Understanding All Medicare Enrollment Periods: A Complete Guide

Medicare is the federal health insurance program designed for:

• Individuals aged 65 and older,
• Younger people with certain disabilities, and
• Individuals with End-Stage Renal Disease (ESRD) or ALS.

Medicare is divided into different parts:

• Part A covers hospital insurance.
• Part B covers medical insurance.
• Part C (Medicare Advantage) is a bundled alternative to Original Medicare, often including additional services like vision, dental, and prescription drugs.
• Part D is for prescription drug coverage.

To ensure you have continuous coverage without penalties, it’s important to sign up for Medicare at the right time. This is where the various Medicare enrollment periods come into play.

Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is the first time you are eligible to enroll in Medicare. This seven-month window allows you to sign up for Medicare Parts A and B, as well as Medicare Advantage (Part C) or Medicare Part D. The Initial Enrollment Period lasts for seven months:

• It begins three months before the month you turn 65,
• Includes the month of your 65th birthday,
• Ends three months after your 65th birthday month.

For example, if your birthday is in June, your IEP starts on March 1 and ends on September 30.

What Can You Do During the IEP?

• Enroll in Medicare Part A (if you don’t qualify for premium-free Part A).
• Enroll in Medicare Part B.
• Choose a Medicare Advantage Plan (Part C) if you prefer private coverage that may include extra benefits.
• Sign up for Medicare Part D for prescription drug coverage.

Note: If you delay enrolling in Part B or Part D without having qualifying insurance (like employer-based coverage), you could face lifelong penalties.

General Enrollment Period (GEP)

The General Enrollment Period (GEP) provides an annual opportunity for people who missed their Initial Enrollment Period to sign up for Medicare Part A and/or Part B. The General Enrollment Period occurs every year between January 1 and March 31.

What Can You Do During the GEP?

• Enroll in Medicare Part A or Part B if you didn’t sign up during your IEP and aren’t eligible for a Special Enrollment Period (SEP).
• If you sign up during the GEP, your coverage will start on July 1.
• You may face late enrollment penalties for Part B and/or Part D, depending on how long you’ve gone without coverage.

Special Enrollment Period (SEP)

A Special Enrollment Period (SEP) allows you to enroll in or change your Medicare coverage outside of the standard enrollment periods, triggered by specific life events.

When Can You Qualify for a SEP?

You can qualify for a Special Enrollment Period under the following conditions:

• You or your spouse are working and you have health coverage through an employer.
• You move out of your Medicare Advantage plan’s service area.
• You lose other coverage, such as from an employer, or lose Medicaid eligibility.
• You leave or join a skilled nursing facility or long-term care hospital.
• You enroll in or leave a Medicare Savings Program or Extra Help.
• You have a change in your Medicaid status.

What Can You Do During a SEP?

• Enroll in Medicare Part A and/or Part B if you delayed enrollment due to having employer-provided health insurance.
• Switch between Medicare Advantage plans or go back to Original Medicare.
• Enroll in or switch a Medicare Part D prescription drug plan.
• If you qualify for a SEP due to employer coverage, you can sign up for Part A and Part B anytime you’re still covered by the employer or within 8 months of losing that coverage without facing penalties.

Medicare Advantage Open Enrollment Period (MA OEP)

The Medicare Advantage Open Enrollment Period (MA OEP) is specifically for people who are already enrolled in a Medicare Advantage Plan and want to make changes to their coverage. The MA OEP runs annually from January 1 to March 31.

What Can You Do During the MA OEP?

• Switch from one Medicare Advantage Plan to another (with or without drug coverage).
• Drop your Medicare Advantage Plan and return to Original Medicare (Parts A and B).
• Add a Medicare Part D prescription drug plan if you switch back to Original Medicare.
• You can only make one change during this period.
• If you revert to Original Medicare and want Medigap coverage, be aware that Medigap policies may require medical underwriting.

Annual Enrollment Period

The Annual Enrollment Period (AEP), also known as the Fall Open Enrollment Period, is the main time of year when everyone with Medicare can make changes to their coverage. The AEP happens every year from October 15 to December 7.

What Can You Do During the AEP?

• Switch from Original Medicare to a Medicare Advantage Plan.
• Switch from one Medicare Advantage Plan to another.
• Drop your Medicare Advantage Plan and return to Original Medicare.
• Join, drop, or switch a Medicare Part D prescription drug plan.
• Any changes made during the AEP will take effect on January 1 of the following year.

Initial Enrollment Period for Part D (IEP for Part D)

The Initial Enrollment Period for Part D follows the same seven-month window as the Initial Enrollment Period for Medicare Parts A and B.

It runs from three months before your 65th birthday to three months after the month you turn 65.

What Can You Do During the IEP for Part D?

• Enroll in a standalone Medicare Part D prescription drug plan if you have Original Medicare.
• Enroll in a Medicare Advantage Plan that includes prescription drug coverage.
• If you delay enrolling in Part D and don’t have creditable prescription drug coverage (such as through an employer), you may face a late enrollment penalty.

Medigap Open Enrollment Period

The Medigap Open Enrollment Period is the six-month period that starts when you first enroll in Medicare Part B and are 65 or older. During this time, you have guaranteed issue rights, meaning insurance companies cannot deny you Medigap coverage based on health conditions.This period begins the first month you have Part B and are 65 or older.

What Can You Do During the Medigap OEP?

• Purchase any Medigap (Medicare Supplement) policy available in your area without medical underwriting.
• After this six-month window, you may not be guaranteed Medigap coverage, and insurers can charge higher premiums or deny coverage based on your health.