Your Guide to Medicare Enrollment Periods

There are specific times when you can enroll in Medicare, known as enrollment periods.

Your Medicare Initial Enrollment Period (IEP) is the first time most people are able to enroll in Medicare.

Most people’s IEP begins three months before their 65th birthday, but some people’s IEP may begin sooner if they have a disability or a medical condition that makes them eligible for Medicare before age 65.

Other enrollment periods include:

  • Special Enrollment Period
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  • Medicare General Enrollment Period
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  • Fall Open Enrollment Period (also known as the fall Annual Election Period)
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  • Medigap Open Enrollment Period

In this guide, we cover the different Medicare enrollment periods, including when they occur, to ensure you have the information you need to successfully enroll.

But before we jump right in, let’s first take a look at who is eligible for Medicare.

Adults smiling together after group exercise

Medicare eligibility

If you’re a United States citizen or permanent legal resident for at least five continuous years, you may be eligible for Medicare if you meet one or more of the following qualifications:

  • You are 65 years or older and are eligible for retirement benefits through Social Security or the Railroad Retirement Board
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  • You have a disability and have received disability benefits for at least 24 months
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  • You have end-stage renal disease and require dialysis treatment or a kidney transplant
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  • You have ALS (Lou Gehrig’s disease)

Now that you better understand the Medicare eligibility requirements, keep reading to learn about the different enrollment periods.

Medicare Initial Enrollment Period

Medicare Initial Enrollment Period

For people who do not qualify for Medicare before age 65, your Medicare Initial Enrollment Period begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.

If you are younger than 65 and eligible for Medicare because of a disability or medical condition, your Medicare coverage typically begins 24 months after your disability benefits are approved, and you will be automatically enrolled in Part A and Part B.

If you have ALS, there is no 24 month waiting period — your Medicare benefits will begin the first month you have Social Security Disability Benefits.

Failing to enroll in Medicare during your Medicare Initial Enrollment Period can cause you to pay late enrollment penalties, so we recommend enrolling as soon as you’re eligible.

Automatic Enrollment vs Manual Enrollment

Some people are automatically enrolled in Medicare and others must manually enroll. Typically, you will be automatically enrolled in Medicare if you get benefits from Social Security or the Railroad Retirement Board at least four months before you turn 65. If this applies to you, your Part A and Part B benefits will start the first day of the month you turn 65.

If you are not automatically enrolled in Medicare, you can manually enroll during your IEP by:

  • Calling Social Security at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday 7AM-7PM
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  • Visiting the Social Security website at www.SocialSecurity.gov
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  • Visiting your local Social Security office
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  • If you worked for a railroad, you can enroll in Medicare by contacting the Railroad Retirement Board at 1-877-772-5772 (TTY users 1-312-751-4701), Monday through Friday 9AM-3:30PM

Medicare Special Enrollment Period

If you or your spouse are still working at age 65 and are covered by a group health insurance plan, you do not have to enroll in Medicare during your Initial Enrollment Period. You will likely qualify for a Medicare Special Enrollment Period (SEP).

If you are eligible for a Special Enrollment Period, you will not have to pay a late enrollment penalty.

Special Enrollment Periods also apply to people who already have Medicare and face certain life events, such as moving or losing their coverage though no fault of their own.

Medicare General Enrollment Period

If you don’t enroll in Original Medicare during your Initial Enrollment Period and don’t qualify for special enrollment, you’ll have another chance to enroll during the General Enrollment Period (GEP).

The General Enrollment Period runs from January 1 to March 31 each year.

Important: Enrolling during this time may not be in your best interest because your coverage will not begin until July 1, and you may have to pay late enrollment penalties.

Medicare Fall Open Enrollment Period

Fall Open Enrollment Period (Annual Election Period)

The Medicare Annual Election Period (AEP), sometimes called the Medicare Open Enrollment Period, runs from October 15 to December 7 each year.

During AEP, you can typically:

  • Enroll or disenroll from a Medicare Advantage plan
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  • Switch from Medicare Advantage back to Original Medicare
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  • Join, drop or switch a Medicare Prescription Drug (Medicare Part D) plan
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  • Switch from one Medicare Advantage plan to another Medicare Advantage plan

Your new coverage will begin January 1 of the upcoming year.

Medigap Open Enrollment Period

Not to be confused with the Medicare Open Enrollment Period, the Medigap Open Enrollment Period is the best time to purchase a Medicare Supplement Insurance (Medigap) plan.

Medicare Supplement Insurance is sold by private insurance companies to help cover some of the out-of-pocket costs of Original Medicare, such as deductibles, copayments and coinsurance.

Your Medigap Open Enrollment Period is a 6-month period that begins the first day of the month in which you are 65 years or older and enrolled in Medicare Part B.

During your Medigap Open Enrollment Period, insurance companies cannot use medical underwriting to determine your eligibility for a plan or charge you higher premiums based on your health or medical history.

If you enroll in a Medigap plan during your Medigap Open Enrollment Period, insurance companies must sell you any Medigap plan it offers.

If you do NOT enroll in a Medigap plan during your Medigap Open Enrollment Period, insurance companies can deny you a plan or use medical underwriting to determine your premium amounts. This means that your premiums may be higher than people who enrolled during their Medigap Open Enrollment Period

Medigap eligibility

To qualify for a Medigap plan, you typically must be 65 years or older and enrolled in Medicare Part B. If you are younger than 65 and are eligible for Medicare because of a disability or medical condition, your Medigap eligibility will vary depending on the state in which you live.

The following states require that insurance companies offer at least one type of Medicare Supplement Insurance plan to people under 65 who receive Medicare benefits:

  • California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont and Wisconsin

Note: California, Massachusetts and Vermont require that insurance companies offer at least one Medigap policy to people under 65 who are disabled. This requirement does not include those who are under 65 and have end-stage renal disease. Delaware requires that insurance carriers offer at least one Medigap policy to those under 65 who have ESRD. This requirement does not include those under 65 who are disabled.

Speak with a licensed agent

For more information about Medicare, including when to enroll and your enrollment options, speak with a licensed insurance agent at TTY Users: 711.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

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