Medicare Transitions & Enrollment Periods

Turning 65 and getting started with Medicare can be stressful. Fortunately, there is free professional help available in your area.

Medicare is often a complex issue and has many moving parts. For many people, transitioning to Medicare or from one plan to another can result in confusion and many questions. Medicare is a federal health insurance program for people who are 65 and older, or those with certain disabilities. Medicare has four parts: Part A (Hospital), Part B (Medical), Part D (Prescription Drug Coverage), and Part C (Medicare Advantage).


Enrollment Periods

There are 4 types of Medicare Enrollment Periods. When you are first eligible for Medicare, you have a 7-month period to sign up for Part A and/or Part B. This period is called the Initial Enrollment Period (IEP) and begins 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65. During this time, if you are not already collecting Social Security benefits you will need to sign up for Medicare online through the Social Security website (SSA.gov).

The most commonly known Enrollment Period happens in the last quarter of the year, known as Annual Enrollment Period (AEP). The Annual Enrollment Period runs from October 15th through December 7th. During this period, you have the chance to “shop” different plans to find the right fit for you. This period allows you to move from a Medigap Supplement and PDP to a Medicare Advantage and vice versa. All plan choices will be effective January 1st of the upcoming year.

Starting in 2019, Medicare approved a new enrollment period called Open Enrollment Period (OEP). The Open Enrollment Period runs from January 1st through March 31st. During this time, anyone on a Medicare Advantage Plan can make a one time change to a different Medicare Advantage plan or revert back to Original Medicare. To properly use this period, contact a professional Medicare agency.

Lastly, there are certain circumstances that can lead to a Special Election Period (SEP). For example, moving to a new address, losing your current healthcare coverage, or gaining or losing Medicaid coverage to name a few. When using a Special Election Period to change or start coverage, there are certain rules that follow.

· If you are moving to a new address, you have a two-month window to make a change. During this window you will have the opportunity to choose any plan that is available at your new address.

· If you are losing employer coverage, you have a two-month window to make a change but will often be required to show documentation (i.e. an Employer Verification form). During this time, you will apply for Part B via Social Security and be able to shop for the best Medicare plan for you.

· If you are gaining or losing Medicaid or Extra Help for drug costs, you have one-time SEP to switch your current plan for up to three months after you are notified. For someone who has Medicaid or Extra Help for drug costs, you also get a once a quarter SEP, where you can make a change.


Special Needs Plans


If you have a chronic illness, for example diabetes or cardiovascular issues, you are eligible to enroll in a Medicare Special Needs Plan (SNP). Special Needs Plans cover the same thing that Medicare Advantage Plans cover but often time cover extra services tailored to the illness. If you lose eligibility for a SNP, you will have a Special Enrollment Period to make another choice. This enrollment period starts when you are notified of the loss of coverage and continues for a two-month period after coverage ends.


As you can see, Medicare is often a complex issue and has many moving parts. Medicare is something you manage annually; it is not something you set and forget. For most people, transitioning to Medicare or from one plan to another can result in confusion and questions. For more information on the type of plans offered and the different Enrollment Periods, please call Affordable Medicare Solutions. We have 25 years of experience handling these issues at no charge to you. We are here to help find you the best plan to fit your needs every year.

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