The Medicare Open Enrollment Period: A Guide
Missing any deadline is a hassle. But it’s especially inconvenient (and costly) when you forget to sign up for Medicare during the standard enrollment period.
If you’re 65 or older, Medicare coverage ensures that you are covered throughout the fiscal year for hospital visits, doctor appointments, prescription drugs, and other health-related expenses that you may incur.
If you plan on obtaining Medicare, it is important to observe the enrollment deadlines. You also need and to know about the different parts of Medicare so that you can determine which are right for you.
How To Enroll in Medicare
What is Medicare and how does it differ from a private health care insurance plan?
Medicare is a federal government health care program for persons 65 and older. You may also qualify if you’re younger than 65 but have certain disabilities. Although costs vary greatly, Medicare typically offers cheaper health care coverage than standard health insurance does (setting aside employer-sponsored health care coverage). As a recipient of Medicare, you can expect lower deductibles and lower premiums than you would pay for private health insurance. Having Medicare coverage saves you money.
When Can I Join a Medicare Plan, Switch Out Of It, Or Drop It?
You can join, switch, or drop a Medicare health plan or a Medicare Advantage Plan (Part C) with or without drug coverage during these times:
- Initial Enrollment Period. When you first become eligible for Medicare, you can join a plan.
- Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan.
- Medicare Advantage Open Enrollment Period. From January 1 to March 31 of each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different plan or switch to Original Medicare..
There are four parts of Medicare that have different enrollment periods and that cover different medical expenses: A, B, C, and D. Enrolling in just one part of Medicare makes you a Medicare participant. But you must enroll in Medicare Part A or Part B to qualify for Medicare Advantage or Medicare Supplement.
Each of the above parts is a separate component of Medicare and has a different period of open enrollment. Learn which parts or plans are best for you so that you can enroll promptly when open enrollment begins.
When Is the Medicare Open Enrollment Period?
The Medicare enrollment dates are the same every year. From October 15 to December 7, anyone can make changes to a Medicare plan or enroll in one. During this period, you can:
- Switch from Medicare to Medicare Advantage (or vice versa).
- Switch from Medicare Advantage with prescription drug coverage to a plan without such coverage.
- Drop or join a Medicare prescription plan.
- Update your coverage.
If you make a change during the annual enrollment period, the modified coverage won’t begin until January 1.
When Is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage enrollment period lasts from January 1 to March 31 each year. If you are already enrolled in Medicare Advantage, you can switch to another Medicare Advantage plan during this period or to original Medicare.
You can make changes to your Medicare plan or enroll in a Medicare plan outside of the enrollment period if you are moving out of the service area of your plan or if you are losing your current health care or prescription coverage. Simply inform your plan provider of what has happened.’
In What Order Should I Enroll In Medicare Parts A, B, and D?
The order of enrollment depends on which enrollment periods come first after you become eligible and which parts you are eligible for as a result of having another type of Medicare.
- During your initial enrollment period, you are eligible to enroll in Part A. When you apply for Social Security benefits, you are automatically enrolled in Medicare Part A.
- You are eligible to enroll in Part B during a seven-month window around your sixty-fifth birthday: the three months before the month of your birthday, the month of your birthday, and the three months after the month your birthday. Part B is also part of your initial enrollment period, and you are enrolled in it automatically if you are receiving Social Security benefits.
- You’re eligible to enroll in Medicare Part D during initial enrollment and during the seven-month period surrounding your sixty-fifth birthday. Enrollment is optional. If you do enroll, you must do so through an insurance company.
In sum: enrollment in Part A and Part B occurs automatically and is necessary before you can enroll in Part C or Part D. Although you can enroll in Part C or Part D in any order, we recommend that you start with Part C in order to determine whether you need D. For example, some Part C plans don’t cover prescription drugs, which Part D would then cover.
Medicare Part A: Hospital Insurance
Medicare Part A covers items like hospital stays, surgeries, nursing care, home health care, and hospice care. For most people, there are no monthly premiums. But in 2021, the deductible is $1,484.
The above-listed coverage includes some important restrictions or qualifications. For instance, Part A will cover hospice care but not care in a hospice facility. Instead, your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness. Your hospice benefit will cover these services even if you remain in a Medicare Advantage Plan or other Medicare health plan.”
Also, if you are hospitalized and your hospital stay is longer than 60 days, for every additional day you must cover a portion of each day’s payment out of pocket.
Medicare Part B: Medical Insurance
Medicare Part B covers doctor visits and medical tests. More specifically, Part B covers:
- Medical visits and equipment
- Outpatient care
- Cancer treatment
- Cardiac rehabilitation
You pay a monthly premium for Part B that in 2021 is $148.50. If you are receiving Social Security, this premium may be deductible.
In 2021, the annual deductible for Part B is $203. Once you have paid this deductible, you must pay 20 percent of any Medicare-approved cost of service (provided that Medicare is accepted by your doctor or medical professional). There is no cap on this out-of-pocket expense, which means that the cost of your contribution can add up quickly.
Medicare D: Prescription Drug Insurance
Medicare D, or prescription drug coverage, is managed through private insurance. If you have Medicare Advantage (Part C), you can also expect Medicare D coverage, since most Medicare Advantage plans include prescription drug coverage.
Some Medicare Part D plans require a copayment, and it’s common to have an annual deductible that you must pay before Part D begins covering the cost of your prescription medication. Medicare Part D also has a coverage gap or a temporary limit on what the plan covers. This coverage gap applies after you and your plan have spent a certain combined total on prescription costs. In 2021, your prescription drug coverage picks up the tab for further prescription drug expensesafter you have paid $6,550 out of pocket.
What Is a Medicare Supplement?
A MMedicare Supplement, also known as Medigap, is offered by private insurance companies to fill the gaps in a standard Medicare plan. Medigap helps pay for expenses that Medicare doesn’t cover, such as copayments, coinsurance, and deductibles. Medigap is also helpful for seniors who enjoy traveling overseas and may need to pay for medical care abroad.
Before enrolling in Medigap, you must first enroll in a Medicare plan. Then you can purchase Medigap from any private insurance company in your state that is licensed to sell it.
A Medicare Supplement policy won’t cover long-term care, vision care, or dental care. These are services that a Medicare Advantage plan may cover. (Routine vision care and dental services are not covered by original Medicare.)
Frequently Asked Questions
Do I automatically get Medicare when I turn 65?
If you are already receiving Social Security benefit checks, the Social Security Administration will automatically enroll you in Part A and Part B of Medicare when you reach your sixty-fifth birthday. About 30 percent of seniors claim their Social Security benefits before age 65.
If you don’t yet need Medicare—e.g., if you haven’t yet retired or you are covered under your spouse’s health care plan—you can decline Medicare coverage. But if you enroll at a later date, you may face penalties at that time.
When can I use a special enrollment period?
A special enrollment period may be available if you are moving out of state (or out of your coverage area), your spouse has died, you are dealing with a divorce or annulment, or you have lost your most recent health care coverage.
If you are unable to use a special enrollment period, you can still obtain Medicare coverage as a late enrollee. But you must pay a 10 percent monthly premium in order to do so.
Do I have to sign up for Medicare if I have employer insurance?
No, you don’t have to. If you are completely satisfied with your employer-provided insurance, you may feel that you don’t need Medicare. But you should nevertheless sign up if you are working for a small company, i.e., one with twenty or fewer employees. If you are working for a small company but don’t enroll when you become eligible, you may face penalties if and when you enroll in the future.
You don’t have an either-or choice here. Many people use Medicare in conjunction with their employer insurance for more comprehensive coverage. The combination of the two is often helpful.