Medicare Questions & Answers: Enrollment Periods
Enrollment Periods Q&A
Showing 58 questions
If a senior is turning 65 but still working, should they enroll in Medicare or delay it?
Whether a senior turning 65 should enroll in Medicare or delay it while still working depends on their job situation—specifically, their employer’s size and health plan. Here’s how it breaks down:If the employer has 20+ employees: The company’s group health plan is usually "primary" (pays first), and Medicare is "secondary." In this case, they don’t have to enroll in Medicare right away. They can stick with the work plan and delay Medicare Parts A and B without penalties, as long as the job coverage is “creditable” (meets Medicare standards). Part A (hospital coverage) is free, though, so some sign up for it as a backup since it can coordinate with the work plan. Part B (doctor visits, outpatient care) has a monthly premium, so delaying it often makes sense to avoid double costs.
If the employer has fewer than 20 employees: Medicare typically becomes primary, and the work plan secondary. Here, they should enroll in Medicare Parts A and B at 65, because the work insurance might not cover much unless Medicare kicks in first. Skipping it could mean gaps in coverage or higher out-of-pocket costs.
Other Factors: If their work plan is pricey or skimpy (high deductibles, limited drug coverage), switching to Medicare might save money or improve care, even with a big employer. They’d need to compare premiums, copays, and drug formularies. Also, if they have an HSA, signing up for Medicare stops HSA contributions—something to weigh if they’re still saving there.
How to Delay: If they skip Medicare Part B (the part that costs a monthly premium) at 65 because of a solid work plan, they will get a Special Enrollment Period (SEP) later to turn on Part B and enroll in a plan in short order at that time.
I am on disability insurance Medicare now I will be 65 in October do I have to to sign up for Medicare again?
No, you do not need to re-enroll again in Medicare. You will retain the same Part A and Part B and Medicare ID #. You are granted a special enrollment (assuming you have Part A & B today) to enroll in a different Medicare Advantage plan or join a Medigap & Part D prescription drug plan. New plans - if chosen will be effective 10/1/2025. If you decide to stay with the same supplemental plans, they will automatically continue - no action needed on your part.
I just moved to a new state. Do I need to do anything with my Medicare coverage?
Yes — moving to a new state can affect your Medicare coverage, and it’s important to take a few steps to ensure you stay properly covered.1. Medicare Parts A & B
If you have Original Medicare (Parts A and B), your coverage is nationwide — so you don’t need to make changes for hospital or medical coverage. However, you should:
Update your address with Social Security (since that’s where Medicare pulls your info).
Check that your new doctors and hospitals accept Medicare.
2. Medicare Advantage (Part C)
If you have a Medicare Advantage Plan, you’ll likely need to switch plans. These plans have service areas, and moving out of your plan’s area gives you a Special Enrollment Period (SEP) to:
Switch to another Medicare Advantage plan available in your new area, or
Go back to Original Medicare and add a Part D (prescription drug) plan.
3. Medicare Prescription Drug Plan (Part D)
If you have a stand-alone Part D plan, you may also need to change it, since Part D plans vary by state and region. You’ll get a Special Enrollment Period to pick a new plan in your new location.
4. Medigap (Supplemental Insurance)
If you have a Medigap policy, you can generally keep it when you move. However, premiums may change by zip code, and some states allow new guaranteed-issue options when you move. It’s smart to compare local rates.
I'm turning 65 soon, when can I enroll in Medicare?
When it comes to enrolling in Medicare, there are really two paths you can take.You can enroll right when you turn 65, or you can enroll later, if you’re still working and covered under a qualifying employer plan, typically one that has 20 or more employees.
If you’re enrolling at 65, you’ll use what’s called your Initial Enrollment Period. That’s a seven-month window that starts three months before your birthday month, includes your birthday month, and continues for three months after. That window matters, because it’s how you avoid late enrollment penalties, especially for Part B. Collecting Social Security already? Then you'll be enrolled automatically.
If you’re still working and covered under a larger employer plan, you may not need to enroll right away. You can delay Part B without penalty. Then, when that coverage ends, you’d use a Special Enrollment Period to get enrolled. In this case, it's a good idea to enroll about 3 months prior to your anticipated retirement or Medicare start date.
The key there is simple, you just need to be able to show that you’ve had continuous, credible coverage the whole time. You'll have your HR or Benefits department help you fill out a Proof of Creditable Coverage form and submit that with your application for Part B.
This is one of those areas where the timing really matters, and getting it right upfront can save you a lot of headaches down the road.
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?
The real answer depends on one specific detail: how many employees your company has.If it's 20 or more, your employer coverage is considered primary, and you can generally delay Medicare Part B without any penalty — as long as you sign up within eight months after you eventually leave that job or the coverage ends, using what's called a Special Enrollment Period.
If your employer has fewer than 20 employees, Medicare typically becomes primary at 65 whether you're still working or not, which usually means you do need to enroll on time to avoid a gap in coverage.
One thing almost everyone should still do, regardless of employer size: sign up for Part A, since it's usually premium-free and can run alongside your employer coverage. The one exception is if you're contributing to a Health Savings Account — enrolling in any part of Medicare stops those contributions, so that's worth planning around.
Before you decide anything, check with your HR or benefits department to confirm your employer's size and whether your coverage is considered "creditable" — that one conversation determines whether waiting is actually safe for your situation, or whether it's setting you up for a penalty later.
At the same time, meet with a trusted independent Medicare agent like myself who will give you guidance about the best steps forward.
I'm planning to delay Social Security until age 70, but I'm turning 65 soon. How does this affect my Medicare enrollment?
Since you’re planning to delay Social Security until age 70 but are turning 65 soon, it’s important to understand that you will not be automatically enrolled in Medicare. Automatic enrollment only happens if you're already receiving Social Security benefits before age 65. Because you're delaying those benefits, you'll need to actively sign up for Medicare yourself during your Initial Enrollment Period (IEP), which is a 7-month window that starts three months before the month you turn 65, includes your birth month, and continues for three months after.At age 65, most people choose to enroll in Medicare Part A, which covers hospital insurance and is usually premium-free if you or your spouse worked at least 10 years. Enrolling in Part A generally makes sense even if you're delaying Social Security. However, Part B—which covers outpatient medical services—has a monthly premium, and whether you should enroll depends on your current health insurance situation. If you have health insurance through your or your spouse’s active employment, and the employer has 20 or more employees, you may be able to delay enrolling in Part B without penalty. But if your coverage is from a smaller employer or you don’t have creditable coverage, it’s important to enroll in Part B during your IEP to avoid late enrollment penalties and gaps in coverage.
Delaying enrollment in Medicare without proper coverage can result in permanent penalties and delayed access to care, so it's critical not to wait until age 70 to make these decisions. If you'd like, I can help you evaluate your current coverage and walk you through the steps for enrolling at the right time.
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?
Many people believe that when they sign up for Social Security, everything under Medicare is free. That is not exactly how it works.Medicare Part A usually does not have a monthly premium if you worked and paid Medicare taxes for at least 40 quarters, which equals 10 years. If someone worked fewer than 40 quarters, they may have a monthly premium under Part A.
Medicare Part B is different. Part B always has a monthly premium. The standard premium changes each year. For 2026, it is $202.90. Some individuals with higher incomes may pay more due to income IRMAA adjustments.
If you are receiving Social Security benefits, the Part B premium is usually deducted automatically from your monthly check. If you are not yet collecting Social Security, Medicare will send you a quarterly bill.
Receiving a bill does not necessarily mean you missed your enrollment period. It usually just means that Part B has a premium that must be paid directly.
If someone delays enrolling in Part B and does not have other creditable coverage, they face a late enrollment penalty. The penalty is 10 percent for every full 12-month period a person was eligible but not enrolled, and that penalty continues for as long as they have Part B.
If you would like, we can review your enrollment timeline together to make sure everything was processed correctly.
Educational Disclosure:
This information is provided for educational purposes only and is not a guarantee of benefits. Medicare premiums, deductibles, and penalties may change annually. Income adjustments may apply. I am not affiliated with or endorsed by the federal government or the Medicare program. For official Medicare information, please visit www.medicare.gov
or call 1-800-MEDICARE.
Janix Barbosa-Llanos, MBA, PMP, CEP, RSSA, FSN
Licensed Health Insurance Broker
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
1. Annual Enrollment Period (AEP)October 15 – December 7
This is the “big one” each year.
During AEP, you can:
Switch Medicare Advantage plans
Switch Prescription Drug Plans (Part D)
Move from Original Medicare + a supplement to Medicare Advantage
Move from Medicare Advantage back to Original Medicare
Changes take effect January 1.
2. Medicare Advantage Open Enrollment Period (MA OEP)
January 1 – March 31
Only for people already enrolled in a Medicare Advantage plan.
You can:
Switch to a different Medicare Advantage plan
Drop your MA plan and go back to Original Medicare + add a Part D plan
You cannot switch from one Part D drug plan to another during this time.
3. Initial Enrollment Period (IEP)
This is when you first turn 65.
It’s a 7-month window:
Starts 3 months before your 65th birthday month
Includes your birthday month
Ends 3 months after
You can enroll in:
Part A
Part B
Medicare Advantage
Part D
4. Special Enrollment Periods (SEPs)
These happen when life changes give you the right to switch your plan outside the regular windows.
Common SEPs include:
Losing employer coverage
Moving to a new county or state
Your plan reduces its service area
Becoming eligible for Medicaid or LIS
Your plan receives a 5-Star rating
Each SEP has its own rules and timing, but most give you 60 days to make a change.
I'm worried about choosing the wrong plan and being stuck with it. How often can I change my Medicare coverage?
You may have more opportunities to change your Medicare coverage than you realize, depending on the type of coverage you have and your situation.If You Have Medicare Advantage (Part C):
You can usually make changes during these periods:
* Annual Enrollment Period (October 15 – December 7):
You can join, switch, or leave a Medicare Advantage plan or change your prescription drug coverage. Changes generally take effect January 1.
* Medicare Advantage Open Enrollment (January 1 – March 31):
If you already have a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare (and possibly add a prescription drug plan).
If You Have Original Medicare:
* You can generally join, switch, or drop a prescription drug plan during the Annual Enrollment Period.
* You may also have opportunities to change coverage if you qualify for certain special circumstances.
Special Enrollment Periods (SEPs)
You may qualify for additional enrollment opportunities if certain life events happen, such as:
* Moving to a new area
* Losing employer coverage
* Qualifying for Extra Help or Medicaid
* Moving into or out of a nursing facility
* Other qualifying circumstances
Important Note About Medicare Supplement (Medigap):
If you want to switch your Medicare Supplement plan later, you may have to answer health questions depending on your state and situation, so timing can matter.
Simple Answer:
You are usually not permanently “stuck” with a Medicare plan, but when and how you can change depends on your current coverage and circumstances.
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?
You're right to feel frustrated, this is a common misunderstanding about Medicare’s Annual Enrollment Period (AEP) and Open Enrollment Period (OEP). First, it is important to know which enrollment period we're discussing. During AEP (Oct 15–Dec 7), you can change your Medicare Advantage or Part D drug plan. However many plans change on December 31st so a provider that was in the plan when you enrolled may no longer be in the plan on January 1st. This is when the Open Enrollment Period OEP (Jan 1 - March 31st), is in effect. If you made a change to your Advantage plan during AEP, you get a chance to change again during the OEP. This is when you can find a new plan that your provider does accept. Keep in mind that after March 31st, there are no more chances to change due to network issues. The only way to change after the OEP is to use a Special Enrollment Period (SEP) which depends on individual circumstances and is a whole other topic.
I want to switch to Medicare Advantage this year. How do I do this?
That’s a great question. It's fantastic that you're looking into your options for the upcoming Annual Enrollment Period. Switching to a Medicare Advantage Plan (MAPD) can be a beneficial choice for many beneficiaries, as it often combines health coverage and prescription drug benefits in one plan.First, make sure you understand the difference between your plan and a Medicare Advantage plan, think about what you like and dislike about your current coverage. Are there specific doctors or medications you want to keep or change?
Next compare Available MAPD Plans: During AEP, which runs from October 15 to December 7, you can explore different MAPD options that are available in your area. Look for plans that cover your medications, have a good network of doctors, and benefits that you are interested in.
After that, use the Medicare Plan Finder on the official Medicare website to compare plans. Additionally, I can help guide you through available options and answer any questions.
Lastly, when you find a plan that fits your needs, you can enroll directly through the plan's website, by calling their customer service, or I can assist you with the enrollment process.
Remember, you have a one time safeguard, if you want to switch back to your Medicare Supplement plan, you can do so within a certain time frame.
If you have specific plans in mind or need assistance comparing options, feel free to ask!
What should I do if I miss the Medicare Open Enrollment period, and I want to change my plan?
If you miss the main Medicare Open Enrollment Period, you may still have options depending on your situation and the type of change you want to make.Main Enrollment Windows
Medicare Annual Enrollment Period (AEP)
October 15 – December 7
You can:
switch Medicare Advantage plans,
move from Medicare Advantage to Original Medicare,
join/change/drop Part D drug plans.
Coverage changes start January 1.
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 – March 31
If you already have a Medicare Advantage plan, you can:
switch to another Medicare Advantage plan once,
or return to Original Medicare and add Part D.
You cannot switch from Original Medicare to Medicare Advantage during this window.
If You Missed Both
You may still qualify for a Special Enrollment Period (SEP).
Common SEP triggers include:
Moving to a new service area
Losing employer or union coverage
Medicaid eligibility changes
Qualifying for Extra Help
Moving into or out of a nursing facility
Plan termination by the carrier
FEMA or disaster-related issues
Gaining or losing a Special Needs Plan condition
Recently leaving incarceration
Centers for Medicare & Medicaid Services allows SEPs for many life events, but the rules and timelines vary.
When is the best time of the year to start looking at Medicare options?
The best time to look at your options is now, but keep these three windows on your radar:* Turning 65 (Initial Enrollment): Start researching 3–6 months before your birthday to ensure coverage begins the day you turn 65.
* Annual Enrollment (AEP): From Oct 15 – Dec 7, anyone can switch plans. I recommend reviewing your "Annual Notice of Change" in September to check for cost or doctor updates.
* Retiring after 65 (Special Enrollment): Start looking 2 months before you stop working to avoid coverage gaps.
A quick review with a licensed agent can often uncover better benefits or lower costs you didn't have last year.
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?
You’re not alone — this is a common source of frustration, and the rules around Medigap open enrollment aren’t as well known as they should be. Here’s why it happens and what to know:Why the Medigap window is so strict
Open Enrollment Period is limited
Starts the month you turn 65 and enroll in Part B, and lasts 6 months.
During this window, insurance companies cannot deny you coverage or charge higher premiums due to health conditions.
After the window ends
Insurers can require medical underwriting, meaning they can:
Deny coverage for pre-existing conditions
Charge higher premiums
This is why missing the window by even a month can make coverage much harder to get.
It’s not widely advertised
Most seniors hear about Medicare Part A/B enrollment, but Medigap rules are less emphasized by Social Security, Medicare, and employers.
Many people only learn about it when trying to switch plans or retire — by then, it’s often too late.
Ways to navigate now
Check for guaranteed-issue rights:
Some states have birthday rules or allow switching if you lose other coverage or your MA plan changes.
Consider Medicare Advantage:
If you can’t get Medigap without underwriting, you can enroll in an MA plan instead, which doesn’t require medical underwriting.
Appeal or ask about exceptions:
Sometimes insurers offer coverage if you have recent job-based insurance loss or other special circumstances.
Bottom line:
The strict window exists to protect insurers from high-risk enrollments, but it can be harsh on seniors who miss it. Awareness is low because most educational materials focus on Part A/B, not Medigap timing.
I have Medicare Part A and B since 06/01/2006 because of disability. My husband retired on 4/1/2024, and I now have no other coverage except for Medicare Parts A and B because I missed open enrollment for insurance coverage. Note: SS dropped SSI and changed it to straight SS. Please help.
Got it — since we’re now in October 2025, your situation changes a bit, but there are still options.Here’s what’s happening:
Because your husband retired back in April 2024, your Special Enrollment Period (SEP) for losing employer coverage has already expired. (That SEP lasts 8 months after losing group coverage — so it would’ve ended around December 2024.)
But the good news is — you’re now in Medicare’s Annual Enrollment Period (AEP), which runs October 15 through December 7 every year. During this time, you can:
Enroll in a Medicare Advantage (Part C) plan, which combines hospital, medical, and often prescription coverage.
Or enroll in a standalone Part D (prescription drug) plan if you want to stay on Original Medicare.
Your new coverage would start January 1, 2026.
Since you mentioned you only have Parts A and B right now, you should definitely look into adding at least a Part D plan — otherwise, you could face a late enrollment penalty later on. You might also qualify for Extra Help or a Medicare Savings Program depending on your income, especially since your SSI changed to standard Social Security. Those programs can help lower your premiums and copays.
So right now, you’re in the perfect window to fix this — just make sure you act before December 7, 2025.
Would you like me to help you figure out what type of plan (Advantage or Supplement + Part D) might work best for your health needs and budget?
When will my provider send my Annual Notice of Change?
Medicare Advantage plans can change every year on January 1st. Insurers of Medicare Advantage Plans are required to provide a notice to the Medicare beneficiaries on their plans that contains information about the changes to the plan benefits by September 30th each year. The notice is called the Annual Notice of Change. Many companies send the Annual Notice of Change well in advance of the September 30th deadline. If you are on a Medicare Advantage plan, you should receive your Annual Notice of Change (or ANOC) sometime during the month of September.The Annual Election Period (which runs from October 15th to December 7th) provides you the opportunity to make changes to your coverage for the upcoming year. Plan changes made using the Annual Election Period will be effective on January 1st.
Your Annual Notice of Change letter is important. When you receive it, review it right away to help you decide whether or not you want to make an Annual Election Period change. Even better, look to your local broker who will help you understand the changes you are seeing in the context of the local and national markets. That information will help you decide whether or not you want to pursue a change. Sometimes it is better to stay put because the grass is not always greener on the other side of the fence!
Can I enroll in Medicare if I've never paid into Social Security due to working overseas?
If you are a US citizen or lawful permanent resident (with 5+ years of residency) you CAN enroll in medicare, but your cost will likely be different if you’ve never paid into the system.Part A is premium free if you’ve worked for 40 quarters (10 years) and paid into the system. If you don’t meet that requirement, you can BUY part A coverage.
Part B would be handled the same as everyone else - you’ll pay the premium appropriate for your income.
Your supplemental coverage (Medicare Advantage, Medigap and/or Part D) are based on your medicare eligibility and not based on your social security contributions.
NOTE - Foreign work credits from countries with TOTALIZATION agreements with the US (ie Canada, the UK, Germany) MAY count toward the Social Security eligibility and COULD reduce or eliminate the Part A premium. Also, if you’re married to someone with US Work Credits that can make a difference, so there are a lot of variables to this situation. Social Security can help you determine what comes next.
How does moving to a new state affect my Medicare enrollment timeline?
When you move to a new state, your Medicare coverage may need to change, especially if you have a Medicare Advantage or Part D drug plan, since these plans are limited to specific service areas. Moving out of your plan’s area triggers a Special Enrollment Period (SEP) that lets you switch to a new plan in your new state. If you tell your plan before you move, your SEP starts the month before and lasts two months after your move; if you tell them afterward, it starts when you report it and lasts two months. Original Medicare (Parts A and B) travels with you nationwide, but you’ll want to review Medigap and Part D options available in your new ZIP code and update your address with Social Security.
When can I change my Medicare Advantage Plan?
You can change your Medicare Advantage plan at a few specific times during the year, and it’s actually simpler than most people think. There are three main windows when changes are allowed.The first is every fall, from October 15th to December 7th. This is the big annual enrollment period. During this time, anyone on Medicare can review their plan, compare options, and switch to a different Medicare Advantage plan if they want to. Any changes you make during this window start on January 1st.
The second window is from January 1st to March 31st, but this one is only for people who are already enrolled in a Medicare Advantage plan. If you start the year and realize your plan isn’t working for you — maybe your doctor isn’t in the network, your medications aren’t covered the way you expected, or the copays are too high — you get one chance to switch to another Medicare Advantage plan or go back to Original Medicare with a Part D plan.
The third way to change your plan is through what’s called a Special Enrollment Period. These happen when life changes — things like moving to a new county, losing Medicaid, your plan leaving the area, or qualifying for a chronic condition plan. These special situations allow you to make a change outside the normal windows.
So the simple version is this: you can change your Medicare Advantage plan every fall, once at the beginning of the year if you’re already in an MA plan, and anytime during the year if a qualifying life event gives you a Special Enrollment Period.
When is a good time to start preparing for AEP?
It is a very good question and there are various timelines to follow.Periodically, you can check mainstream media to identify what changes are happening in the healthcare industry. Mainstream media may leak information or make announcements based on what insurance carriers may release on their own news releases.
If you have a Medicare Supplement or Medigap plan, you can get ahead of the curve. Medicare Beneficiaries have anniversaries at different times of the year. You do not have to wait for annual enrollment period to change a Medicare Supplement or Medigap plan.
Agents usually can only start certifying in late June and it can take independent agents several months to certify for the new annual enrollment period as insurance carriers have different release dates for agents to complete certification requirements for that carrier.
Annual Notice of Changes (The Insurance Industry calls it ANOC for short) usually comes out in September. Please make note of all of the changes that will take place January 1st should you decide to keep your current plan.
One thing that is important is making sure all of your information such you keep a list updated of you current doctors and specialists, as well as all of your medications (Make sure to make note of exact name of prescription as it could be a brand name or generic), the dose, and frequency you take your prescriptions as well as preferred pharmacy or pharmacies. Some agents have different resources that can share with you to update this information and some even update the information on Medicare.gov.
From October 1st - October 14th, Medicare agents or brokers can review the upcoming year's plans with you. However, please note that Medicare agents or brokers cannot make any changes until the official Annual Enrollment Period begins. Annual Enrollment Period is from October 15th - December 7th of each year. Any changes will take place on January 1st.
What is the Medicare Advantage 5-Star Special Enrollment Period? Is this different from '"OEP'" and "AEP"?
The Medicare Advantage 5-Star Special Enrollment Period (SEP) allows beneficiaries to switch to a 5-star-rated Medicare Advantage or Part D plan once per year, anytime between December 8 and November 30. It is distinct from AEP and OEP because it is not based on a specific calendar season, but rather the availability of a high-quality plan. Differences in Enrollment Periods:5-Star SEP: Runs Dec 8–Nov 30. You can change plans once during this period, but only if a 5-star plan is available in your area. AEP (Annual Enrollment Period): Oct 15–Dec 7. Everyone with Medicare can change plans (Advantage or Drug). OEP (Open Enrollment Period): Jan 1–March 31. Only for those already in Medicare Advantage; allows one change. Key Differences Summary: The 5-star SEP is solely to move to a top-tier rated plan. Flexibility: 5-Star SEP allows changes almost all year, whereas AEP and OEP have strict, narrow windows. Requirement: A 5-star plan must be active in your service area to use the 5-star SEP.
Can I switch from a Medicare Advantage plan to Original Medicare with a Medigap plan mid-year if I’m diagnosed with a serious illness?
Generally no. There are, however, two scenarios where you might be able to switch from a Medicare Advantage (MA) plan to Original Medicare with a Medigap policy mid-year.The first scenario is if you moved or are about to move. Your new location might have guaranteed issue options for a new Medigap plan when you are coming from an MA plan. You have a two month window to utilize this option.
The second scenario is a concept called "Medicare trial rights (MTR)". According to Medicare.gov this is how MTRs work:
MTR #1 - If you drop a Medigap policy to join an MA plan for the first time, you’ll have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. If it isn't available, you can buy a Medigap policy you qualify for that's sold by an insurance company in your state (except for Plans M and N). You may also have an opportunity to enroll in a Medicare drug plan at this time.
MTR #2 - If you joined an MA plan when you were first eligible for Medicare Part A at 65, you can choose from any Medigap policy that's sold by an insurance company in your state if you switch to Original Medicare within the first year of joining the MA plan. You may also have an opportunity to enroll in a Medicare drug plan at this time.
As always, check with a local and reputable licensed Medicare expert. You can also check with Medicare.gov, 1-800-Medicare, and your local SHIP counselor.
Why do so many seniors wait until the last minute to enroll in Medicare, and how can agents help prevent bad decisions?
Switching to Medicare can feel like a big change, and people often wait because:1. They think they’re already covered: Still working and assume employer insurance means “I don’t need Medicare yet,” plus confusion about whether employer coverage is creditable for Part B/Part D.
2. It’s confusing/intimidating: A/B/D, Medigap vs Advantage, networks, formularies, and penalties—too many moving parts.
3. They don’t know the deadlines/penalties: Many miss the Initial Enrollment Period (IEP) and learn about penalties afterward.
4. Life gets in the way: Retirement, moving, health issues, caregiving, loss of a spouse—Medicare gets pushed down the list.
5. Bad or oversimplified advice: “Just take the free plan,” “You can enroll anytime,” or “You don’t need Part B if you’re healthy.”
6. They assume it’s quick: Social Security processing, plan selection, provider checks, and Rx research all take time.
How my office can help:
1. Start early (3–6 months before turning 65/retiring) so you’re not rushed.
2. Confirm what you actually need: doctors, prescriptions, travel habits, budget.
3. If you’re still working, verify employer coverage in writing to avoid penalties/gaps.
4. Check doctors and hospitals (especially for Medicare Advantage networks).
5. Compare prescription costs (formulary, tiers, restrictions, preferred pharmacies).
6. Explain tradeoffs in plain English: premium vs pay-as-you-go, networks/prior auth, worst-case yearly cost.
7. Help you enroll correctly and on time with a simple checklist.
8. Review annually so coverage stays a good fit as plans and medications change.
What happens if I am unable to provide creditable coverage?
If you go without creditable coverage for too long, you could face a late enrollment penalty when you sign up for Medicare Part B or Part D.Part B (Medical Insurance) – If you don’t have creditable coverage and delay enrolling, your premium may go up 10% for every 12 months you were eligible but didn’t sign up. This penalty is permanent.
Part D (Prescription Drug Coverage) – If you go 63 days or more without creditable drug coverage, you may pay an extra monthly penalty for as long as you have Part D.
Creditable coverage means your existing insurance is at least as good as Medicare’s standard coverage. If you’re ever unsure whether your plan is creditable, ask your insurer for a written notice—keep it in your records in case Medicare ever asks for proof.
I am moving to a different county in my same state, should I look at getting a new Medicare plan?
I assume that this question refers to a Medicare Advantage Plan (which has a defined service area). Check your existing plan Summary of Benefits or Evidence of Coverage to see if your new county is in the service area of the plan you currently have. If your existing specific plan is available in both counties, then you don't have to change plans. Be careful: Insurance companies list their plans by county, so even if the insurance company has a presence in the new county, your existing plan may not be available there.If you don't have to change plans, I would still contact the plan to change your address.
Whether or not your plan is available in the new county, I suggest you contact a local agent that understands how Medicare works and is familiar with the plans and providers available in the local area to help you determine how you want to move forward in the future.
In the case of any change to your address, be sure to update your home address with Social Security.
Do I qualify for SEP if my health dramatically gets worse out of nowhere?
A sudden worsening of health, even with hospitalization, generally does not give you a Medicare Special Enrollment Period (SEP) to change coverage mid-year.What can create a Medicare SEP that sometimes relates to a health change is one of these situations:
- You qualify for a Chronic Condition Special Needs Plan (C‑SNP): If you are diagnosed with a qualifying chronic condition and a C‑SNP is available where you live, you may be able to join that plan using an SEP.
- You enter, live in, or leave an institution: If you are in a skilled nursing facility, nursing home, or similar facility, you may have an SEP to change Medicare Advantage/Part D coverage.
- You gain or lose Extra Help (LIS) or Medicaid: These programs can allow plan changes outside the usual enrollment periods.
- You move or lose other coverage: Moving out of your plan’s service area or losing creditable drug/employer coverage can trigger SEPs.
- Your plan changes materially: Certain plan terminations or other CMS-approved circumstances can trigger an SEP.
If none of those apply, your main options are usually:
- Annual Enrollment Period (AEP): Oct 15–Dec 7 (changes effective Jan 1).
- Medicare Advantage Open Enrollment Period (MA OEP): Jan 1–Mar 31 (only if you are already in a Medicare Advantage plan).
- State Medigap switching rules (where available): If you have a Medigap (supplement) policy, some states give extra opportunities to switch plans without medical underwriting, such as California and Oregon's “birthday rule,” which can allow a switch to a Medigap plan with equal or lesser benefits around your birthday (subject to state timing and requirements).
Can I backdate my Medicare enrollment if I missed my initial window due to a medical emergency?
Short answer: Usually no—but there are limited exceptions.Here’s how it works, in clear terms:
General rule
Medicare does not backdate enrollment just because you missed your Initial Enrollment Period (IEP), even due to a medical emergency. If you enroll late, coverage typically starts prospectively, not retroactively.
When you may get relief
You might qualify for help in these situations:
1. Special Enrollment Period (SEP) for “exceptional circumstances”
Medicare can grant an SEP if you can show you were incapacitated (for example, hospitalized or unable to make decisions) during your IEP.
This is handled case by case
You must provide medical documentation
CMS must agree the situation directly prevented enrollment
If approved, you can enroll without a late penalty, but coverage still usually starts the month after enrollment, not backdated.
2. Medicare Part A (hospital insurance)
If you qualify for premium-free Part A, Medicare can backdate Part A coverage up to 6 months (but never earlier than your 65th birthday).
This happens automatically once you enroll
This does not apply to Part B
3. Social Security enrollment corrections
If Social Security made an error or gave incorrect information that caused the delay, they may allow a correction. This requires proof and documentation.
What happens if you don’t qualify for an SEP?
You must wait for the General Enrollment Period (Jan 1–Mar 31)
Coverage starts July 1
Late enrollment penalties may apply (especially Part B and Part D)
Important next steps
Contact Social Security (not Medicare) to request a review
Ask specifically about an SEP due to incapacity
Gather hospital records or physician statements
Enroll as soon as you are able—waiting longer can make penalties worse
If you want, tell me:
Which part of Medicare you missed (A, B, or D)
When your Initial Enrollment Period ended
Whether you were hospitalized or incapacitated
I can help you determine the best path forward and how to expla
Is Guaranteed Issue available after the Medicare Open Enrollment period ends?
Absolutely! Guaranteed Issue rights protect you from being denied a Medicare Supplement plan—even after your Open Enrollment period has passed—as long as you meet certain conditions.For instance, when you turn 65, you’re granted a 6-month Guaranteed Issue window to enroll in a Medicare Supplement plan without any medical underwriting. During that time, you cannot be denied coverage.
There are also special circumstances that trigger these rights. Say you originally enrolled in a Medicare Supplement plan, then switched to a Medicare Advantage plan to test it out. If it’s been less than 12 months, you’re eligible to use the Trial Right Special Enrollment Period (SEP) to return to your original Supplement plan with Guaranteed Issue protection. Note: this option is available only once in your lifetime and only within that 12-month period.
Another scenario would be if your Medicare Advantage plan is discontinued in your area. In that case, you’re entitled to a Guaranteed Issue right to enroll in a Medicare Supplement plan without having to go through medical underwriting. However, you must act within 63 days of your Advantage plan ending.
Your best next step? Connect with a knowledgeable local broker who can help you understand your rights and explore your coverage options. They’ll make sure you don’t miss a beat.
If someone enrolls in a MAPD C-SNP and gets disenrolled for not providing a CCV form within 60 days, is there a SEP to enroll in another MAPD plan?
Yes, disenrollment from a C-SNP for failing to provide the Chronic Condition Verification (CCV) form within 60 days is classified as a loss of SNP eligibility. This qualifies the individual for a Special Enrollment Period (SEP) to enroll in another MAPD plan.SEP DETSAILS & RULES TIMELINE: The SEP begins the month you are notified of disenrollment and lasts for two full calendar months after the notification date.
OPTIONS: You can switch to another Medicare Advantage plan (MAPD) that you are eligible for, or switch back to Original Medicare with a standalone Prescription Drug Plan (PDP).
COVERAGE: Your new coverage will typically begin the first day of the month after you submit a completed application.
How often can I change my Medicare Plan?
Question from a Senior: How often can I change my Medicare plan?There are four main times when you may be able to change your Medicare plan:
Initial Enrollment Period (IEP): This begins 3 months before your Medicare Part A and/or Part B starts and ends 3 months after. If you are newly enrolling in Part B, this may also trigger an enrollment opportunity.
Annual Enrollment Period (AEP): October 15 to December 7 each year. This is the most common time to review and change your Medicare Advantage or Part D prescription drug plan.
Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31. If you already have a Medicare Advantage plan, you can make a one-time change or return to Original Medicare.
Special Enrollment Period (SEP): This varies and is based on specific life events, such as moving to a new area, losing or changing coverage, qualifying for Medicaid or Extra Help, experiencing a natural disaster, or being diagnosed with certain chronic conditions (eligibility depends on the plan).
If you are unsure about your options, it is best to speak with a licensed insurance agent who can guide you based on your healthcare needs and situation. As a trusted agent, I am here to walk you through the process every step of the way.
Jessica Parker
Do I need to do anything for Annual Enrollment Period (AEP)?
Annual Enrollment is the most important time of the year for Medicare enrollees. This is the time you will want to review your Part D or Medicare Advantage plan for the coming year as this will be the only open enrollment time of the year for both products without qualifying for a Special Enrollment Period. Some of the changes you will see from year to year are premium increases, drug formulary changes, plan area reductions, plan eliminations, doctor network changes, copay increases, etc. There are many changes that you want to review just to be sure that the plan you are on will be the best option for next year. You don't want to be on a plan that has a drastic increase in price or decrease in coverage when a similar plan can be found for a better price or more benefits.
Are Medicare agents paid by specific insurance to sign up clients to their plans only
Many insurance companies offer a commission when enrolling a client in a plan. Independent brokers often represent multiple carriers, thus they are not typically incentivized to sign up a client with one carrier over another carrier as most commission structures are the same. This is not too dissimilar to a home or automobile insurance broker. Those brokers also typically shop rates across multiple carriers and therefore are incentivized to find the best coverage for the client at the lowest possible rate. The same holds true for most independent Medicare agents. If the agent is a captive agent, however, then they only work for one carrier, and they are therefore incentivized to only sell plans for that one carrier. I would beware of any agents calling clients from a call center or directly from the health plan as these are all typically captive agents and again incentivized to only write plans for that one particular carrier. They are driven by sales metrics and not what’s in the best interest of the client.
I started taking a new prescription this year. Do I need to change my Medicare plan?
Not necessarily, but it is absolutely worth checking. Every Part D drug plan and Medicare Advantage plan with drug coverage has its own formulary, which is the list of covered medications, and your new prescription may or may not be on your current plan's formulary at a tier you can afford. The best thing to do is run a formulary check on your current plan right away to see how your new medication is covered and what your cost sharing looks like. If your plan does not cover it well, you may qualify for a Special Enrollment Period depending on your situation, and the Annual Enrollment Period each fall from October 15 through December 7 is always an opportunity to switch to a plan that better covers your medications. Do not wait until the bills start adding up to take a look at this, because the difference in cost between a plan that covers your drug well and one that does not can be significant.
What Medicare penalties are most common?
Here’s a clear breakdown of the most common Medicare penalties people run into:1. Late Enrollment Penalty for Part B (Medical Insurance)
When it happens: If you don’t sign up for Part B when you’re first eligible and don’t have other “creditable” coverage (like group insurance through a job).
The penalty: Your Part B monthly premium goes up 10% for each full 12-month period you were eligible but didn’t enroll.
Duration: You pay this higher premium for as long as you have Part B.
2. Late Enrollment Penalty for Part D (Prescription Drug Coverage)
When it happens: If you go 63 days or more without Part D coverage (or other creditable drug coverage).
The penalty: Your Part D premium increases by 1% of the “national base beneficiary premium” for each month you didn’t have coverage. (This amount can change each year.)
Duration: You pay the penalty for as long as you have Part D.
3. Medicare Advantage (Part C) Late Enrollment Issues
No direct “penalty,” but if you miss your enrollment periods, you may have to wait until the Annual Enrollment Period (Oct 15–Dec 7) to join a plan.
During that wait, you may be left without the coverage you want.
✅ In short:
Part B Penalty = 10% higher premium for every year late.
Part D Penalty = 1% higher premium for every month late.
Part C (Advantage) = Not a penalty, but missed timing can leave gaps in coverage.
When should my plan be reviewed?
The best time to do this is during Medicare’s Annual Enrollment Period (AEP):📅 October 15 – December 7 each year.
During this period, you can:
• Review your current coverage (whether you have Original Medicare + Part D or a Medicare Advantage plan).
• Compare new plan options for the coming year.
• Switch plans, add or drop drug coverage, or move back to Original Medicare.
Any changes you make take effect January 1 of the next year.
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🧭 You should also review your plan anytime your needs or costs change, such as:
• Your medications change or you start a new prescription.
• Your doctors or preferred hospitals are no longer in your plan’s network.
• You move to a new ZIP code or state (this can trigger a Special Enrollment Period).
• Your income changes and you may qualify for Extra Help or a Medicare Savings Program.
• Your plan announces premium or copay increases for the next year.
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Tip:
Even if you’re happy with your plan, check each fall that it still covers your medications, doctors, and pharmacies — plans update their benefits and drug lists every year.
What’s the best time of year to change my Medicare plan if I develop a new diagnosis?
The best time to review your Medicare coverage after a new diagnosis is right away — but whether you can actually change plans depends on the type of Medicare coverage you have and whether you qualify for an enrollment period.A new diagnosis by itself does not always create an automatic opportunity to change Medicare plans.
For many people, the main time to change Medicare Advantage or Part D coverage is Medicare Open Enrollment, which runs October 15 through December 7 each year. Changes made during that time generally begin January 1.
If you already have a Medicare Advantage plan, you may also have a one-time opportunity to make certain changes during the Medicare Advantage Open Enrollment Period from January 1 through March 31.
In some situations, a new diagnosis may make it worth checking whether you qualify for a Special Needs Plan, often called an SNP. These plans are designed for people with certain chronic conditions, people who qualify for both Medicare and Medicaid, or people who meet certain institutional care requirements. Availability depends on your location and eligibility.
The important thing is not to wait until a crisis. If you receive a new diagnosis, review your doctors, specialists, prescriptions, treatment locations, prior authorization rules, and out-of-pocket costs as soon as possible. Then confirm whether you have an enrollment window available before making any changes.
If I switch plans to cover a brand-name eye drop my current plan won’t cover, but my new doctor later takes me off that medication after open enrollment ends, do I have any way to change my plan again?
Short answer:Usually no. Once the Medicare Open Enrollment Period (Oct 15 – Dec 7) ends and your new coverage starts on January 1, you generally cannot change plans again just because your doctor stops the medication.
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When you could change plans again
There are only a few exceptions called Special Enrollment Periods (SEPs) or the Medicare Advantage Open Enrollment Period:
1) Medicare Advantage Open Enrollment (Jan 1 – Mar 31)
If you enrolled in a Medicare Advantage plan, you get one extra change:
• Switch to another Medicare Advantage plan or
• Drop MA and return to Original Medicare (and possibly add Part D)
But you can only use this once per year, and not if you’re already in Original Medicare with Part D.
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2) Special Enrollment Periods (SEPs)
You may change plans outside enrollment only if you qualify for special situations, such as:
• Moving out of your plan’s service area
• Qualifying for Medicaid or Extra Help
• Losing other creditable drug coverage
• Plan contract changes or termination
Medication changes alone do NOT qualify for an SEP.
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Bottom line for the senior’s situation
• Switching plans for a specific drug is allowed during Open Enrollment.
• If the doctor later stops that drug after enrollment ends, the person usually must stay in the new plan until the next Open Enrollment—
unless they qualify for:
• The Jan–Mar Medicare Advantage Open Enrollment, or
• A Special
I have Medicare A and B, which was secondary to my large group health plan. My spouse passed away in late June 2025, and his company is providing COBRA coverage for six months, through January. If I wait until then, will I still have guaranteed issue for a Medicare supplement, or do I have only 63 days from June 30 (until Sept 1) to enroll? I'm in CO
You have a Guaranteed Issue right to enroll in a Medicare Supplement plan when your COBRA coverage ends in January. Since you're losing employer-sponsored coverage, you're eligible for a 63-day window to enroll in a Medigap plan without medical underwriting. This means you can choose from specific plans (A, B, C, D, F, G, K, or L) without being denied coverage or charged more due to pre-existing conditions .Key Points:
• Guaranteed Issue Window: You have 63 days from the date your COBRA coverage ends (January) to enroll in a Medigap plan.
• Eligible Plans: You can choose from Plans A, B, C, D, F, G, K, or L, depending on your eligibility and plan availability.
• No Medical Underwriting: Insurance companies can't deny you coverage or charge more based on your health status during this period.
Action Steps:
• Mark Your Calendar: Note the end date of your COBRA coverage (January) and plan to enroll in a Medigap plan within the 63-day window.
• Gather Documents: Prepare proof of coverage termination, such as a letter from your insurer or a disenrollment notice.
• Compare Plans: Research and compare Medigap plans from different insurance companies to find the best fit for your needs .
Can I drop my employer health insurance and switch to Medicare instead?
You should talk to your benefits coordinator about when you can drop your coverage. In general, yes you can, but you will want to ensure you get the timing right. Losing employer coverage (or spousal coverage) triggers a special election period to get your Parts A & B started and get your supplemental coverage set up, but you want to so do it so you have no gaps in coverage.If you are past your 65th birthday, you’ll also want to have a loss of coverage letter handy in case medicare asks for evidence you had creditable coverage in the intervening time frame.
You’ll also want to look at cost. Medicare Part B is $202.90 per month in 2026 and depending on which route you go for your supplemental coverage you could pay additional premiums of $200 or more. If your employer coverage costs less the part B Premium at a minimum, it might make more financial sense to keep your employer coverage until you’re ready to retire.
In any case, it’s worth talking to a broker to fully understand your situation and what options are available to you.
What is the Medicare Advantage (Part C) Open Enrollment period?
The Medicare Advantage Open Enrollment Period (MA OEP) is a specific window of time each year that allows beneficiaries already enrolled in a Medicare Advantage Plan to switch or drop their plan.It is distinct from the fall Annual Enrollment Period (AEP) because you generally cannot use this time to join a Medicare Advantage plan if you are currently on Original Medicare.
Dates
January 1 – March 31 every year.
Who Can Use It?
This period is strictly for individuals who are already enrolled in a Medicare Advantage (Part C) plan as of January 1.
What Changes Can You Make?
During this window, you are allowed to make one change to your coverage. The new coverage typically begins the first day of the month after you make the request.
You can:
Switch to a different Medicare Advantage Plan (with or without drug coverage).
Drop your Medicare Advantage Plan and return to Original Medicare.
Join a separate Medicare prescription drug plan (Part D) if you return to Original Medicare.
What You Cannot Do
You cannot switch from Original Medicare to a Medicare Advantage plan.
You cannot switch from one standalone Part D prescription drug plan to another.
Can you change Medicare Supplement plans at any time?
Changing Medicare Supplement (Medigap) PlansThe short answer is: not always freely — it depends on your situation and timing.
Guaranteed Issue Rights (Best Time to Switch)
You have the strongest protections during specific windows when insurers must sell you a plan at the best available rate, regardless of health:
Initial Enrollment Period — the 6-month window starting when you're 65+ and enrolled in Medicare Part B. This is the best time to buy any Medigap plan.
Special Enrollment Periods — triggered by specific life events, such as losing other coverage (employer plan, Medicare Advantage, etc.).
Outside of Guaranteed Issue Periods
Outside those windows, you can technically apply to switch plans at any time, but:
Insurers can use medical underwriting — meaning they can review your health history and deny you coverage or charge higher premiums based on pre-existing conditions.
Only exception: A few states (like New York, Connecticut, Massachusetts, and California) have stronger consumer protections that allow more open switching.
Are Medicare Advantage plans guaranteed issue?
Medicare Advantage plans are guaranteed issue, meaning you cannot be denied coverage or pay more for your plan based on preexisting conditions, recent diagnosis or your current health condition. However, you can only enroll in plans within your service area, have Medicare Part A and B, and enroll during valid enrollment periods.If you're concerned about managing costs during a health crisis or illness, here are some things to consider when selecting a Medicare Advantage Plan:
- look for a lower maximum out of pocket amount. This can help reduce costs for medical services that use original Medicare billing such as radiation, chemotherapy, and infusions.
- understand what services you will use or need most frequently and estimate how many visits you may need in a plan year. Then, compare copays from different plans.
- ensure that all of your providers are in network and your prescriptions are on the plan's formulary.
- $0 premium plans might not always be the best option. Plans with a premium may have lower copays for services you use the most, saving you money even with paying a monthly premium.
An experienced broker who knows your area's network of providers and plans can guide you through finding the right plan for you.
How do I change my Medicare plan during open enrollment?
People often confuse Open Enrollment with Annual Enrollment, so I’ll address both.Annual enrollment (AEP) lasts from October 15th to December 7th each year. You can enroll in a medicare advantage plan or prescription drug plan, disenroll (go back to original medicare) or change your coverage. You can make multiple changes in this time frame. Whatever plan you’ve set up as of close of business December 7th is the plan you’ll have come January 1st.
How do you change your coverage? All you need to do is enroll in the new plan you want (on or after October 15th). The disenrollment from your current coverage happens automatically so you don’t even need to contact them. You can enroll via the carrier’s web site, through Medicare.gov, or with the assistance of a licensed sales agent (my favorite option). A sales agent will work with you to ensure your doctors accept the new plan, your medications are covered, you’re not sacrificing something important in the process, etc. They’ll compare the plans they’re appointed with in your area and present you with the options.
Open enrollment (MA-OEP) happens from January 1st to March 31st and is only for people with a Medicare Advantage plan in place. Agents aren’t allowed to market this enrollment period so many people don’t know about it. In AEP, people often change plans and find out in the new year they don’t like the new one, or they hear about a plan their neighbor got and wish they had signed up for that one instead. MA-OEP gives people ONE change - think of it as a do-over - in the first quarter. Any changes go into effect the 1st of the next month, and after April 1, for most people the ability to change again won’t happen until the next AEP. The process to enroll in a new plan is the same as in AEP.
AEP is just around the corner so I hope this was helpful!!
How long do I have to change my Medicare plan after I move to a new area?
If you’re currently in a Medicare Advantage (MA) or MAPD plan and you move permanently to a new area (or new state) where that plan does not operate, you qualify for a Special Enrollment Period.During this time, you can:
>Switch to a different Medicare Advantage plan that serves your new area, or
>Return to Original Medicare and buy a Medigap (Medicare Supplement) plan.
IMPORTANT: One of the biggest benefits is that you get GUARANTEED ISSUE rights. This means insurance companies cannot turn you down or charge you more for a Medigap plan because of your health or pre-existing conditions.
Important Details:
>You usually have about 63 days from the time your current plan stops covering you to make a change.
>During this Special Enrollment Period, you can buy most Medigap plans without having to answer medical questions.
>This protection only applies if you’re moving out of your Medicare Advantage plan’s service area. Simply wanting to switch plans does not give you these rights.
Can my Medicare Advantage plan drop me, and what happens if it does?
In most cases, a Medicare Advantage plan cannot simply drop you because you have health problems or because you are using your benefits. However, there are certain situations where your coverage can end:* You move outside the plan’s service area.
* You lose eligibility for Medicare Parts A or B.
* You fail to pay any required plan premiums.
* The plan terminates its contract with Medicare.
* The insurance company decides to discontinue the plan. (medicare.gov)
What Happens If Your Plan Ends?
If your Medicare Advantage plan is discontinued or its contract with Medicare is not renewed, you will receive advance notice and typically have a Special Enrollment Period to choose another Medicare Advantage plan or return to Original Medicare. Depending on your circumstances and state, you may also have certain protections when applying for a Medicare Supplement (Medigap) policy. (medicare.gov)
The Bottom Line
A Medicare Advantage plan cannot drop you simply because you become sick, develop a chronic condition, or use expensive healthcare services. If your plan does leave the market or you become ineligible, Medicare provides opportunities to choose new coverage so you’re not left without healthcare benefits.
Have questions about Medicare Advantage plans, prescription coverage, dental benefits, or other healthcare concerns? Visit Ohana Medicare. We offer concise clarity to important Medicare questions, helping you understand and manage your healthcare benefits with your best interests in mind. Explore our resources and educational content designed to help you make informed healthcare decisions with confidence
Do I need to notify Medicare or Social Security if I move to a new address?
Yes, you will want to notify both Medicare and Social Security when you move. This not only helps ensure you continue receiving important communications regarding your Medicare coverage, premiums, Social Security benefits, and annual plan information, but it may also qualify you for a Special Enrollment Period (SEP) if you need to change your Medicare plan based on your new location.In many cases, updating your address with Social Security will also update your Medicare records automatically.
You can update your address:
✔️ Online through your SSA.gov account
✔️ By calling Social Security
✔️ Or by visiting your local Social Security office
If you are moving, it’s always a good idea to contact a local Medicare broker who can help you review whether your current plan still fits your needs in your new area.
If you have questions, I’m always happy to help!
How do I switch back to Original Medicare from a Medicare Advantage plan, and will I face any penalties or coverage gaps?
You can switch from a Medicare Advantage plan back to Original Medicare during the Annual Enrollment Period (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31). Special Enrollment Periods may also apply in certain situations.There is no penalty for switching back. However, you may face a Part D late enrollment penalty if you go more than 63 days without creditable drug coverage.
Be aware of potential coverage gaps, particularly with Medigap (supplement) plans—depending on your situation, you may not have guaranteed acceptance and could be subject to medical underwriting.
What is creditable coverage and why does it matter for Medicare?
Creditable coverage means your health plan or drug plan meets Medicare minimum coverages. Another way to say this is that your existing coverage such as an employer plan will pay and cover at least as much as what a Medicare plan would pay and cover. It’s very important because if you do not have creditable coverage, you could be subject to late enrollment penalties. The Good News is that if you like your employer health insurance and it IS considered creditable, you can stay on the plan – without a penalty. CAUTION: when you decide to retire, there are timelines to move from the employer plan to Medicare. Be sure to understand enrollment timelines to transition smoothly without any penalties.
Is there a penalty for switching from Medicare Advantage back to Original Medicare?
There is no penalty for switching back from Medicare Advantage to Original Medicare. However, there are several things you need to consider before doing so. Most important, you need to be aware that you will likely need to pass underwriting, which will consist of a medical review. In some cases, depending on the state, there are also anniversary or birthday rules, where you can switch without an underwriting requirement. Other major considerations are below:1) Original Medicare is a 80/20 plan with no stop gap. Therefore, if you have a chronic condition or a catastrophic health event, you could be responsible for very large medical bills. I recommend that you apply for a Medigap or Medicare Supplement plan that would pick up the majority of the 20% covered costs. This however, is an additional premium on top of the Part B premium ($202.90) that you would already be paying monthly.
2) If you move to Original Medicare and a Supplement, you will also be responsible for enrolling in a stand alone Part D plan to cover your prescription drug costs. This is also another monthly premium (average premium is approximately $45 monthly).
3) Your Medicare Advantage plan also bundles dental, hearing and vision. Original Medicare and Supplements do not cover these ancillary services. If you want coverage for dental, vision or hearing, you would also need to consider a rider to your supplement, or a stand alone plan. These will run between $30-$80 monthly.
4) The timing of this change is also an important consideration. You can change to Original Medicare from a Medicare Advantage Plan during the annual enrollment period (AEP) 10/15-12/7 (change would be effective with January 1), or you can change during the Open enrollment Period (OEP) January- March (change would be effective the following month).
If this is something that you are seriously considering, I recommend that you reach out to a local Medicare broker that can walk you through each of these considerations.
Can I change my Medicare plan after open enrollment ends?
The Short answer is yes, but the long answer requires me to go into more detail.If you just turned 65 and used your open enrollment option on a plan, then you need to wait till the Annual enrollment, which starts 10/15 of each year and ends on 12/7, to make changes. These changes are for Medicare Advantage (Part C) and Drug plan Changes (Part D).
-If you have opted for a Medicare supplement (Medigap plan), those have an open enrollment of 6 months from when you got your Part B, and in some states (like CA and OR), a recurring open enrollment around your birthday every year.-
If you have a Medicare Advantage plan, you can also make a one-time change during the first 3 months of each year (Jan 1 through March 31), called the Open enrollment for Medicare Advantage plans.
Lastly, you can change Medicare supplement plans from one plan to another whenever you want as long as you medically qualify. That is because they are medically underwritten policies. This will save you money if you switch from time to time (like care and home insurance). Finally, there are Special election periods for Medicare Advantage and Drug plans where you can change throughout the year due to special circumstances, and this is like if you moved or have a chronic condition.
All in all, call me Dave Boehm (Medicare Dave) so I can help you navigate this and get you into the right plan for you.
Can I change my Medicare Part D plan anytime during the year?
Generally no — Part D changes are limited to specific windows:• Annual Open Enrollment – October 15 to December 7 each year, for coverage starting January 1.
• Medicare Advantage Open Enrollment – January 1 to March 31, but only for people already in a Medicare Advantage plan switching plans (can include adding/dropping drug coverage).
• Special Enrollment Periods – allowed outside those windows only for specific situations: moving out of the plan’s service area, losing other creditable drug coverage, qualifying for Extra Help/Medicaid, moving into or out of a nursing home, or a few other qualifying life events.
Outside of those windows, someone is generally locked into their Part D plan for the year.
Do I need to enroll in Medicare if I already have VA health benefits?
That's a trick question and relies heavily on what your goals or even your benefit level with the VA is. If you live near a VA location or maybe you have Tricare the answer could be no you dont need to enroll in medicare. However if you receive limited benefits and do not have easy access to a VA location or maybe you want more private access to doctors and specialist versus government employees, you may want to get Medicare parts A and B and potentially even enroll into a Part C or medicare advantage plan. This doesn't remove your ability to go to the VA for care or prescriptions but can actually enhance your healthcare benefits and provide some really important benefits you may not be getting like dental, vision, gym memberships and so on all at no cost in most cases.What is the CMS-L564 form and when do I need it for Medicare enrollment?
Seniors who are still working and covered by a large group plan can delay starting part B and enroll, without penalty, if they've maintained proof of continuous creditable coverage.The CMS-L564 form is used to document creditable coverage, it is signed by a representative of the employer, and is submitted with the application for part B.
For many seniors, it can make sense to delay starting part B, and the CMS L564 form helps avoid part B late enrollment penalties by documenting continuous creditable coverage.
Can I drop Medicare Part B if I go back to work and get employer health coverage, then re-enroll later without a penalty?
Yes, you may be able to drop Medicare Part B if you return to work and have creditable employer coverage from an employer with 20 or more employees. When that employer coverage ends, you'll generally qualify for a Special Enrollment Period (SEP) to re-enroll in Part B without a late enrollment penalty.Before dropping Part B, confirm that your employer coverage meets Medicare's requirements, because COBRA, retiree coverage, and Marketplace plans do not qualify for this protection. Also remember that dropping Part B is voluntary and requires contacting the Social Security Administration. It’s a good idea to speak with Social Security before making the change to avoid any unintended gaps in coverage.
When can a Medicare agent sell a standalone Part D prescription drug plan?
There are 4 key times that stand alone Part D plans can be sold.1. Initial enrollment period. When a person is first enrolling into Medicare. Typically, 3 months before the month they turn 65 through 3 months after the month they turn 65.
2. Annual Enrollment Period. Each year between October 15 and December 7th Medicare members can make changes to their plans for the upcoming calendar year.
3. Special Enrollment Periods. These are enrollment periods that are triggered most frequently by life events such as loss of credible coverage, moving service areas, or leaving employer provided coverage.
4. Medicare Advantage Open Enrollment Period (January 1 - March 31 each year) ONLY if a Medicare member is changing from a Medicare Advantage plan to traditional Medicare.
Can my employer force me to take Medicare when I turn 65?
It depends on your individual situation, which feels like a bit of a cop-out. If your employer is considered a small employer (less than 20 employees) they can force you to enroll in Medicare. Smaller employers do not have to operate by the same federal rules as larger companies. Medicare Part A & B will become your primary coverage.If your employer is over 20 people, the employer cannot legally force you to enroll into Medicare. People with larger employers have three choices for their insurance. First, just stay on your employers plan. You can delay Medicare without penalty but make sure to notify Social Security of your intent to delay. The second option is to enroll in Medicare Part A, defer Part B, and stay on your employer coverage. Last, you could drop the employer plan and enroll in Medicare Part A&B.
Make sure and review your options with your employer's HR department to verify you are taking are taking a correct action. They may even be able refer you to a Medicare agent that can review Advantage and Supplement Options.
if you defer Medicare you can visit the Social Security website at this link: https://www.ssa.gov/medicare/sign-up/part-b-only. If you don't like doing things online, you can call SSA directly for assistance at 1-800-772-1213.
Can I change my Medicare Part D plan anytime, or only during certain enrollment periods?
You generally cannot change your Medicare Part D plan anytime; most people can switch only during specific enrollment periods. The main time is the annual Open Enrollment Period, October 15 to December 7, and changes take effect January 1 of the next year.When you can change
• Annual Open Enrollment: You can join, switch, or drop a Part D plan.
• Special Enrollment Periods: You may be able to change outside Open Enrollment if you have a qualifying life event, such as moving, losing coverage, or becoming eligible for Extra Help.
• Extra Help / LIS: If you get Extra Help, you may be able to switch more often, including once per quarter during part of the year.
I'm confused about when I can change my Medicare plan. Can you clarify the different enrollment periods for me?
There are several Medicare enrollment periods, each with a different purpose. Your Initial Enrollment Period (IEP) is when you first become eligible for Medicare, starting 3 months before your 65th birthday month, including your birthday month, and ending 3 months after. The Annual Enrollment Period (AEP) runs October 15 through December 7 each year and allows you to change Medicare Advantage or Part D plans. The Medicare Advantage Open Enrollment Period (OEP) runs January 1 through March 31 and allows people already enrolled in a Medicare Advantage plan to make one plan change or return to Original Medicare. You may also qualify for a Special Enrollment Period (SEP) if you experience certain life events, such as moving, losing other coverage, or becoming eligible for Medicaid.Browse Other Questions & Answers
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