Medicare open enrollment: Know your coverage options

4-minute read

If you're thinking about getting Medicare health coverage, you should know about Medicare open enrollment and other enrollment periods.

To participate in Medicare, you must meet one or more of the following criteria, according to Medicare.gov:

• You must be age 65 or above or be younger than 65 but have a certain disability (other rules and regulations apply).
• You must have permanent kidney failure and use dialysis or are awaiting a kidney transplant.

Medicare coverage options

Coverage options depend on what you need. Before enrolling in Medicare, compare plans and choose the ones with the coverage you're seeking. Plans offered include:

• Medicare Part A. This provides coverage for long-term healthcare — hospice services, inpatient skilled nursing care, and hospitalizations, among other needs. It also helps people with Medicare with certain home healthcare services. Part A is free for most people.
• Medicare Part B. Unlike Part A, Part B handles everyday medical needs. Outpatient care, preventive services, medical supplies, and more fall under Part B. You will pay a monthly premium for this plan.
  
• Medicare Part C. Also known as Medicare Advantage, this is available if you have Medicare Part A and Part B. With Medicare Advantage, a private company provides your insurance and may cover services that Medicare does not, such as vision, hearing, and dental services. These plans may charge different out-of-pocket costs and have different coverage rules.
  
• Medicare Part D. This option covers prescription medications. This prescription drug plan keeps the cost of medication down and helps pay for important vaccinations you may need.
  
• Medigap. Medigap provides supplemental insurance that helps you pay for out-of-pocket charges you may be responsible for under your original Medicare (A and B) plan, such as deductibles and copayments. Like Medicare Advantage, you purchase these plans through private insurers. You must have Medicare Part A and Part B before you can purchase a Medigap plan.

Understanding Medicare open enrollment

Medicare open enrollment allows you to enroll in or change a Medicare plan. The time for open enrollment depends on where you are in your Medicare journey but generally occurs during one of two time periods:

• You're new to Medicare. You're eligible for Medicare when you turn 65. This initial open enrollment period begins three months before your birthday and ends three months after. There's also an enrollment period for people on disability.
• You're currently enrolled in Medicare. Open enrollment for people who want to switch from one Medicare coverage plan to another takes place from Oct. 15 to Dec. 7 every year. During this time, you can switch from original Medicare (A and B) to Medicare Advantage or vice versa. You can also add or remove medication coverage. Once you have Medicare Part B, you can also add the Medigap supplement, but be sure to do it within six months.

Beginning and changing Medicare coverage

Your first day of Medicare coverage is based on when you enroll:

• When you sign up for initial coverage before your 65th birthday, coverage starts on the first day of your birthday month. For example, if your birthday is July 17 and you enroll the preceding May, your coverage begins on July 1.
• When you sign up after you're eligible, coverage starts at the beginning of the next month.
• If you sign up for Medicare or make any changes to an existing plan during open enrollment, your new coverage begins on the first day of the next calendar year.

Every fall, you'll receive an annual notice of change (ANOC). Whether you're enrolled in Medicare Part A, B, C, or D, the ANOC explains how your coverage will change in the coming year. Review this information closely. Then sign up for the coverage you need.

Enrolling throughout the year

While Medicare open enrollment is the best time for joining Medicare, it isn't the only way to get coverage. There's also a general enrollment period and a special enrollment period.

Medicare's general enrollment period allows you to get insurance if you missed open enrollment. It begins Jan. 1 and ends March 31. While convenient, it comes at a cost. In most cases, you must pay a penalty to participate in general enrollment. You'll also have to wait until July 1 for your insurance to kick in if you use general enrollment to sign up for Medicare for the first time.

The special enrollment period is an exception to the open enrollment rules. It allows you to start or change your Medicare coverage any time of the year. However, as the name suggests, the special enrollment period is for special cases. You may be eligible for the following reasons:

• Changes to your private insurance plan's Medicare contract
• Gaining access to other coverage, such as employer-based health insurance
• Loss or change of current insurance coverage (including COBRA)
• Moving to a new physical address
• Recently being released from jail or prison

After Medicare open enrollment

Medicare open enrollment is only the first step in your health journey. To make the most of your coverage, be sure to use it. Find a primary care provider you trust and schedule a Medicare wellness exam.

Every time you visit your provider, go prepared. Write a list of health questions and bring them with you. Jot down your provider's answers. This will help you stay on top of your health and get the care you need when you need it.

If you have Medicare and need a trusted partner on your health journey, let us help you. Find a provider at Reid Health.