when to enroll in Medicare Archives

Medicare Late Enrollment Penalties

By Ed Crowe | General Articles | 0 comment | 14 December, 2024 | 0

Medicare provides crucial health coverage for millions of Americans, but timing is everything when it comes to enrollment. In some cases, missing the initial enrollment period can result in Medicare late enrollment penalties and a lapse in coverage.

We will provide some information about Medicare enrollment periods and how to avoid late enrollment penalties.

Enrollment periods for Original Medicare

Initial Enrollment Period (IEP): A 7-month window that starts 3 months before the 65th birthday, includes the birthday month, and extends 3 months after.
Special Enrollment Periods (SEP): Available for certain qualifying life events, such as losing employer-based coverage.
General Enrollment Period (GEP): Each year from January 1 to March 31 there is a general enrollment period for those who missed other enrollment opportunities.

Those who don’t sign up during their IEP and don’t qualify for an SEP may face late enrollment penalties.

Late enrollment penalties

1. Medicare Part A

Most people receive Part A premium-free if either they or their spouse paid Medicare taxes for at least 10 years. Although, if you must pay for Part A and do not enroll during your IEP, your monthly premium increases by 10%. This penalty applies for twice the number of years you delayed enrollment.

2. Medicare Part B

Those who neglect to sign up for Part B when either first eligible for Medicare or if they come off a qualified healthcare plan such as employer coverage receive a penalty.

The penalty they pay is a 10% increase in their monthly premium for every 12-month period they were eligible but didn’t enroll. The penalty applies to their premium for as long as they have Part B coverage.

3. Medicare Part D (Prescription Drug Coverage)

The Part D penalty is a 1% increase in the “national base beneficiary premium” for every month they went without Medicare prescription drug coverage (Part D) or other creditable prescription drug coverage.

Click here for the Part D late enrollment penalty calculator

Unfortunately, this penalty is similar to the Part B penalty and applies to the monthly premium for life as long as the beneficiary has Part D coverage.

GEP (General Enrollment Period)

Those who miss enrolling in Medicare Parts A or B during their IEP can sign up during the GEP. This enrollment period runs from January 1 to March 31 each year. Coverage starts the month after they sign up.

Please note: Those who use the GEP to enroll in Medicare A and/or B qualify for a Part D SEP to enroll o in a prescription drug plan. The SEP starts once they apply for Part A or Part B and lasts for two months. Prescription drug coverage starts the first day of the month after the month of enrollment.

Avoid Late Enrollment Penalties

Be aware of the IEP (Initial Enrollment Period) . Do not delay enrollment. It is important to sign up before the 7-month window for enrollment closes.
Make sure you maintain creditable coverage if you are on employer-sponsored health coverage. Be sure to your coverage qualifies as creditable to avoid penalties.
In the event you lose creditable coverage, use an SEP quickly to avoid a lapse in coverage.
Consult a licensed Medicare agent for advice and assistance navigating enrollment periods and eligibility requirements.

Watch our YouTube video on Medicare Enrollment Periods

Please note: individuals who have income and resources below specific limits may qualify for financial assistance programs and may not have to pay late enrollment penalties.

To Sum it up

Missing Medicare enrollment deadlines can result in significant penalties and coverage delays. Those either nearing 65 or managing Medicare on behalf of a loved one must be proactive to avoid making costly mistakes.

Understanding Medicare Enrollment Periods

By Ed Crowe | General Articles | 0 comment | 27 October, 2024 | 0

Understanding Medicare enrollment periods is crucial if you plan to offer Medicare plans to potential clients. It is also important to those becoming eligible for Medicare or hoping to make changes to an existing plan. We will break down the different Medicare enrollment periods and help beneficiaries make informed decisions.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is when a beneficiary first becomes eligible for Medicare. This period is a 7-month window, starting three months before the month you turn 65, including your birthday month, and ending three months after. For example, if your 65th birthday is in May, your IEP runs from February 1st to August 31st.

During your IEP, you can enroll in:

Medicare Part A (Hospital Insurance)
Medicare Part B (Medical Insurance)
Medicare Advantage (Part C) or Part D (Prescription Drug Plan)

Individuals under 65 who qualify due to disability, have their own IEP. The IEP starts the 25th month of receiving Social Security Disability Insurance (SSDI).

Medicare General Enrollment Period (GEP)

If a beneficiary misses their Initial Enrollment Period, they can sign up for Medicare during the General Enrollment Period (GEP). The GEP runs from January 1st to March 31st each year. Coverage begins the 1st of the month after the beneficiary enrolls.

Although the GEP provides a second chance to get Medicare coverage, it’s important to note there may be late enrollment penalties for those who did not sign up for Medicare Part B when they were first eligible, unless they qualify for a Special Enrollment Period (SEP).

Medicare Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP) is a critical time for those already enrolled in Medicare to make changes to their plans. It occurs every year from October 15th to December 7th. During this period, you can:

Switch from Original Medicare (Part A & B) to a Medicare Advantage (Part C) plan, or vice versa
Change from one Medicare Advantage plan to another
Add or drop a Part D (Prescription Drug Plan)
Switch from one Part D plan to another

Click here for strategies for the 2025 AEP

Changes made during AEP will take effect on January 1st, 2025. This is the time to review your coverage, compare plans, and ensure that your healthcare needs will be met in the upcoming year.

Medicare Advantage Open Enrollment Period (MA OEP)

Those enrolled in a Medicare Advantage (Part C) plan, can use the Medicare Advantage Open Enrollment Period (MA OEP) to make a one-time change. This period runs from January 1st to March 31st annually. During the MA OEP, beneficiaries can make the following changes:

Switch from one Medicare Advantage plan to another
Disenroll from a Medicare Advantage plan and return to Original Medicare
Join a Part D plan if you return to Original Medicare

Please note, beneficiaries cannot switch from Original Medicare to a Medicare Advantage plan during this period; changes are available only to those enrolled in MA/MAPD (Part C) plans.

Special Enrollment Periods (SEP)

Special Enrollment Periods (SEP) allow beneficiaries to enroll in or change Medicare plans outside of the usual enrollment periods as long as they qualify for them. A few reasons for SEP eligibility include:

Loss of an employer-sponsored health plan
Moving to a new location outside the current plan’s service area
If the beneficiary gains eligibility for Medicaid or other financial assistance programs
Disaster related emergencies may offer an SEP if an enrollment opportunity was missed
Those who leave incarceration

SEPs vary in length and timing, depending on the reason for eligibility. For instance, those losing employer coverage, generally have an 8-month SEP starting from the month after their employment ends or group coverage ends (whichever comes first).

5-Star Special Enrollment Period

Both Medicare Advantage and Part D plans are rated on a 5-star scale by Medicare. The 5-star plans are the highest rated. If there is a 5-star plan available the beneficiaries’ service area, beneficiaries can enroll in it using the 5-Star Special Enrollment Period. This SEP allows a one-time switch to a 5-star plan at any point between December 8th and November 30th of the following year.

This election period provides an excellent opportunity to switch to a high-quality plan if there is one available in the beneficiaries’ area.

Key Tips for Navigating Enrollment in 2025

Know the dates for each enrollment period to ensure an opportunity is not missed.
Review the current coverage. During AEP, it is important to review your existing coverage and compare it with other available plans. Changes to premiums, coverage options, and provider networks may impact your decision.
Use the beneficiaries should use all the tools available to them including Medicare agents Annual Notice of change ANOC, evidence of coverage and the Medicare Plan Finder tool on Medicare.gov. All these tools can help to compare plans, coverage, and costs.
Understanding Medicare can be complex, Medicare agents are available to guide beneficiaries on available plans and options to best fit their needs. Reach out to a Medicare advisor or SHIP (State Health Insurance Assistance Program) counselor for guidance.

Agents, click here to fill out an online contract and join the team at Crowe

Understanding Medicare enrollment periods for 2025 is essential for making the right coverage is provided at the right time. Whether enrolling for the first time, looking to change, or there is a need for a special enrollment opportunity, it is important to stay informed about key dates and rules to help manage enrollment options effectively.

Medicare enrollment dates

By Ed Crowe | General Articles | 0 comment | 20 March, 2024 | 0

Medicare enrollment dates

If you are either getting close to your 65th birthday or are in Medicare sales, you should understand the Medicare enrollment dates.

Enrolling in Medicare can be confusing for beneficiaries and understanding the enrollment process is crucial to access the benefits your clients need. From IEPs to SEPs, the Medicare system is designed to accommodate various life circumstances. In this post, we go over several of the Medicare enrollment periods and how beneficiaries can use them to get the healthcare coverage they need.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first opportunity for most individuals to enroll in Medicare. IEP is a 7 month time frame that starts 3 months before the month of your 65th birthday, includes your birthday month, and ends three months after the month you turn 65. During this period, individuals can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if they choose to.

Learn more about enrollment periods

Special Enrollment Periods (SEPs)

Special Enrollment Periods (SEPs) are designated times outside the initial enrollment period when individuals can sign up for Medicare due to specific qualifying events. Some of the most common qualifying events include:

Loss of Employer Coverage

If a beneficiary is covered under a group health plan through their own or their spouse’s current employment, they are eligible for an SEP when they lose the employer coverage.

Moving out of the plans service area

When a client moves out of their plan’s service area, they qualify for an SEP to enroll in a new Medicare plan.

Becoming Eligible for Extra Help

Individuals who become eligible for Extra Help with Medicare prescription drug costs qualify for an SEP to enroll in a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) that includes prescription drug coverage.

General Enrollment Period (GEP)

For individuals who miss their initial enrollment period, the General Enrollment Period (GEP) provides another chance to enroll in Medicare. The GEP runs each year from January 1st to March 31st. Coverage obtained during this period begins the first of the month after you enroll. it’s important to note, beneficiaries who wait until the GEP may have to pay a late enrollment penalty.

Click here to learn about late enrollment penalties LEPs

Annual Enrollment Period (AEP)

The Annual Enrollment Period (AEP), also known as the Medicare Open Enrollment Period, runs each year from October 15th until December 7th. During this time, Medicare beneficiaries can make changes to their Medicare coverage. This includes; switching from Original Medicare and Medicare Advantage plans, as well as joining, dropping, or switching prescription drug plans.

How to best use the Medicare enrollment dates

Stay Informed: Keep track of your eligibility and enrollment periods to ensure you don’t miss important deadlines.
Review Your Coverage Needs: Regularly assess your healthcare needs to determine if current coverage is still suitable or if changes are necessary. Agents make sure you contact your clients regularly, especially during AEP to go over coverage options for the following year and ensure they are happy.
Seek Assistance if Needed: If you have questions or need guidance regarding Medicare enrollment, it is best to reach out to a licensed insurance agent.

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Understanding Medicare enrollment dates is essential for to ensure beneficiaries have access to the healthcare coverage they need. By familiarizing yourself with the various enrollment periods and their significance, you can navigate the Medicare system with confidence and peace of mind. Remember, staying informed and proactive is key to making the most of your Medicare enrollments.

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Medicare SEPs

By Ed Crowe | General Articles | 0 comment | 14 March, 2024 | 0

Medicare SEPs

If you are in Medicare sales, you know there are several opportunities to enroll a client in a Medicare plan, that is why Medicare SEPs are so important to understand. There are times when a beneficiary qualifies for an SEP such as; if they move or lose their current coverage through no fault of their own. If they lose coverage for non-payment, they do not qualify for an SEP.

As of January 1, 2024, beneficiaries who sign up for Part A and/or Part B due to an exceptional situation, have a 2 month period to enroll in either a Medicare Advantage Plan (MA or MAPD) or a Medicare Part D (PDP). Plan coverage begins on the first day of the month after the plan receives your application for enrollment.

Click here to view more SEP details

Below we list some common reasons for an SEP

Your client moves to a new location:

If the beneficiary’s new address is outside the PDP or MA/MAPD plan’s service area, they qualify for a special election period. When this happens, the beneficiary must notify the plan’s carrier. If the beneficiary notifies the plan before they move, they can change plans anytime the month before they move and up to 2 months after the move. When the beneficiary does not tell the plan before they move, they can change plans starting the month they notify the plan and continues for 2 full months after the move.

If the beneficiary does not choose another Medicare Advantage plan, they will be enrolled in Original Medicare once they are disenrolled from their previous plan. The enrollee can decide to use this election period to return to Original Medicare and add a Medicare Supplement and PDP plan.

The client moves back to the U.S. after living outside the country

There is also an SEP available for qualified U.S. citizens who lived outside the country and recently moved back. This SEP last for 2 full months after the month they move back.

Clients recently moved out of a nursing home or rehabilitation facility

When this is the case, the client is eligible to enroll in a MA/MAPD, PDP or Original Medicare and a Med Supp. This SEP is available to individuals any time during their stay in the facility and last for up to 2 full months after they leave the facility.

Individuals who are released from incarceration

Those who were incarcerated and released qualify for an SEP as long as they kept paying for their Part A & Part B coverage while incarcerated. They have 2 full months to enroll in a Medicare plan form the date they are released. Please note: Part A & Part B must be in place before they can enroll in coverage.

Loss of current coverage

There are a few times this may be the case including; they are no longer eligible for Medicaid or lose their employer or union coverage. When this happens, the beneficiary can then switch to Medicare Advantage, drop the Medicare Advantage plan and return to Original Medicare and a PDP plan. If this happens, it is important to enroll in a new plan to avoid a lapse in creditable coverage which can result in a penalty.

Chance to enroll in other coverage

Beneficiaries can drop their MA/MAPD or Part D plan if they have a chance to enroll in another plan offered by a union or employer. This SEP is available anytime during the year, although it is important to be sure there is no lapse in coverage. This can also be the case if a beneficiary qualifies for Tricare or VA coverage.

Plan changes its contract with Medicare

There are circumstances when Medicare takes an official action called a sanction to protect beneficiaries. If this happens, the contract the insurance carrier has with Medicare is changed and the differences can affect the plans that beneficiaries enrolled in. When this is the case, the beneficiary can enroll in another MA/MAPD or PDP plan offered by either the same or a different carrier.

Watch a YouTube video on OEP, SEPs & late Part B enrollment

Some special circumstances

There are several other circumstances that allow beneficiaries a special enrollment period. Here are a few examples:

If the beneficiary is eligible for both Medicare and Medicaid.

When the beneficiary qualifies for the Extra Help, they may qualify for a Special Needs Plans that provides additional benefits. In the event they lose Extra Help, this also provides a SEP.

If the beneficiary dropped a Medicare supplement to join a Medicare Advantage plan, they have a “trial right” period they can use to drop the MA/MAPD plan and go back to Original Medicare if they change their mind. This period last for 12 months.

More special circumstances

When there is a 5 Star plan available, beneficiaries can drop their current coverage and enroll in the 5 Star plan anytime from December 8th through November 30th of the following year. In the event, a beneficiary is enrolled in a plan that is rated less than 3 Stars for the last 3 years, the beneficiary is qualified to switch to a higher rated plan.

If the beneficiary has a specific disabling condition, there are CSNP plans available to provide extra care to those individuals. Individuals can enroll in this plan anytime, although you cannot use this election to make any further changes.

There are also opportunities to change plans if a beneficiary misses their chance to change plans due to a Weather related or other FEMA disaster that occurs during a valid election period.

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As you can see, there are many qualifying life events that results in a special enrollment period. If you have questions or need to look at plan options, you contact your Medicare agent or if you are a Medicare agent with questions on SEPs, contact your upline for help. For more assistance; call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

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Blog

Enrollment periods for Original Medicare

Late enrollment penalties

1. Medicare Part A

2. Medicare Part B

3. Medicare Part D (Prescription Drug Coverage)

GEP (General Enrollment Period)

Avoid Late Enrollment Penalties

To Sum it up

Initial Enrollment Period (IEP)

Medicare General Enrollment Period (GEP)

Medicare Annual Enrollment Period (AEP)

Medicare Advantage Open Enrollment Period (MA OEP)

Special Enrollment Periods (SEP)

5-Star Special Enrollment Period

Key Tips for Navigating Enrollment in 2025

Medicare enrollment dates

Initial Enrollment Period (IEP)

Special Enrollment Periods (SEPs)

Loss of Employer Coverage

Moving out of the plans service area

Becoming Eligible for Extra Help

General Enrollment Period (GEP)

Annual Enrollment Period (AEP)

How to best use the Medicare enrollment dates

Medicare SEPs

Below we list some common reasons for an SEP

Your client moves to a new location:

The client moves back to the U.S. after living outside the country

Clients recently moved out of a nursing home or rehabilitation facility

Individuals who are released from incarceration

Loss of current coverage

Chance to enroll in other coverage

Plan changes its contract with Medicare

Some special circumstances

More special circumstances

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