Missed Your Initial Enrollment Period? Here’s What You Do:

Laura Floor
November 15, 2017
Medicare Part B

Medicare recipients are given a certain time frame each year to change their Medicare choices. If you miss making changes during that time period, you may still have some options available to you. Meanwhile, for any older adult not already enrolled in Medicare, it is best to consider the type of Medicare coverage needed prior to your seven-month Initial Enrollment Period (IEP). This IEP is described by the Centers for Medicare and Medicaid Services (CMS) as:

  • Beginning three months before you turn 65 years of age;
  • Including the month you turn 65 years of age;
  • Ending three months after you turn 65 years of age

There are also three categories of Medicare enrollment, and these are the IEP, Special Enrollment Period (SEP), and General Enrollment Period (GEP).

General (Open) Enrollment Period – Changing Plans

The following are the customary six options available to you during the annual open enrollment period (from October 15 – December 7) per AARP:

  1. You can switch from one Medicare Part D plan to a different one.
  2. You can switch from one Plan C (Medicare Advantage) plan to a different one.
  3. You can change from Original Medicare to a Medicare Advantage plan.
  4. You can change from a Medicare Advantage plan to Original Medicare coverage.
  5. You can enroll in a Part D plan if you switch from a Medicare Advantage plan to Original Medicare.
  6. You can enroll in a Part D plan for the first time if you opted out of other drug coverage (e.g., from an employer).

Late Enrollment Penalties – Who Gets Them?

You may be financially penalized if you enroll in Medicare after your IEP has passed. A late initial enrollment in Original Medicare Part B usually results in a 10% late enrollment penalty added to the annual Part B premium cost—and this financial penalty is increased for each year that Part B is not chosen by the Medicare enrollee.

While Medicare enforces differing late enrollment penalties, you can submit a reconsideration request. However, you will need to meet Medicare’s exception requirements to be approved. A reconsideration request form is downloadable from the Office of Medicare Hearings and Appeals (OMHA).

Medicare’s Inclusive Enrollment Dates

Recognizing Medicare’s enrollment (and Medicare plan change) periods is crucial, so that you do not receive a financial penalty and/or find yourself unable to change your health plan until the following year. The enrollment time periods for Medicare’s different Parts (as well as Medicare Supplemental Insurance [MSI]) are:

  • Part A (Original Medicare – Hospital Insurance): January 1 through March 31.
  • Part B (Original Medicare – Medical Insurance): January 1 through March 31.
  • Part C (also called Medicare Advantage – private insurers’ health plans): October 15 through December 7.
  • Part D (Original Medicare’s prescription drug coverage): October 15 through December 7.
  • MSI (also called Medigap) [private insurers’ supplemental health plans]: variable enrollment dates. Note that if you miss the Medicare enrollment date for Medigap coverage, you will need to meet certain criteria in order to purchase a Medigap policy at a later date.

Qualifying for a Special Enrollment Period

You can enroll in Part D (prescription drug coverage) outside of the usual enrollment period under the following circumstances:

  • You prescription drug benefits were terminated from your current employer (or your spouse’s employer) on retirement, or due to circumstances beyond your control.
  • Your existent COBRA drug coverage has been terminated.
  • You lost your drug coverage from a retiree health plan, and this loss was not under your control.
  • You returned to permanently reside in the US from living in a foreign country.
  • You were released from prison.

You can also make changes to your Medicare Parts C or D plans if you move out of the insurer’s coverage area. Other qualifying circumstances exist, and Medicare’s website includes a chart to guide you in determining if you are generally allowed to enroll during a SEP, the SEP’s inclusive enrollment dates, and when your coverage will begin under the given SEP.

Workplace Coverage and Medicare

Nearly 20% of seniors in the US aged 65 and older were still working as of 2013, and that percentage continues to grow. If you did not enroll in Medicare upon turning age 65 because you were still employed, the size of your employer (i.e., number of employees) determines whether you will have to pay a penalty for late enrollment.

According to MedicareRights.org, it is advisable to contact a Social Security office if you are delaying enrollment in Medicare Part B due to current coverage through employment—and also to keep a record of who you spoke to in that Social Security office and exactly what you were told by that employee!

Your Medicare Advantage Plan and Special Enrollment Periods

If your Medicare Advantage (or your Medicare drug plan) ends mid-year through no fault of your own, the good news is that you will likely be granted at least two months to make your decision pertaining to replacing your Medicare Advantage (or Part D) plan.

Sometimes a Medicare contract with an insurer’s Medicare Advantage plan is not renewed, and you have to change plans. In that instance, the Center for Medicare Advocacy notes that Medicare will allow you to enroll in a different Medicare Advantage health plan during a SEP.

Entering or Leaving a Nursing Home

Elderly Medicare enrollees who enter (or leave) a nursing home are granted the capacity to do the following, according to a Medicare publication:

  • Join a Medicare Advantage or Plan D (prescription drug) plan.
  • Switch from the currently-held Medicare plan to a different Medicare Advantage or Part D plan.
  • Drop the currently-held Medicare Advantage Plan and return to Original Medicare.
  • Drop Medicare Part D coverage.

Notably, this SEP is only existent upon entering the nursing home, as it is based on the SEP for relocation to a new abode—and also for only two months after moving from the nursing home to another place of residence.

What is SPAP?

Besides Medicare Part D coverage, some states offer a State Pharmaceutical Assistance Program (SPAP) to assist their residents to pay for drug coverage. If you are enrolled in Original Medicare’s Part D, this can help you to cover the following related costs:

  • Premium;
  • Deductible;
  • Co-payments;
  • Coverage gap

SNAP may also assist you to pay drug costs if you are not enrolled in a Part D plan. You can find out if your state has a SPAP via the Medicare.gov website.

Medigap Coverage and SEP

You cannot be enrolled in a Medigap plan if you are covered by a Medicare Advantage plan. On the other hand, you can enroll in a Medigap plan if you drop Medicare Advantage coverage and enroll in Original Medicare.

If you decided during the first year of Medicare Advantage enrollment (chosen during your IEP at age 65 or thereabouts) that you really wanted to switch to Original Medicare, you are allowed to purchase a Medigap plan within certain time parameters designated by Medicare. Specifically, you can enroll in a Medigap plan as early as 60 calendar days (but not later than 63 days) before the date your Medicare Advantage plan will end.

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