B when you are first eligible for it, you may be assessed a late B enrollment penalty.  You will need to pay it for the rest of your life. If this  is the case, the monthly part B premium will be 10% higher for every 12 months you did not have part B. The penalty is most common for people that have employer coverage and think they do not need part B.  If they are on employer coverage and are not actively working, they need part B.  If they get coverage through a spouse and he/she retires, they should sign up for part B immediately.

Initial Enrollment Period

The Medicare A and B IEP starts 3 months before turning 65 and continues with the birthday month and 3 months after the 65th birthday.

Some situations where you would enroll in Medicare during your initial enrollment include:

If you are not getting Social Security benefits

If you do not get a Social Security payment every month, you will not automatically get Medicare A and B.  You must sign up for it manually to get it.  This can be done a number of ways. We will provide details below.

Medicare General Enrollment Period (MGEP)

If you did not enroll during the IEP when first eligible, you will need to sign up during the MGEP.  The time to do that is from Jan 1 through March 31 for a July 1 start date.

Medicare Special Enrollment Period

You may choose not to enroll in Medicare Part B when you are first eligible because you are already covered by group medical insurance through an employer or union. If you lose your group insurance or if you stop actively working. (or you get coverage through a spouse that stops working) you would need to sign up for Medicare B using a special election period.

Your eight-month special enrollment period begins either the month that your employment ends or when your group health coverage ends, whichever occurs first. If you enroll during an SEP, you generally do not have to pay a late enrollment penalty.

Medicare Advantage and Medicare Part D Rx plans

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Medicare Advantage (MA or MAPD) also called Medicare Part C or Managed Medicare is offered through insurance companies that have contracts with Medicare. At minimum, all Medicare Advantage plans must offer the same Medicare Part A and Part B benefits as Original Medicare. They offer the equivalent of Original Medicare benefits but the benefits are certainly not structured the same as Original Medicare.  The majority of Medicare Advantage Plans include drug benefits.  Some also offer extra benefits such as vision, dental, OTC, etc… . You must have Medicare parts A and B in order to take an advantage plan.  Original Medicare is no longer your primary insurance when you are enrolled in MAPD plans

Medicare Advantage plan Initial Coverage Election Period:

Most people are first eligible to take a  Medicare Advantage plan during their Initial Coverage Election Period. (ICEP) This enrollment period takes place at the same time as your Initial Enrollment Period for Original Medicare (IEP), (3 months before, during and three months after your 65 birthday.   This enrollment is delayed for those that take Medicare part B on a delayed basis.

Medicare Advantage plan Annual Election Period: (AEP)

You can also add, drop, or change your Medicare Advantage plan during the Annual Election Period, which occurs from October 15 to December 7 of every year. During this period, you may:

• Switch from Original Medicare to a Medicare Advantage plan, and vice versa.
• Move from one Medicare Advantage plan to a different one.
• Switch from a Medicare Advantage plan without prescription drug coverage to a Medicare Advantage plan with drug coverage or vice versa.

MAPD Open Enrollment (OEP):  

The Medicare Advantage Open Enrollment Period starts on January 1 and ends on March 31 each year.  You can use this enrollment period to do one of the following:

• If you are in a Medicare Advantage plan, you can move to another Medicare Advantage plan.
• You may also Dis-enroll from your Medicare Advantage plan to go back to Original Medicare.

Because original Medicare does not cover prescription drugs, if you decide to leave your Medicare Advantage plan, you are eligible to enroll in a stand alone Medicare prescription drug plan.  Be aware that this period will not allow for other changes in coverage.

In most cases, you are not permitted to change your Medicare Advantage plan unless it is during the Annual Election Period or the Medicare Advantage Open Enrollment Period.  The only other time you can make changes to you MA plan is if you qualify for a Special Election Period.

Medicare PDP (Part D) Initial Election Period prescription drug plan election:

Medicare beneficiaries have the choice of weather to purchase prescription drug coverage or not.  This is not an automatic benefit.  Beneficiaries can obtain prescription drug coverage one of two ways; they can either enroll in a stand alone drug plan or enroll in a Medicare Advantage plan that provides drug coverage.  Both Medicare prescription drug plans and Medicare Advantage plans are purchased through private insurers.  You may only use one of the prescription drug coverage options at a time not both.

You are eligible for prescription drug coverage if:  You are enrolled in both Medicare Part A and Part B and you choose a plan that is available in your service area.

In most cases. your initial enrollment period for Part D will begin the same time your Part B initial enrollment starts.  This can be anytime during the seven months that starts three months before your 65th birthday.  The month you turn 65 is part of the initial election period.  The initial election period ends 3 months after your 65th birthday.

During the 7 months you are eligible, you must either enroll in a Medicare prescription drug plan or Medicare Advantage Prescription Drug plan.  Unless you have other creditable prescription drug coverage.  This means drug coverage that is at least equal to Medicare prescription drug coverage.  If you have credible drug coverage through an employer’s group plan, you may delay Medicare Part D enrollment.

Please be aware:

You can be penalized if you do not sign up for prescription drug coverage during the time you are eligible for Part D if you do not have credible prescription drug coverage for 63 or more days.

Medicare Part D Enrollment

If you chose not to enroll in a PDP plan during IEP, you can sign up for prescription drug coverage during the AEP (Annual Election Period).   AEP starts each year on October 15 and runs until December  7.

PDP options

• Choose to enroll in a Medicare PDP.
• Cancel your current Medicare PDP.
• Enroll in a Medicare Advantage plan with prescription drug coverage.
• Change from a Medicare Advantage plan without prescription drug coverage to a Medicare Advantage plan with prescription drug coverage or the other way around.

The only time you can make a changes without either a special election period, outside of the Part D Initial Enrollment Period and the Annual Election Period,  is during the MA Open Enrollment Period.  This election period applies only if you are going from a Medicare Advantage plan back to Original Medicare.

Because Medicare Part A and Part B do not include prescription drug coverage, if you switch back to Original Medicare during the Medicare Advantage Open Enrollment Period, you have from January 1 until March 31 to enroll in a stand-alone Medicare PDP.