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Medicare Part B Enrollment Periods

Medicare Part B is a vital part of your healthcare coverage, helping to pay for doctor visits, outpatient care, preventive services, and medical supplies. However, knowing when to sign up is just as important as understanding what Part B covers. Enrolling at the right time ensures you avoid costly late penalties and gaps in coverage. Here’s a breakdown of the key Medicare Part B enrollment periods and what each means for you.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is your first chance to enroll in Medicare Part B. It lasts seven months — beginning three months before, including your birth month, and continuing three months after you turn 65.

• If you enroll before your birthday month, your Part B coverage starts the month you turn 65.
• If you enroll during or after your birthday month, coverage begins the month after you enroll.

Tip: Even if you’re still working, check with your employer’s HR department to see whether you should enroll right away or delay Part B to avoid duplicate coverage.

Special Enrollment Period (SEP)

If you or your spouse are still working past 65 and have employer-sponsored health coverage, you can delay enrolling in Part B without penalty. Once that coverage ends, you qualify for a Special Enrollment Period.

The SEP lasts eight months from the date your employment or group coverage ends — whichever comes first. Enrolling during this window ensures you don’t face the Part B late enrollment penalty, which can increase your premium by 10% for every 12 months you were eligible but didn’t sign up.

Important: COBRA or retiree coverage doesn’t count as active employer coverage, so your SEP clock may start ticking sooner than you think.

Watch a YouTube video on Medicare OEP, SEPs and Late Part B Enrolllments

General Enrollment Period (GEP)

If you missed both your Initial and Special Enrollment Periods, the General Enrollment Period gives you another chance. The GEP runs every year from January 1 to March 31.

• Coverage begins the first day of the month after you enroll.
• You may owe a late enrollment penalty added to your monthly premium for as long as you have Part B.

While this period can be a helpful safety net, it’s best to avoid relying on it if possible due to potential penalties and delayed coverage.

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Medicare Advantage (Part C) and Other Related Enrollment Periods

Once you have Part B, you can explore Medicare Advantage (Part C) or Medigap plans to supplement your coverage. Enrollment in these plans often depends on your Part B effective date, so timing your Part B enrollment correctly is crucial for coordinating your full Medicare coverage.

Understanding Medicare Part B enrollment periods can save you money and prevent headaches down the road. Whether you’re turning 65 soon, working past retirement age, or helping a loved one with their coverage decisions, planning ahead is key.

If you’re unsure when to enroll, a licensed Medicare agent can review your situation, explain your options, and help you avoid penalties or coverage gaps.

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Medicare A and B Basics

Understanding Medicare can feel overwhelming at first, but it becomes much simpler once you break it down into the two core parts of Original Medicare: Part A and Part B. These two components form the foundation of Medicare coverage and help beneficiaries access essential hospital and medical care. Whether you’re approaching age 65 or helping a loved one navigate enrollment, here’s the Medicare A and B Basics.

What Medicare Part A Covers (Hospital Insurance)

Medicare Part A is often called hospital insurance because it helps cover care you receive in a hospital or similar inpatient setting. Most people receive Part A premium-free as long as they or their spouse worked and paid Medicare taxes for at least 10 years.

Part A covers:

Inpatient Hospital Care

This includes semi-private rooms, meals, nursing care, medications given in the hospital, and other hospital services. Part A does not cover private rooms unless medically necessary.

Skilled Nursing Facility (SNF) Care

Part A may cover care in a skilled nursing facility after a qualifying three-day inpatient hospital stay. This is not long-term custodial care, but medically necessary rehabilitation services such as physical or occupational therapy.

Home Health Care

If ordered by a doctor and medically necessary, Part A can help cover intermittent skilled nursing care, physical therapy, or speech therapy delivered in the home.

Hospice Care

For patients with a terminal illness and a prognosis of six months or less, Part A provides comprehensive hospice benefits, including pain relief, symptom management, and family support.

Part A Costs

Most beneficiaries pay no monthly premium, but deductibles and coinsurance still apply. For example, there is a per-benefit-period deductible for hospital stays and daily coinsurance after certain lengths of inpatient care.

Watch a YouTube video on Medicare Enrollment Periods

What Medicare Part B Covers (Medical Insurance)

Medicare Part B is medical insurance that covers outpatient and physician services. Unlike Part A, everyone pays a monthly premium for Part B, and higher-income beneficiaries may pay more.

Part B covers:

Doctor Visits

This includes primary care, specialists, and certain preventive screenings and exams.

Outpatient Services

Such as X-rays, lab work, outpatient surgeries, and emergency room or urgent care services (when not admitted as an inpatient).

Durable Medical Equipment (DME)

Items like walkers, wheelchairs, CPAP machines, and home oxygen equipment.

Preventive Care

Medicare Part B provides a wide range of preventive services at no extra cost when using participating providers; annual wellness visits, vaccines, mammograms, colonoscopies, and more.

Mental Health Services

Includes outpatient therapy, psychiatric evaluations, and some partial hospitalization programs.

Part B Costs

Beneficiaries pay a standard monthly premium, an annual deductible, and typically 20% coinsurance for most covered services. Part B has no out-of-pocket maximum unless you pair it with a Medigap plan or choose a Medicare Advantage plan.

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How Medicare A & B Work Together

Part A and Part B complement each other to provide broad medical coverage. Part A focuses on inpatient care, while Part B handles outpatient and ongoing medical needs. Many people choose to add:

• A Medicare Supplement (Medigap) to reduce out-of-pocket costs
• A Part D prescription drug plan
• Or a Medicare Advantage plan that bundles A, B, and often D into one

Your choice depends on your budget, health needs, and preferred style of coverage.

Understanding the basics of Medicare Parts A and B is the first step in building reliable coverage for your healthcare needs. By knowing what each part covers and what it doesn’t; you can make confident decisions as you prepare for enrollment or compare additional coverage options

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Although there are millions of people on Medicare, many find it a confusing subject especially since there are so many different parts to it. For individuals approaching 65 or anyone who or just wants to understand more about how this insurance works, here’s a brief answer to the question; what is Original Medicare and what does it cover.

What Is Original Medicare

The federal government established Original Medicare, a federal health insurance program, in 1965. The following individuals may qualify for Medicare benefits:

• People age 65 or older
• Certain younger people with qualifying disabilities
• People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

There are 2 parts of Original Medicare: Part A and Part B.

Medicare Part A

Medicare Part A is sometimes referred to as hospital insurance. It provides coverage for:

• Inpatient hospital care (once the enrollee is formally admitted)
• Skilled nursing facility care (following a qualifying hospital stay)
• Home health care (limited and medically necessary services)
• Hospice care for individuals with a terminal illness

For most people, Part A is free,there is no premium payment as long as eiither the beneficiary or thier spouse worked and paid Medicare taxes for a minimum of 10 years.

Please note: Although Part A covers hospital stays, it doesn’t cover long-term care such as; nursing homes, custodial care or unlimited days in a hospital or facility. There are limits to what it pays; beneficiaires must pay a portion of their expenses (cost-sharing), such as deductibles and coinsurance and copays.

Medicare Part B

Medicare Part B is also known as medical insurance. It provides coverage for the following:

• Doctor visits and outpatient medical care
• Preventive services such as; wellness visits, flu shots and cancer screenings
• Durable medical equipment (DME) this include things like; walkers, wheelchairs, oxygen as well as some diabetes supplies and more
• Lab tests and diagnostic imaging
• Mental health services
• Some home health care

Unlike Part A, beneficiaries do pay a monthly Part B premium. Fo rmost people, this is a standard amount although higher-income beneficiaries may pay an additional cost.

Click here to learn more about Part B eligibility

Part B coverage includes an annual deductible (this amount is adjusted annually). Typically beneficiaries pay 20% coinsurance for most covered services; in other words, Medicare pays about 80% of the cost leaving enrollees responsible for the remaining 20%.

What Original Medicare Doesn’t Cover

Original Medicare provides coverage for many medical expenses; although, they do not cover everything. Some important things to know about what Medicare does not cover:

• Prescription drugs (beneficiaries must enroll in separate Part D plan)
• Routine dental, vision, and hearing care
• Long-term custodial care
• Most care received outside the U.S.

In order to fill some of these coverae gaps, many people purchase additional insurance. Some of the plans people choose are; Medicare Supplement (Medigap) plans, Stand-alone PDP (prescprion Drug) plans, Medicare Advantage (Part C) plans. Beneficiaries also may opt for ancillary coverage like dental, vision and hearing or cancer heart attack and stroke plans.

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Original Medicare provides valuable health coverage for millions of Americans, but it’s important to understand what it cover and what it doesn’t. Knowing the basics helps beneficiaries make informed decisions and avoid unexpected costs.