Medicare Questions & Answers: Enrollment Periods
Enrollment Periods Q&A
Showing 17 questions
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
If you have employer-based health insurance through your or a spouse's current employment, where there are more than 20 employees, and you're happy with the costs, such as monthly deductions/premiums and coverage, like potential out-of-pocket costs, you can delay Medicare enrollment without accruing penalties. If this is you, it's best to schedule a quick call so we can discuss your situation. Chad
I'm turning 65 soon, when can I enroll in Medicare?
You are guaranteed coverage with no underwriting evaluations starting three months before your 65th birthday month and continuing for three months after that month. I always advise people to start thinking about their Medicare coverage at least six months before they turn 65.
What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
If a person misses the Open Enrollment time frame that runs January 1st through March 31, then depending on where the member lives, they may be able to use a disaster SEP to change plans, if they are a veteran, they may be able to use the Veterans SEP; If they move, they can use the Move SEP and finally can call Medicare directly.I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
1. A Medicare supplemental plan may be changed to another Medicare supplement plan at any time of the year.2. A Medicare supplemental plan can be changed to a Medicare Advantage plan between October 15 and December 7. However, this change will not take effect until January 1 of the following year.
3. Medicare Advantage plans can be changed to another Medicare Advantage plan once during open enrollment, which runs from January 1 to March 31.
4. Medicare Advantage plans can revert back to traditional Medicare with a supplement plan between January 1 and March 31. However, you may be without a drug plan for the remaining of the year.
5. Medicare Part D stand long prescription drug plans can only be changed between October 15 to December 7 and do not take affect until the following year of January one.
6. There are other special enrollment periods allow for case by case situations.
I'm planning to delay Social Security until age 70, but I'm turning 65 soon. How does this affect my Medicare enrollment?
You can still enroll at 65. You will need to do this from the SSA website or by visitin your SSA office.If you don't enroll at 65 and don't have coverage through a group plan you will be penalized 1% per month for each month you don't have coverage.
You will be billed by Medicare for your part B premium 3 months at a time.
I just moved to a new state. Do I need to do anything with my Medicare coverage?
Yes, you will have 60 days to make a change upon arrival into your new state. This will vary by the type of plan you are enrolled in. Consult with an agent to avoid any penalties and missing deadlines.
Can I backdate my Medicare enrollment if I missed my initial window due to a medical emergency?
If you missed your initial Medicare enrollment window because of a medical emergency, I’m sorry you had to go through that—unfortunately, Medicare doesn’t typically allow backdating for missed deadlines unless you qualify for a Special Enrollment Period (SEP), like if you were hospitalized or incapacitated during your sign-up time. The rules are strict, but if you can show proof—like hospital records or a doctor’s note—explaining how the emergency prevented you from enrolling, you might appeal to CMS for a retroactive adjustment, though approvals are rare and case-by-case. Without that, you’d face a late penalty on Part B premiums—10% per year missed, added for life.
Is Guaranteed Issue available after the Medicare Open Enrollment period ends?
They need to have an SEP Special enrollment after OEP such as moving out of the county their current plan is in.
How does moving to a new state affect my Medicare enrollment timeline?
When you move out of a service area, whether from one county to another, or a different state, you must change plans if you have a Medicare Advantage (MA) or Prescription drug plan (PDP). The ability to change plans after a move falls under a Special Enrollment Period (SEP).If you don't notify your plan before you move, you have the month you move and 2 months after (3 months total) to change plans. If you notify your plan before you move, you have the month before, the month of, and 2 months after (4 months total) to make a change.
Plans vary greatly by service area, so don't be surprised if you have different benefits, including maximum out-of-pocket, deductibles, co-pays, and co-insurance. Extra benefits may also differ from area to area.
Be advised that some counties with low populations don't have MA plans, so adding a supplement and a PDP may be your only option. Medicare Supplement SEPs are similar but exclude the month before a move. You can join a Medicare Supplement plan the month you move and up to 2 months after. Guaranteed issue is available ONLY if there is no MA plan available in your new service area.
Sound complicated? Contact me and I'll walk you through it.
Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?
When new Medicare prospects call me, I advise them to sign up for Medicare Part B two months before their start date, so it leaves plenty of time to generate a Medicare number and start date.
I thought I signed up for both Part A and B when I got my Social Security, but now I'm getting bills for Part B. Did I miss something during the enrollment period?
Part B has a deductible each year (increases a little each year-2025 is $257) and a 20% co-pay WITHOUT a maximum out of pocket! Have you looked into either a Medicare Supplement/Medigap OR Medicare Advantage Plan that can help with the Part B "out of pocket costs"?
I missed my Medigap window by a few months and now no one will cover me without underwriting. Why isn't this rule more well known?
The first thing that comes to mind is that you probably did not meet with a long-time Medicare professional agent who knows the ins & outs of its very quirky rules. In my opinion, enrolling with Medicare yourself online means that you may be bypassing the rules concerning the different periods during the year when one can enroll AND make changes.The only thing for you to do at this point is to enroll with a Medicare Advantage plan temporarily (you HAVE the right to do this at anytime since you've never enrolled before by picking up Medicare Part B with a monthly premium). Then, when the Open Enrollment begins on October 15th thru Dec. 7th (to become effective on Jan. 1st of the following year), you have what is known as "a trial right", meaning since you have your very 1st Medicare plan for less that 12 months, you will be able to apply for a Medigap (a.k.a., Med. Supp.) without having to answer any medical questions concerning pre-existing conditions.
Using any online information only yields the more well-known tenets of Medicare. The best advice I could ever give anyone regarding THE most important aspect of your life: HEALTH, is to be certain to get a 2nd & even 3rd opinion from an independent rep who is also known as a broker. However, in using a "Captive Agent": one who only has allegiance to one insurance firm, is foolhardy since all companies who offer Medicare-compliant Advantage plans can vary the rules to a certain extent. Though I truly hope that most agents are honest/reliable and can cover the gamut of the regulations, as an instructor myself, I will deliberately "over"-emphasize the more important areas/rules to all of my clients. Good luck and if needed, call 1-800-MEDICARE so that the person on the other end who's trained for this, confirms what a trial right means.
