What You Need to Know About 2014 Medicare Enrollment Periods and Medicare Advantage Disenrollment

Medicare Initial Enrollment, Open Enrollment, and Special Enrollment are terms that confuse a lot of people. Fortunately, it isn’t difficult at all to learn the difference between the various Medicare enrollment periods and the opportunities they provide.

Medicare Initial Enrollment Period

Every American with age 65 in his or her sights needs to be aware of the Initial Enrollment Period. Although there has been plenty of talk in recent years about possibly raising the Medicare age, the Medicare eligibility age for the vast majority of Americans has been 65 ever since Medicare was established in 1965. Some people are eligible earlier due to disability, but for about six out of seven Americans Medicare eligibility begins around the time they turn 65, with Initial Enrollment occurring around the same time.

Does coverage start the day someone turns 65?

Not exactly. The Initial Enrollment Period for Medicare is actually a seven-month window beginning three months before the month you turn 65. This means, for example, that if you were born on Dec. 1, 1948, and will turn 65 on Dec. 1, 2013, your Initial Enrollment Period started on Sept. 1 of this year, or three months before your 65th birthday. But if you were born on New Year’s Eve 1948 and will turn 65 on Dec. 31, 2013, your Initial Enrollment Period also started on Sept. 1 of this year-almost four months before your 65th birthday. But in neither of those cases will coverage start exactly on your 65th birthday.

Then when will it start?

If you enroll during the first three months of your Initial Enrollment Period, coverage should begin the first day of your birthday month. But if your birthday falls on the first of the month, your Medicare coverage should begin on the first of the previous month. Keep in mind that you shouldn’t wait too long to enroll because if you do the start of your coverage may be delayed.

And the Initial Enrollment window closes …

Again, the Initial Enrollment Period is seven months long. It ends three months after the month you turn 65 if you’re among the 83 percent of Americans who become Medicare-eligible at 65. If you are among the one in seven who become eligible for Medicare prior to reaching 65, you have a similar seven-month enrollment period starting three months before the month your Medicare eligibility begins.

What if the window closes before someone signs up?

That’s often bad news.

Ask poor Bubba. He assumed Uncle Sam would take care of everything, and never bothered to enroll in Medicare during his Initial Enrollment Period. He’d heard somewhere that enrollment in Medicare was automatic-which it is for people who are already receiving Social Security benefits. But if you’re not already collecting Social Security before age 65, you’d better remember to enroll in Medicare during Initial Enrollment.

As it turned out, by letting that Initial Enrollment window close, Bubba had to wait months for a second chance to sign up for Medicare. His next opportunity to enroll didn’t come until the next Medicare General Enrollment Period-which we’ll get into in a moment. You can imagine how mad Bubba was when his tractor rolled over his foot a few weeks before General Enrollment came around. Poor Bubba was so mad he hadn’t signed up for Medicare during his Initial Enrollment Period that he kicked himself with his good foot.

Compare Bubba’s story to Nancy’s …

Bubba’s neighbor Nancy went to SocialSecurity.gov and enrolled in Medicare early during her Initial Enrollment Period. She signed up for Medicare Part A-premium-free for about 99% of people on Medicare-and Medicare Part B. Those two parts of Medicare are called Original Medicare because they date back to Medicare’s inception in 1965. Nancy thought about dropping Part B because it does have a monthly premium-just over $100 for most people-but she decided her health wasn’t something to gamble with.

And from there …

Knowing Original Medicare is full of gaps, Nancy debated whether to invest in a Medicare Advantage or Medicare supplement plan. Initial Enrollment is a great time to investigate every option. Nancy decided to go with a Medicare supplement, or Medigap, plan partly because she had Medigap guaranteed issue rights for six months, meaning there was a one-time, six-month period in which no insurance company could deny her any available Medicare supplement policy she wanted regardless of her medical history. Nancy also signed up for a Medicare Part D prescription drug plan. Again, during Initial Enrollment, it’s good to investigate all your options. Also, by joining a prescription drug plan when she was first eligible, Nancy avoided having to pay a Medicare Part D penalty by joining later.

Bubba wasn’t as lucky.

Remember, he waited until the Medicare General Enrollment Period to sign up for Medicare.

Medicare General Enrollment Period

General Enrollment takes place from Jan. 1 to Mar. 31 every year, and it’s a second chance for people like Bubba to sign up for Medicare.

Bubba was ecstatic when he found out about the General Enrollment Period-that is, until he learned it wasn’t quite everything he’d hoped for.

First of all …

By missing out on his Initial Enrollment opportunity, Bubba had to wait until July 1 for his coverage to begin. While the General Enrollment Period takes place during the first three months of each year, coverage normally doesn’t begin until the year is halfway over … in Bubba’s case, over half a year after that tractor went over his foot.

At least Bubba did one thing right.

He avoided having to pay the Medicare Part B late enrollment penalty by making sure he didn’t miss his General Enrollment opportunity. The Medicare Part B late enrollment penalty can be costly-with 10% added to your Part B premium every month for each full 12-month period you were eligible for Part B but not enrolled in it-but Bubba avoided the penalty by not letting 12 months lapse before signing up for Part B. At least he didn’t have to kick himself about that.

Another neighbor of Bubba’s, Vinny, didn’t sign up for Medicare Part B until three full years after first becoming eligible. But Vinny didn’t have to pay the Part B penalty, either, because when he became eligible for Medicare Vinny was still enrolled in his employer’s health insurance plan. Having other health coverage during standard enrollment periods often qualifies someone for a Special Enrollment Period later on.

Video of enrolling in part C and D

Medicare Special Enrollment Period

People, like Vinny, normally qualify for a Special Enrollment Period if they are employed and covered by an employer’s or union’s health plan when they become eligible for Medicare. Special Enrollment generally allows them to enroll in Medicare later without penalties as long as the reason for the delay is that they are working and covered under the employment-based plan. The same considerations normally apply to employees’ spouses.

If employment or employment-based coverage ends, there is normally an eight-month Special Enrollment Period starting the month after employment or coverage ends.

Special Enrollment also applies to Medicare Part C (Medicare Advantage) and Medicare Part D (prescription drug plans).

Conditions qualifying you for a Special Enrollment Period for Medicare Advantage and Medicare Part D include:

Returning to the United States after living outside the country
Being released from jail
Living in, or having just left, an institution such as a skilled nursing facility or long-term care hospital
Losing eligibility for Medicaid
You may also qualify for a Part C/Part D Special Enrollment Period if you are currently enrolled in a plan and move to a new address outside your plan’s service area. Losing creditable drug coverage-which means coverage considered roughly equal to what Part D provides-normally qualifies you for a Special Enrollment Period and exempts you from having to pay the Medicare Part D penalty, which many people who enroll in Part D after their first period of eligibility have to pay.

What about Medicare supplements?

Note that you never need a Special Enrollment Period if you want to enroll in a Medicare supplement plan. As long as you are 65 or older and enrolled in Medicare Part A and Part B, you can enroll in a Medicare supplement plan at any time. Keep in mind, though, that guaranteed issue rights usually do not apply unless you apply for the Medicare supplement plan you want within six months of enrolling in Medicare Part B. This means that if you apply outside your guaranteed issue period, medical underwriting may apply and you may not get to enroll in the plan you want.

Medicare Open Enrollment Period

It’s inadvisable to think that once you’re enrolled in the Medicare plan or plans of your choice, there’s nothing left to do. It’s important to reevaluate your coverage from time to time, and the Oct. 15-Dec. 7 Open Enrollment Period gives you the opportunity to do that annually.

For people on already on Medicare …

Open Enrollment provides an opportunity to evaluate current coverage and consider making certain changes in Medicare coverage including:

Switching from Original Medicare to a Medicare Advantage plan
Switching from a Medicare Advantage plan back to Original Medicare
Switching from one Medicare Advantage plan to another one
Joining a prescription drug plan or switching from one prescription drug plan to another
Dropping Medicare Part D prescription drug coverage
Medicare plan premiums and health concerns can change frequently.

That’s why many of the more than 13 million Americans enrolled in Medicare Advantage plans use Open Enrollment as an opportunity to assess their current coverage and shop the market for the most suitable and most affordable coverage for the following year.

That’s what Bubba did.

Like so many other people, he came to the conclusion that Original Medicare wasn’t sufficient to meet his healthcare needs-plus, it was burning a hole in his pocketbook. That’s why he enrolled in a Medicare Advantage plan during an annual Open Enrollment Period.

As far as Vinny is concerned …

He used Open Enrollment as an opportunity to enroll in a Part D prescription drug plan. He already had Medigap, and decided he definitely wanted to stick with that, but wanted to add the protection of an inexpensive Part D plan. As with Bubba’s new plan, Vinny’s drug plan took effect on Jan. 1 of the following year.

And Nancy?

Wisely, Nancy weighed all her options, but decided her Medicare supplement plan and prescription drug plan were priced right. She also determined those plans had already saved her a lot of money and were likely to continue doing so in the future. As a result, she decided not to change a thing going into a new year.

Is Open Enrollment the last opportunity to make changes for the following year?

To a degree, yes. However, you have the option of disenrolling from a Medicare Advantage plan during the Medicare Advantage Disenrollment Period that begins on Jan. 1 of each year.

Medicare Advantage Disenrollment Period

During the Jan. 1-Feb. 14 Medicare Advantage Disenrollment Period, anyone currently enrolled in any Medicare Advantage plan can:

Return to Original Medicare
Apply for a Medicare supplement
Enroll in a stand-alone Part D plan
Changes made during the Medicare Advantage Disenrollment Period are effective at the start of the following month.

But beware …

Because the Disenrollment Period for Medicare Advantage does not offer the option of enrolling in another Medicare Advantage plan, you need to be prepared to return to Original Medicare if you decide to disenroll from your current Medicare Advantage plan.

If you decide to disenroll from Medicare Advantage in order to enroll in a Medicare supplement plan …

The best advice is to look at Medicare supplement options well before disenrolling from your Medicare Advantage plan. This gives you time to shop the market and to seek the advice of an agent with a proven track record in the Medicare supplement insurance business.

There’s another reason to act early during the Medicare Advantage Disenrollment Period.

If you decide to disenroll from Medicare Advantage because you want to enroll in a Medicare supplement plan, you’ll want to know before Feb. 14 whether your Medigap application is accepted. Remember, unless you have guaranteed issue rights there is a chance you cannot enroll in the plan you want.

This means …

You should not disenroll from your Medicare Advantage plan until you’re certain you’ll be able to get a Medigap policy to replace it … unless you’re prepared to cross your fingers with Original Medicare alone. True, you’re likely to be able to get a Medigap policy, but without guaranteed issue there’s no certainty that you’ll get the plan you want.

Bubba’s other neighbors …

The Thomases heard so much about how certain Medicare supplement plans fill the high-risk gaps in Original Medicare that they decided take advantage of the Medicare Advantage Disenrollment Period by leaving their Part C plan and enrolling in a Medicare supplement plan instead.

The problem was …

They did things backwards. They dropped their Medicare Advantage coverage and then learned they were unable to get the Medigap policy they wanted. Unable to reenroll in Medicare Advantage until the next Medicare Open Enrollment Period came around, they ended up getting a Medigap policy that wasn’t really the Medicare plan they wanted. Not only did they kick themselves, they asked Bubba to kick them, too.

But at least …

The Thomases eased some of their pain by enrolling in a stand-alone prescription drug plan-as anyone dropping Medicare Advantage can do during the annual Medicare Advantage Disenrollment Period. And, fortunately, they learned that even though they did not get to enroll in their first-choice Medicare supplement plan, the plan they got was still highly affordable and a huge improvement on Original Medicare.

Happy Ending

As it turned out, not long afterwards the Thomases consulted an agent who knew the Medicare supplement industry inside out. The agent found a company that accepted the Thomases’ application for a Medigap Plan F policy-which is what the Thomases wanted when they disenrolled from Medicare Advantage. Since they started enjoying the comprehensive coverage of Plan F, the Thomases have taken full advantage of Medicare services while saving a great deal of money.

Knowing about Medicare enrollment periods and the opportunities they offer can go a long way toward making prudent choices and minimizing some of the mistakes made in Bubba’s neighborhood. To learn more about Medicare enrollment periods, visit Medicare.gov.

MedicareMall.com is happy to answer your questions during open enrollment period. They will provide you with a free Quote on Medicare Supplement, Medicare Advantage, or Prescription drug plan.