Medicare Initial Enrollment Period (IEP) 2020
You need to make sure you are eligible for Medicare before you try to sign up during any enrollment period:
You must be 65 or older, a US citizen or a permanent legal resident who has lived in the US for at least five consecutive years.
You already receive Social Security retirement or Railroad Retirement Board benefits.
You are disabled and receive Social Security Disability Insurance or Railroad Retirement disability insurance benefits. Except if you suffer from ALS, there is a two-year waiting period when you first start receiving disability benefits. You do not have to be 65 in this case.
You have end-stage renal disease (ESRD) and your kidneys no longer work, you need regular dialysis or you have had a kidney transplant, or you suffer from amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS). With ALS, there is no waiting period. Medicare benefits start concurrently with your SSDI benefits.
What is the Medicare Initial Enrollment Period (IEP)?
For most people, their Medicare Initial Enrollment Period (IEP) is sandwiched around the time you turn 65. Specifically, it is a 7-month window encompassing the three months before you turn 65, the month of your 65th birthday, and the three months afterward.
During this time, if you aren’t already enrolled or you don’t qualify for automatic enrollment, you can enroll in Original Medicare Part A and Part B, a Medicare Advantage Part C plan, Medicare Part D prescription drug plan or one of several possible Medicare Supplement Plans.
If you’re eligible for Medicare due to a diagnosis of either ESRD or ALS, you can enroll following your diagnosis. If you start receiving disability benefits from Social Security, you will be automatically enrolled in Medicare as soon as your benefits begin.
When you become eligible for Medicare due to Social Security Disability Income (SSDI), you will be automatically enrolled in Medicare during your 25th month of receiving benefits.
How to apply for Original Medicare (Part A and Part B)
To Enroll in Part A and Part B:
If you’re over 65 or you’re turning 65 within the next three months, you can enroll in Part A and/or Part B online through Social Security. If you’re already getting Social Security benefits when you turn 65 (due to a disability such as ALS or ESRD), you’re automatically enrolled in both parts. If you have enough work credits (40 quarters/10 years) then Part A will be free in most cases, but you will still need to pay a monthly premium for Part B.
You can also call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 am to 7 pm or you can apply in person at your local Social Security office.
If you worked at a railroad, you can enroll by calling the Railroad Retirement Board at 1-877-772-5772 (TTY users 1-312-751-4701). Assistance is available Monday through Friday, from 9 am to 3:30 pm.
Part C and Part D:
There are literally hundreds of choices and plan options to choose from in the marketplace. Not all policies cost the same or are offered in all parts of the country. Things can get confusing in a hurry, which is best to work with an experienced agent who can answer your questions and guide you to the best possible solution for your particular needs
You will need to compare plans and shop for the one that best meets your particular situation. There are several online resources to help you, or you can work with an expert agent who will provide the guidance you need to make the right choices.
You can also visit Medicare’s website for answers, including the agency’s Medicare eligibility and enrollment calculator.
Initial Coverage Election Period for Medicare Advantage plans (Part C)
The timing of your Initial Coverage Election Period (ICEP) for Medicare Part C plans depends on when you enroll in Part A and Part B coverage.
For most people, their ICEP takes place during the same 7-month window as their IEP.
However, if you hold off enrolling in Part B because you have employer paid insurance, your ICEP will not take place until you eventually sign up for Part B. Remember, to enroll in a Medicare Advantage Part C plan, you must already have Part A and Part B coverage in place.
If you enroll outside of your IEP, then your ICEP is the three-month period before your Part B start date, and it ends on the last day of the month before your Part B coverage starts.
You have other opportunities to sign up for a Part C plan. These include the Annual Election Period and when you qualify for a Special Election Period.
Initial Enrollment Period for Prescription Drug Plans (Part D)
The same rules for your Initial Enrollment Period for Part D coverage as well. When you sign up for Part A and Part B during your IEP, you can also sign up for Part D coverage at that time as well.
If you’re under 65 and you have a qualifying disability, you have a 7-month window to enroll in Part D coverage. This window starts three months before the 25th month of receiving Social Security or Railroad Retirement Board benefits and ends 3 months afterward.
Just like with Part C coverage, you can also sign up for Part D during the Annual Election Period and when you qualify for a Special Election Period.
When does Medicare Coverage begin?
It depends on how and when you sign up for Medicare.
If you enroll during the first three months of your IEP, then coverage will begin on the first day of the month you turn 65. If you wait until you turn 65 to enroll in Medicare during your IEP, then you may have to wait one month or possibly longer for your coverage to kick in.
If you don’t sign up during your IEP and have to enroll during the General Enrollment Period (January 1 through March 31), then your coverage will begin on July 1 of that year.
If you sign up for Medicare Part D during the Annual Open Enrollment that runs October 15 through December 7, then your coverage will start on January 1 of the following year.
If you qualify for Medicare because of a disability or illness, your IEP is a 7-month period starting three months before your 25th month of receiving SSDI. Your Medicare coverage usually starts the 25th month you receive disability benefits.
What is Medicare Creditable Coverage?
Under the Medicare Modernization Act, a Medicare insurance provider must notify policyholders if their prescription drug coverage is creditable coverage. Creditable coverage is defined as health insurance coverage that will pay on average as much as standard Medicare prescription drug coverage.
Providers must give a written disclosure to all policyholders covered under a prescription drug plan by October 15 every year and at other times, according to regulations.
A second disclosure requires entities to complete a disclosure form and submit it to Medicare to report the creditable status of their current prescription drug plan.
It should be completed annually no later than 60 days from the beginning of a prescription drug plan year, within 30 days after the termination of a prescription drug plan, or within 30 days after any change in the status of your creditable coverage.
Creditable coverage comes into play when beneficiaries have other drug coverage sources, such as through a group health plan and choose to stay in that plan instead of enrolling in a Medicare drug plan. If that coverage is as good as Medicare’s drug plan, then it is considered creditable coverage.
This way, in addition to getting good quality prescription drug coverage, a beneficiary can enroll in a Medicare drug plan later on and avoid higher payments than they normally would.
What happens if I miss my Initial Medicare Enrollment Period?
If you don’t sign up for Medicare during your IEP, you could be charged a late enrollment penalty. If you have other medical coverage, you might avoid those late penalties by signing up during other periods noted below.
How to enroll in Medicare if you missed your Initial Enrollment Period
If you do not sign up for Medicare during your IEP, you may have several other enrollment opportunities.
Medicare General Enrollment Period (GEP)
If you don’t enroll during your IEP, you can still sign up for Medicare Part A and Part B during the General Enrollment Period (GEP) that runs from January 1 through March 31 every year.
When you enroll during the GEP, your coverage begins the following July 1.
Be aware that if you enroll during the GEP, you might be subject to late enrollment penalties. For Part A, these penalties could increase by 10% for twice the number of years you could have been enrolled but chose not to do so. For example, if you delay signing up for Part A by three years, you would have to pay a Part A late enrollment penalty for six years.
Your Part B premium could go up 10% for every 12-month period you were eligible but did not sign up. So, if you delayed Part B enrollment for three years, you would pay a 30% enrollment penalty for as long as you’re enrolled in Part B from that point on.
Medicare Special Enrollment Periods (SEP)
A Special Enrollment Period (SEP) allowing you to enroll in Medicare coverage can take place at any time of the year. If you qualify for a SEP, you won’t have to pay a late enrollment penalty that might otherwise be due. You can qualify for a year-long SEP which allows you to change plans once every quarter for the first three quarters of a year, based on low-income factors.
You can also qualify for a circumstantial SEP following a qualifying event such as if you lose your coverage because you moved to a new service area, you lost your job or existing medical coverage, or you gain or lose Medicaid or Medicare Savings Program eligibility, among others.
If you were still working during your IEP and/or had employer group health insurance coverage through you or your spouse, you will have an 8-month SEP when your employment or your group coverage ends.
If you’re under 65 and you become Medicare eligible because you are disabled you are also eligible for a SEP. However, if you are disabled due to end-stage renal disease (ESRD), then you will have a different SEP than with other conditions.
SEPs also apply to Part C Medicare Advantage and Part D prescription drug coverage. There are several instances when you can qualify for a SEP. For example, you have a 2-month window for Part C and Part D enrollment after your employer or union coverage ends. If you’re eligible for Medicaid benefits or the Extra Help program, your SEP is open-ended. However, if you lose your Medicaid benefits, you have a 3 month SEP to switch to a Part C and Part D plan.
There are other circumstances that let you use SEPs to enroll in Part C and Part D coverage.
Medicare Annual Enrollment Period (AEP)
The Annual Enrollment Period (AEP) runs October 15 through December 7 each year. During this time, private Medicare providers send out plan updates for the following year so you can decide if you want to change, drop or add Medicare Part C and Part D coverage for the coming year.
Also, if you didn’t sign up for a Part C or Part D plan during your IEP, the AEP is when you have the chance to make changes unless you qualify for a Special Enrollment Period.
During the AEP, you can:
- Change to or from a Medicare Part C plan from Original Medicare, Part A and Part B.
- Change from one Medicare Advantage plan to another
- Add a Medicare Supplement Plan
- Enroll in a Part D prescription drug plan.
- Change from one Medicare Part D plan to another.
- Cancel Medicare Part D coverage completely.
Changes made during the AEP go into effect on January 1 of the following year.
Medicare Advantage Open Enrollment Period (OEP)
Medicare beneficiaries can take advantage of the Medicare Advantage Open Enrollment Period (OEP) that runs January 1 through March 31 annually.
If you’re already enrolled in a Medicare Advantage Part C plan, you can make a one-time change. During the OEP, you can switch from one Part C plan to another, or disenroll from a Part C Plan and return to Original Medicare (Part A and Part B) with or without a Part D prescription drug plan.
Medicare Supplement (Medigap) Open Enrollment Period
You get more choices and better prices if you buy a Medigap policy when you’re first eligible during your 6-month Medigap Open Enrollment Period.
During your Medigap open enrollment period, you can’t be denied coverage, even if you have health issues (known as a guaranteed issue right). It’s important to know that when you apply after your open enrollment period, an insurance company is not required to sell you a Medigap policy if you don’t meet underwriting requirements, except for a few specific situations.
And if you are able to buy one, it could cost more due to past or present health conditions. But, during your OEP, you can buy any policy that a company sells for the same price as people who are in good health.
If you’re 65 or older, your Medigap OEP starts the first day of the month you’re enrolled in Part B.
If you’re under 65, some states may require Medigap insurers to sell you a policy but federal law does not require insurers to sell you a Medigap policy if you’re under 65.
If you’re covered through an employer’s group insurance, then you can enroll in Part B at a later date without an enrollment penalty. Your Medigap OEP would start at that time.
Some states have additional Medigap OEPs. Be sure to check and see what your state’s specific regulations are.
How do I get help paying for my Medicare?
Medicare Savings Programs (MSP) can help you pay for premiums, copays, deductibles, and coinsurance costs. You may qualify if you meet certain income and asset restrictions.
Three MSPs help you pay for Part A and Part B costs:
- Qualified Medicare Beneficiary Program (QMB)
- Specified Low-Income Medicare Beneficiary Program (SLMB)
- Qualified Individual Program (QI)
Each of these has its own asset and income limits.
You can also be “dual eligible” meaning that you can receive both Medicare and Medicaid benefits which will also help to defray Medicare costs.
When you qualify for a savings program, you also automatically qualify for Extra Help (Low-Income Subsidy) to help pay for Medicare Part D costs.