PostHeaderIcon Medicare enrollment – confusions and overlaps

There are four Medicare enrollment periods. These enrollment periods are confusing and overlapping. A beneficiary who does not act carefully may lose needed Part B or Part D coverage.

Annual Coordinated Election Period (AEP)

The Annual Coordinated Election Period runs from November 15 through December 31 each year.  During this time, people whom are already enrolled on Medicare, may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time.  Enrollment changes take effect on January 1.

General Enrollment Period (GEP) 

Medicare beneficiaries who did not enroll in Part B when they first became eligible, usually at age 65, for Medicare may elect Part B coverage during the General Enrollment Period. This runs from January 1 through March 31 each year.  Enrollment changes take effect on July 1 of the same year.

Beneficiaries who delay enrollment in Part B is assessed a late enrollment penalty on their Part B premium.  The penalty is 10% for each full year of delayed enrollment for as long as the beneficiary remains covered under Part B. 

Part B enrollment during the General Enrollment Period also has a Special Enrollment Period (SEP) for Part D.  From April through June of each year a new Part B enrollee may make one election to join a Part D plan.  This enrollment also enables beneficiaries who elect Part B during the General Enrollment Period to enroll in a Medicare Advantage plan with drug coverage (MA-PD).

Open Enrollment Period (OEP) 

The Open Enrollment Period allows Medicare beneficiaries to enroll in, disenroll from, or change a Medicare Advantage plan.  Like the General Enrollment Period, the Open Enrollment Period extends from January 1 through March 31 each year.  Unlike enrollment in Part B, the change in Medicare Advantage enrollment or disenrollment becomes effective the month after the change is made. 

Any beneficiary who wants to change must have both Medicare Part A and Medicare Part B and must live in the area served by the Medicare Advantage plan. 

Beneficiaries may not add or drop Part D drug coverage during the Open Enrollment Period.  Those who already have drug coverage can only change to another option with drug coverage. 

Special Enrollment Period (SEP) – for the working aged

Beneficiaries who delay enrolling in Part B because they are covered by employer-sponsored health insurance as an active worker or as a dependent of an active worker, are not limited to enrolling in Part B during the general enrollment period.

They have special enrollment, that runs for eight months from the time they (or their spouse) retire or they lose their health insurance. Part B coverage starts the month after the election is made, and no late premium penalty is assessed.

Special Enrollment Period (SEP) – for others

A number of special enrollments exist for Medicare Advantage and Prescription Drug Plan (PDP) enrollment and disenrollment.  For example, someone who moves out of a Medicare Advantage Plan or PDP service area has special enrollment to enroll in a plan that serves their new location. Beneficiaries, who move into, reside in, or move out of a nursing home may also have a special enrollment.

4 Responses to “Medicare enrollment – confusions and overlaps”

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