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Rules and Regulations for Medicare

General Enrollment Period Rules are Changing: What do you NEED to Know?

January 1 marks the first day of Medicare’s General Enrollment Period. The GEP is especially important for individuals who are eligible for Medicare but have delayed enrolling in the federal Medicare program. There are a few important things to know about the current GEP and more changes to come in the next General Enrollment Period.

Medicare General Enrollment Period

The Medicare General Enrollment Period runs from January 1 – March 31 every year. You can enroll in Original Medicare (Medicare Part A and Medicare Part B) during this time. The GEP is for individuals who missed their Initial Enrollment Period and did not qualify for a Special Enrollment Period. (We’ll talk more about those later.)

If you must enroll in Medicare during the GEP, you will likely be paying a late enrollment penalty. Medicare Part B and Part D penalties are common in those who delay their Medicare enrollment without other health insurance in place.

The problem with the GEP is that if you enroll during this time, your Medicare Part B effective date will not be until July 1. Unfortunately, this also means you cannot get a Medicare supplement plan or a Medicare Advantage plan until that time. As a result, beneficiaries could see a gap in coverage of six months or more.

Changes Ahead?

Positive changes are coming to the General Enrollment Period in 2023. Congress recently passed a new law that will simplify the enrollment timeline. As of January 2023, whether you enroll during your Initial, Special, or General Enrollment Period, your coverage will begin the following month.

An earlier version of the law would have required the Social Security Administration (SSA) to notify individuals turning 65 about their Initial Enrollment Period. This could have been helpful since most people miss their Initial Enrollment Period simply because they don’t know about it.

There will also be changes to the current enrollment periods. By 2023, the new law calls for the alignment of Part B, Medicare Advantage, and Part D enrollment periods.

Missing one of these windows can cost a beneficiary hundreds of dollars every year and negatively impact their coverage.

Other Medicare Enrollment Periods

The Medicare program is littered with important enrollment periods, which are often overlooked because of the system’s complexity. Missing one of these windows can cost a beneficiary hundreds of dollars every year and negatively impact their coverage. Outside of the GEP, here are a few of the current enrollment periods you should add to your calendar. (And keep in mind these could change in 2023!)

Initial Enrollment Period

Your unique Medicare Initial Enrollment Period marks the very first time you are eligible to enroll in Medicare. It begins three months before the month of your 65th birthday and ends three months after. In total, it’s a 7-month window of time.

Your coverage effective date will depend on which of those seven months you enroll.

  1. Any 3 months before your birthday = the month of your birthday
  2. On your birthday month = the month following our birthday
  3. 1 month after your birthday = 3 months after your birthday
  4. 2 months after your birthday = 5 months after your birthday
  5. 3 months after your birthday = 6 months after your birthday

If you are already collected Social Security benefits, you’ll automatically be enrolled in Medicare and will get your ID card about three months before your 65th birthday.

Special Enrollment Period

There are a number of things that could qualify you for a Special Enrollment Period, but the most common reason is that you chose to continue working past age 65 and had health insurance through your employer. As long as your group health coverage is “creditable,” you will qualify for an SEP when your employer’s plan terminates. (You also get to delay enrollment without incurring any penalties.) In this case, you’ll have 60 days after your other coverage ends to enroll in Medicare.

If you decide to delay enrollment, make sure you have creditable coverage! Late enrollment penalties can add up quickly, and you’ll pay some of them for life.

During your SEP, you can choose to enroll in other types of coverage as well, like a Medicare supplement, Medicare Advantage (Part C) plan, and a Part D prescription drug plan. Your coverage begins the month after you submit your application.

As we mentioned, there are many reasons you could qualify for an SEP. Some pertain to your first time enrolling in Medicare, and others pertain to specific Medicare products. Medicare.gov has a comprehensive list of Special Enrollment Period circumstances.

Annual Enrollment Period

The Annual Enrollment Period (AEP) is important for every Medicare beneficiary. While you can make other changes during AEP, it is especially significant for those with Medicare Advantage and Part D drug plans.

Medicare Advantage plans and Medicare prescription drug plans change from year to year, so you’ll need to review each Annual Notice of Change (ANOC) to determine if changing your Medicare coverage would be in your best interest. In Medicare, it’s always important to shop for coverage since so many plans offer the same benefits. You could find a new plan that works just as well (or better) than your current plan and has a lower monthly premium. Whatever you do, don’t ever ignore the AEP!

If you haven’t enrolled in Medicare yet, work with a licensed insurance agent to determine when you are eligible to enroll. They can guide you through the enrollment process, educate you on your Medicare options, and help you find the plan that’s right for you.

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