Paramount Retirement Solutions
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Medicare Enrollment Periods

Initial Enrollment Period (IEP)

IEP is a 7-month window that is centered around the first month you’re eligible for Medicare. For most people (other than those eligible for Medicare younger than 65 because of a disability), that month is the month in which they turn 65. So for example, someone that turns 65 on November 10, 2016, the first month they are eligible for Medicare is November 2016. So their IEP would start July 1st, 2016 and end February 28th, 2017. Medicare effective dates are always on the 1st of a month. There is one exception where if your birthday is on the 1st of a month, your first month of Medicare eligibility is the month before your birthday.

During this time you can do several things. This is the time when you can enroll in Medicare if you’re not enrolled automatically. For a better idea on if you need to sign up or how to do it, click on the Medicare overview part of my tutorial. If you enroll in Medicare at any time in the first 3 months of your IEP, Medicare will start on the 1st day of the month you’re first eligible. If you wait and enroll until sometime during your first month of eligibility, Medicare will start the 1st of the following month. If you wait to enroll until the month after your first month of eligibility, Medicare will start 2 months afterwards. So if you turn 65 in May of 2019 but wait to enroll until sometime in June, your Medicare effective date will be August 1st. If you wait til the second month after your first month of eligibility, Medicare won’t start until 3 months later (e.g. turn 65 in December 2017, wait to sign up til February 2018, then Medicare starts May 1st, 2018). This 3 month wait also applies to waiting to sign up until 3 months after your first month of eligibility just like for waiting until 2 months after. See the chart below for a cleaner summary:

Medicare Part B effective dates

You can also sign up for a stand-alone prescription drug plan (PDP) or a Medicare Advantage (MA) plan during your IEP. If you enroll in a PDP or MA plan at any time in the first 3 months of your IEP, it will start on the 1st day of the month you’re first eligible. If you enroll a PDP or MA plan in any of the remaining 4 months of your IEP, the plan will simply start the 1st of the following month.

Medigap Open Enrollment Period (OE)

OE applies specifically to Medigap plans. The best time to buy a Medigap policy is during your Medigap Open Enrollment Period because you can’t be turned down, charged more, or made to wait for your plan to start because of any health conditions you may have. This OE period starts when you’re both: 65 or older, and enrolled in Part B. So this period does not apply to those who are on Medicare and younger than 65, or to those who are 65 or older but don’t have Part B yet because they may still be working.

Special Enrollment Period (SEP)

An SEP could apply to several different situations. For Original Medicare, an SEP applies for a time period you can enroll in Part A and/or Part B that is later than your IEP. A perfect example of this would be if you work past 65 and continue to be covered under your employer’s group health plan. At any point after this when you’re ready, you can enroll in both Parts A and B using this SEP. This SEP ends 8 months after either your (or your spouse’s) employment ends or the group coverage ends, whichever happens first.

​If you signed up for Part A only when you were first eligible but not Part B, you can use Form CMS 40B to apply for Part B. Write in the ‘Remarks’ sections of this form what you want your Part B effective date to be keeping in mind it can only be on the 1st of a particular month. This way you can coordinate it to start when the group coverage ends so you don’t have any gaps in coverage. You will also need Form CMS-L564 that both you and your employer will need to fill out. This second form just verifies that you’ve been on your employer’s group plan in the last 8 months. Once you fill out these 2 forms, I recommend taking them down to your local Social Security office and deliver them by hand anywhere from 4-8 weeks before your desired Part B effective date. If you mail them there’s a chance they could get delayed and not processed in time.

An SEP can also apply to a PDP or MA plan too. This type of SEP refers to a time period when you can sign up for a plan or switch plans because of a special circumstance. Normally you can only do this during certain time frames like your IEP and AEP (which will be discussed below). Some of the reasons you could qualify for a PDP or MA SEP are:

  • ​Your current plan is ending its contract with Medicare
  • You recently moved outside of your current plan’s service area
  • You are moving into or out of a long-term care facility
  • You now qualify for Extra Help for your prescription coverage

To see a complete list of circumstances, visit https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html

Annual Enrollment Period (AEP)

AEP is the time every year when you can enroll or disenroll in PDPs and/or MA plans. This period lasts from October 15th – December 7th. You can know it’s AEP time because the number of Medicare-related commercials on TV seems to triple. However, the biggest misconception by far that folks I’ve come across seem to have about Medicare and Medicare plans is that you can only change plans during AEP. That only applies to PDPs and/or MA plans. You can switch Medigap plans during any time of the year! So as long as you want to go from one Medigap plan to another Medigap plan, you can do this during any time. Keep in mind, however, that once your OE period is over, the new Medigap you’re applying for will ask you health questions and you’ll go through underwriting.

Medicare Advantage Disenrollment Period (MADP)

MADP lasts from January 1st – February 14th. During this time period, you can disenroll from a MA plan and go back to Original Medicare. You can also get a Medigap plan and/or a PDP at the same time. The PDP application has to be submitted to the insurance company by February 14th, otherwise you will lose out on the opportunity to sign up for this drug plan until your next eligible enrollment period. Whenever you submit this PDP application, it will be effective the first of the next month. The Medigap application is not required to be submitted during this specific time frame, but generally you want it to start both when the PDP does and when the MA plan terminates so as to not have any gaps in coverage.

A strong word of caution: make sure you are approved into the Medigap plan before you fill out and turn in the PDP app. Whenever you submit the PDP app, not only will the effective date of the PDP be the 1st of the next month, but also it will automatically disenroll you from the MA plan effective at the end of the month. So if you turn in the Medigap and PDP applications at the same time to the respective insurance companies and you get declined for the Medigap policy, your MA policy will terminate and you will be liable for all the cost shares under Original Medicare Parts A and B.

General Enrollment Period (GEP)

If you didn’t qualify for premium-free Part A and didn’t sign up for it and/or for Part B during your IEP, and you weren’t covered under a group health plan, you can only sign up during January 1st - March 31st. If you sign up during this GEP, your Part A and/or Part B will start July 1st of that year, and you might have to pay the late-enrollment penalties involved.

IEP, OE, SEP, AEP, MADP, GEP; talk about alphabet soup! You can see how complex Medicare and supplemental insurance can be. You can see how easy it is to make a mistake which could result in gaps in coverage and penalties for late enrollments. These are among the many reasons to have an independent agent in your corner to help you navigate the traps and pitfalls involved in the process, and give you peace of mind that you’re making the right decisions. Contact me to do just that and we can find a time to talk so I can answer all your questions and get you on the right path.