Medicare Questions & Answers: Enrollment Periods
Enrollment Periods Q&A
Showing 19 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?
3 months before your 65th birthday. And up to 3 months after. You may delay enrollment if you have a job that gives you creditable coverage if you want to delay signing up for Medicare. Normally if you are receiving Social Security you will be signed up automatically.
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
Medicare Advantage Plans (Part C) can be changed during the Annual Enrollment Period - October 15th to December 7th, or during the Open Enrollment Period - January 1st to March 31st. There are also some Special Election Periods that can be used, such as:* You change where you live
* You lose your current coverage
* You have a chance to get other coverage
* Your plan changes its contract with Medicare
* Other special situations
Medicare Supplement plans can be changed at any time throughout the year if you qualify medically. Some states even have guaranteed issue periods such as 60 days following your birthday, loss of creditable coverage through employer or another plan, or if the plan exits the market.
Prescription Drug Plans (Part D) can only be changed during the Annual Enrollment Period - October 15th to December 7th, unless there is a Special Election Period that would allow you to change.
Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?
Why Seniors Delay Enrollment:1. Lack of Awareness or Understanding
Many seniors aren’t fully aware of their Medicare Initial Enrollment Period (IEP), the penalties for late enrollment, or the options they have. They might assume they’ll automatically be enrolled or think they don’t need to worry until a later time.
2. Fear or Overwhelm
The Medicare system can feel overwhelming with its various parts (A, B, C, D, Medigap). The fear of making the wrong choice often leads to procrastination.
3. Health or Work Factors
If seniors are still working or have employer-provided health insurance, they may think they can delay Medicare enrollment without consequences. However, this can be risky if their employer insurance isn’t considered "creditable" (as good as Medicare).
4. Waiting for a "Perfect" Plan
Some seniors wait until they are sure about which plan is best, hoping to get more information or thinking they’ll figure it out later. However, waiting can often result in missed opportunities or more limited choices.
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.
What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
If you have a Medicare Advantage plan and you have missed your opportunity to make a change in the Open Enrollment Period, then perhaps you might have the ability to make a change using one of the several Special Enrollment Periods (SEP) that are allowed by Medicare.Some of the SEP's include things like the following:
1) Have you moved to another county or state? Have you recently moved back to the United States after living abroad? Have you moved into or out of a skilled nursing facility?
2) Have you lost Medicaid? Or lost the Extra Help for prescription drugs? Did you lose the PACE program?
3) Have you recently been granted Medicaid or Extra Help with prescriptions? Do you have a Chronic condition like diabetes or heart disease?
4) You could join a 5-star rated plan
5) Were you affected by a FEMA disaster?
There are many other SEP's that you might possibly qualify for. So, talk to a local Medicare Insurance Broker to know all your options.
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?
Yup. If you don't speak to an experienced and honest agent, you won't know what your monthly payments will be. For example, there is a premium for the Part B, for the Part B one-time per year deductible, possibly a Medigap plan along with a Part D(rug) plan. If you want better coverage for the more expensive Dental, Vision & Hearing procedures, that can also be an extra cost per month. Sounds like you tried to get around using an agent whereas YOU are not paying for the agent's commission since the firm you chose pay the agents!
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.
I am on disability insurance Medicare now I will be 65 in October do I have to to sign up for Medicare again?
Since you’re already on Medicare due to disability insurance and will turn 65 in October 2025, you do not need to sign up for Medicare again. When you turn 65, your Medicare coverage will continue seamlessly, but your eligibility reason shifts from disability to age. This happens automatically—no need to reapply.
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 changed my plan during Open Enrollment and now I can't see my regular specialist. Isn't this what the whole review period is supposed to prevent?
The agent should have checked all of her doctors before they switched their policy. The client should of been aware of all of the benefits the new policy afforded her.
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.
When is the best time of the year to start looking at Medicare options?
For seniors turning 65 - its best to start reviewing options 3 month prior to your birthday month. For Senior already receiving Medicare Benefits, it's important to review your Part D Prescription drug plans during Annual Enrollment Period, October 15 - December 7th. I encourage clients to review their Medicare Supplement rate annually after the first of the year.
I'm turning 65 in three months but still working with employer coverage. Do I need to sign up for Medicare right now or can I wait?
You can wait as long as you are maintaining employer coverage. Medicare part A will still get assigned to you but (as long as you are not receiving SS benefits) not part B. When you do choose to leave employer coverage make sure you visit SSA.gov and “apply for Medicare part B only”. Keep in mind this may take at least a few weeks and you may have to collect some signatures from your employers HR dept so start this process at least a month before you plan on quitting/ leaving employer coverage.
Is Guaranteed Issue available after the Medicare Open Enrollment period ends?
Guaranteed Issue is available for up to 6 months after your Part B becomes effective, and it doesn't have to coincide with with the Medicare Open Enrollment Period. There are also other situations in which Guaranteed Issue applies, but consult with a local independent health broker to determine if your situation applies.
Can I enroll in Medicare if I've never paid into Social Security due to working overseas?
Yes, you can enroll in Medicare even if you've never paid into Social Security due to working overseas. However, your eligibility and costs will depend on your residency status and work history.Medicare Eligibility Without U.S. Work History
To qualify for Medicare, you must be either a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five continuous years before applying.
While most people receive Medicare Part A (hospital insurance) premium-free by earning 40 work credits (approximately 10 years of work paying into Social Security), you can still enroll in Medicare by paying premiums if you haven't met this requirement
Costs Without Work Credits
Part A (Hospital Insurance): If you have fewer than 30 work credits, you'll pay the full premium for Part A. For 2025, this premium is up to $505 per month.
Social Security
Part B (Medical Insurance): Part B requires a monthly premium for all enrollees, regardless of work history. In 2025, the standard Part B premium is $185 per month
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.
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