Medicare IEPs and SEPs
Turning 65 comes with a few important Medicare deadlines, and understanding when to enroll can help you avoid gaps in coverage, penalties, or limited options down the road. Here’s what you need to know about when you should start the Medicare process and what situations you can make changes in down the line.
The Medicare Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. It typically begins three months before your 65th birthday, includes your birthday month, and ends three months after your birthday. If you are still working and have a qualified employer health plan, you may be able to delay Medicare enrollment until you retire. However, if your employer has 20 or fewer employees, you will need to enroll in Medicare at that time.
Your IEP is the time to start the application process for Parts A and B, also known as Original Medicare. Depending on when you enroll, your Medicare coverage will generally begin on the first day of your birthday month. Once you are enrolled in Parts A and B, you will receive a Medicare card with your Medicare number. From there, you are able to move on to enrolling in supplemental coverage.
As a quick refresher, Part A covers hospital care, while Part B covers doctor visits and other outpatient services. Original Medicare generally covers about 80% of approved costs, leaving you responsible for the remaining 20% and other out-of-pocket expenses. This is where supplemental coverage comes in. Medigap plans help cover some of the costs that Original Medicare does not, while a separate Part D plan provides prescription drug coverage.
There are several Medigap and Part D plans available from various carriers, with different premiums, coverage, and networks. This is where we step in to help narrow down your options. You then have three months following your 65th birthday to enroll in supplemental coverage, giving you a six-month window around your birthday month to get your Medicare coverage in place.
If you have spent any time with The Insurance People, you know we are not big fans of Medicare Advantage plans due to their limited networks and prior-authorization requirements. Whether you choose traditional Medicare with a Medigap and Part D plan or a Medicare Advantage plan, however, the same general rules regarding your Initial Enrollment Period and Special Enrollment Periods apply.
Once you enroll in Medicare, there are a few opportunities to change your coverage depending on your circumstances. For your Medigap plan, you can apply to change plans at any time. However, once you are outside your initial Medigap open enrollment period, you may be required to go through medical underwriting. Depending on your health, this could result in a higher premium, fewer plan options, or even a denial of coverage. Because of this, we recommend choosing your Medigap plan carefully during your initial enrollment period, assuming you may keep it for the long term.
For Part D prescription drug plans, the annual Medicare Open Enrollment Period runs from October 15 through December 7. During this time, you can change your prescription drug plan for the following year. An important note for our current clients: Part D plans do not pay commissions, so our agents are only available to assist with Part D plan changes during the first two weeks of Medicare Open Enrollment.
Outside of Open Enrollment, there are also certain circumstances that may qualify you for a Special Enrollment Period. These can include moving to a new service area, involuntarily losing other prescription drug coverage, or experiencing another qualifying life event. You can check out a list of potential qualifying events on the Medicare page here.
Understanding these enrollment windows is an important part of setting yourself up for the right Medicare coverage. The rules can be confusing, and the decisions you make when you first enroll can affect your options and costs later on. If you’re approaching 65 and ready to start looking into Medicare, we’re here to help you understand your deadlines, compare your options, and make a plan for coverage.
