So Many Medicare Enrollment Periods! Which One Is Right For You?

One of the most important and also most intimidating questions is, “When can I enroll in Medicare Part A and Part B?” This is important because missing your chance to enroll or enrolling at the wrong time can have both immediate and lasting repercussions. It is intimidating because there is no one perfect answer. When to enroll depends on your individual circumstances. 

Let’s look at the most common enrollment periods, the situations to which they apply, and what can go wrong. 

The Initial Enrollment Period (IEP) – Turning 65, decide what to do about Medicare. 

This is a seven-month period, wrapped around a person’s 65^th birthday. For most, this period will start three months before and end three months after the birth month. The IEP for a person born on April 5 would begin January 1 and end July 31. However, the IEP for those who were born on the first of the month shifts to four months before and two months after the birth month. Someone born on April 1 would have an IEP from December through June. (Click here if you need to figure out your IEP.) 

This is probably the most important Medicare enrollment period because it applies to every single individual who is eligible for Medicare. No matter an individual’s circumstances, this is the time to pay attention and make decisions about Medicare. 

• Must you enroll in Medicare? Those who have no other coverage must.
• What about those who are still working?  They must determine whether they can keep that coverage once they turn 65. If so, how will it work with Medicare? What if they decide to give it up or the plan ends? Failing to figure all that out can lead to some nasty surprises in the future. 

David did not have to enroll in Medicare because he was still working and had coverage through an employer group health plan. However, when retiring at age 72, he discovered that his prescription drug coverage was not considered creditable for all those years. He would pay a Part D late enrollment penalty for the rest of his Medicare life. 

The Medicare Part B Special Enrollment Period (SEP) – Over 65, enroll when retiring.

A special enrollment period occurs after the IEP has ended. A special enrollment period is triggered by a qualifying event and allows an individual to take Medicare action. I have dealt with over two dozen of these special periods, such as 5-star plan, moving in and out of an institution, involuntary loss of coverage, even retroactive entitlement. However, there is one at the top of the list that applies to many who have employer group coverage at age 65. That is the Part B Special Enrollment Period.

Those who have coverage sponsored by a company with 20 or more employees can defer Medicare enrollment, without facing a late enrollment penalty or delay in coverage at retirement. They can decide at age 65 to enroll in Medicare Part A, hospital insurance, because it is premium-free and may provide additional coverage. At retirement, these individuals will need to enroll in Part B, medical insurance. They can do this at any time they still have the employer’s coverage or within an eight-month period that begins with the earlier end date of either coverage or employment. 

A large company was eliminating a department and would have to terminate 15 people, all over the age of 65. The company planned to pay for a year of medical coverage and then the employees could deal with Medicare. Thankfully, the HR department learned, in advance, that their well-intentioned plan would put every one of those employees in a late enrollment situation. 

The General Enrollment Period (GEP) – For those who missed their chance to enroll. 

Those who did not enroll during their IEP and do not qualify for a SEP must wait until  the General Enrollment Period. This period starts January 1 and ends March 31. If the enrollee has gone more than 12 full months without Part B, a late enrollment penalty will apply. 

In my experience, many who missed their chance to enroll know they will pay a penalty but are very surprised to discover that there can be a gap in coverage. 

Susan, age 68 and enrolled in Part A only, lost her job and had a COBRA continuation plan. When that was ending August 31, she contacted Social Security to enroll in Part B. She was stunned to discover that, because she did not qualify for a Part B SEP, she could not enroll until January and coverage would not start until July 1.

Not understanding Medicare enrollment periods can soon lead to some significant discomfort, financially and otherwise. Pay attention to these important tips. 

1. Determine what you need to do about Medicare during your Initial Enrollment Period. 
2. If delaying enrollment, know when and how to enroll upon retirement.