Medicare Initial Enrollment, Open Enrollment, and Special Enrollment are terms that confuse a lot of people. Fortunately, it isn’t difficult at all to learn the difference between the various Medicare enrollment periods and the opportunities they provide. ▪ Myaarpmedicare
Medicare Initial Enrollment Period
Every American with age 65 in his or her sights needs to be aware of the Initial Enrollment Period. Although there has been plenty of talk in recent years about possibly raising the Medicare age, the Medicare eligibility age for the vast majority of Americans has been 65 ever since Medicare was established in 1965. Some people are eligible earlier due to disability, but for about six out of seven Americans Medicare eligibility begins around the time they turn 65, with Initial Enrollment occurring around the same time.
Does coverage start the day someone turns 65?
Not exactly. The Initial Enrollment Period for Medicare is actually a seven-month window beginning three months before the month you turn 65. This means, for example, that if you were born on Dec. 1, 1948, and will turn 65 on Dec. 1, 2013, your Initial Enrollment Period started on Sept. 1 of this year, or three months before your 65th birthday. But if you were born on New Year’s Eve 1948 and will turn 65 on Dec. 31, 2013, your Initial Enrollment Period also started on Sept. 1 of this year-almost four months before your 65th birthday. But in neither of those cases will coverage start exactly on your 65th birthday.
Then when will it start?
If you enroll during the first three months of your Initial Enrollment Period, coverage should begin the first day of your birthday month. But if your birthday falls on the first of the month, your Medicare coverage should begin on the first of the previous month. Keep in mind that you shouldn’t wait too long to enroll because if you do the start of your coverage may be delayed.
And the Initial Enrollment window closes …
Again, the Initial Enrollment Period is seven months long. It ends three months after the month you turn 65 if you’re among the 83 percent of Americans who become Medicare-eligible at 65. If you are among the one in seven who become eligible for Medicare prior to reaching 65, you have a similar seven-month enrollment period starting three months before the month your Medicare eligibility begins.
What if the window closes before someone signs up?
That’s often bad news.
Ask poor Bubba. He assumed Uncle Sam would take care of everything, and never bothered to enroll in Medicare during his Initial Enrollment Period. He’d heard somewhere that enrollment in Medicare was automatic-which it is for people who are already receiving Social Security benefits. But if you’re not already collecting Social Security before age 65, you’d better remember to enroll in Medicare during Initial Enrollment.
As it turned out, by letting that Initial Enrollment window close, Bubba had to wait months for a second chance to sign up for Medicare. His next opportunity to enroll didn’t come until the next Medicare General Enrollment Period-which we’ll get into in a moment. You can imagine how mad Bubba was when his tractor rolled over his foot a few weeks before General Enrollment came around. Poor Bubba was so mad he hadn’t signed up for Medicare during his Initial Enrollment Period that he kicked himself with his good foot.
Compare Bubba’s story to Nancy’s …
Bubba’s neighbor Nancy went to SocialSecurity.gov and enrolled in Medicare early during her Initial Enrollment Period. She signed up for Medicare Part A-premium-free for about 99% of people on Medicare-and Medicare Part B. Those two parts of Medicare are called Original Medicare because they date back to Medicare’s inception in 1965. Nancy thought about dropping Part B because it does have a monthly premium-just over $100 for most people-but she decided her health wasn’t something to gamble with.
And from there …
Knowing Original Medicare is full of gaps, Nancy debated whether to invest in a Medicare Advantage or Medicare supplement plan. Initial Enrollment is a great time to investigate every option. Nancy decided to go with a Medicare supplement, or Medigap, plan partly because she had Medigap guaranteed issue rights for six months, meaning there was a one-time, six-month period in which no insurance company could deny her any available Medicare supplement policy she wanted regardless of her medical history. Nancy also signed up for a Medicare Part D prescription drug plan. Again, during Initial Enrollment, it’s good to investigate all your options. Also, by joining a prescription drug plan when she was first eligible, Nancy avoided having to pay a Medicare Part D penalty by joining later.
Bubba wasn’t as lucky.
Remember, he waited until the Medicare General Enrollment Period to sign up for Medicare.
Medicare General Enrollment Period
General Enrollment takes place from Jan. 1 to Mar. 31 every year, and it’s a second chance for people like Bubba to sign up for Medicare.
Bubba was ecstatic when he found out about the General Enrollment Period-that is, until he learned it wasn’t quite everything he’d hoped for.
First of all …
By missing out on his Initial Enrollment opportunity, Bubba had to wait until July 1 for his coverage to begin. While the General Enrollment Period takes place during the first three months of each year, coverage normally doesn’t begin until the year is halfway over … in Bubba’s case, over half a year after that tractor went over his foot.
At least Bubba did one thing right.
He avoided having to pay the Medicare Part B late enrollment penalty by making sure he didn’t miss his General Enrollment opportunity. The Medicare Part B late enrollment penalty can be costly-with 10% added to your Part B premium every month for each full 12-month period you were eligible for Part B but not enrolled in it-but Bubba avoided the penalty by not letting 12 months lapse before signing up for Part B. At least he didn’t have to kick himself about that.