When is the Medicare Open Enrollment Period?
The Medicare Open Enrollment Period takes place every year from October 15th through December 7th. During this period, people who have Medicare have the opportunity to make changes to their coverage.
If you are covered by Medicare and interested in reviewing and comparing your coverage options, make sure that the plans you are considering are part of Medicare and not the healthcare marketplace.
Medicare plans are not sold through the federal or state health insurance marketplace websites. You can review and compare your Medicare options using the Medicare Plan Finder, a search tool on the medicare.gov website, or by calling 1-800-MEDICARE (1-800-633-4227).
You can also get in touch with the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized assistance and advice to people with Medicare and their families. You can call 877-839-2675 to obtain the telephone number for SHIP in your state.
What is the Medicare Plan Finder?
The Medicare Plan Finder is an online search tool on the Medicare.gov website that allows users to compare Medicare plan options, including Medicare Advantage plans, Medicare Part D plans and supplemental Medigap policies.
You can obtain information on this coverage as well as the costs and benefits of the different plan options in your area by using the Plan Finder. You can also enroll in a Medicare Advantage or a Medicare Part D plan on the Medicare Plan Finder.
I am on traditional Medicare and do not want to make any changes to my coverage. How does the Medicare Open Enrollment Period affect me?
If you are satisfied with your traditional Medicare coverage, you do not need to take any action during the Medicare Open Enrollment Period. If you do not do anything during this time, your traditional Medicare coverage will continue into the next year.
What changes can I make to my Medicare coverage during the Open Enrollment Period?
Depending on the coverage you already have, you can make many changes to your Medicare coverage during the Medicare Open Enrollment Period, which runs from October 15th through December 7th. You can change from traditional Medicare to a Medicare Advantage plan (or vice-versa).
If you prefer Medicare Advantage, during this period you can choose between the Medicare Advantage plans that are offered in your area. If you are on traditional Medicare and you would like prescription medication coverage, you can choose between the Medicare prescription medication plans.
I am about to turn 65 and I want to enroll in Medicare, but I am not sure about what my coverage options are. Where can I get more information?
To obtain more information on your Medicare coverage options, including Medicare Advantage plans, Part D prescription medication plans, and Medigap supplemental policies that are available in your area, as well as how to enroll, you can go to the Medicare Plan Finder, a search tool available on the website Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). You can also get in touch with the State Health Insurance Assistance Program (SHIP) in your state or the Social Security Administration.
SHIPs offer local, personalized assistance and advice to people with Medicare and their families. You can call 877-839-2675 to obtain the telephone number for SHIP in your state. Medicare provides links and telephone numbers for these and other organizations on its website. Information on Medicare Advantage plans, Part D prescription medication plans, and Medigap policies is not available through the federal or state health insurance markets.
I am going to turn 65 next year. When can I enroll in Medicare?
If you are eligible for Medicare, you initial enrollment period for Parts A and B starts three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your enrollment period will extend from March 1st until September 30.
Once you have Parts A and B, you will also be eligible for a Medicare Advantage (Part C) and/or a prescription medication plan (Part D).
If you are already receiving Social Security benefits when you turn 65, you will be automatically enrolled in Parts A and B. If you do not receive Social Security benefits yet and you wish to enroll in Medicare, you must get in touch with Social Security.
Part B is voluntary, but you may have to pay a fine for late enrollment if you do not enroll when you turn 65, unless you or your spouse are still working and one of you has a group healthcare plan through your employer.
Part D is also voluntary, but you may have to pay a fine for late enrollment if you enroll in a Part D plan after your initial enrollment plan has ended and more than 63 days go by without a prescription medication coverage source that is at least as good as what is offered by Medicare Part D.
I will turn 65 soon, but I like my current insurance. Do I have to enroll in Medicare? Are there penalties if I do not?
That depends on how you receive your current insurance. If you are receiving employer-sponsored health insurance through your job or your spouse's job when you turn 65, you may be able to keep your insurance until you (or your spouse) retires. You should get in touch with your employer's employee benefits representative to find out if your coverage will continue when you turn 65.
As Medicare Part A does not include premiums for most beneficiaries, you may want to enroll in Part A as soon as your are eligible (that is, three months before your 65th birthday), even if you will continue receiving employer-sponsored health insurance for the time being.
If you are covered by an employer-sponsored plan, you may want to delay enrollment in Part B until you (or your spouse) retire. However, it is a good idea to consult with Social Security or Medicare to confirm that a fine for late inscription will not be applied.
Similarly, unless you have prescription drug coverage that is as good as what is offered by the Medicare prescription plans, you must enroll in a Medicare prescription medication plan when you enroll in the program. Otherwise, you may face a fine for late enrollment.
If you have coverage through a health insurance marketplace plan, you must enroll in Medicare when you turn 65 and notify your marketplace plan that you now qualify for Medicare coverage. Your plan will not automatically cancel coverage when you turn 65 and enroll in Medicare, but if you receive subsidies to help you pay the marketplace plan premiums, your eligibility for these tax credits will end when your Medicare Part A coverage begins (people with Medicare are not eligible for these tax credits, and these subsidies can only be used to buy coverage on the marketplace).
If you decide to cancel your marketplace coverage when you become eligible for Medicare, make sure that your Medicare coverage has started before canceling your marketplace plan in order to avoid any coverage gaps. You can start enrolling in Medicare three months before turning 65.
Can immigrants enroll in Medicare?
That depends. United States residents, which includes citizens and permanent residents (those who have a green card), are eligible for Medicare Part A premium-free if they have worked for at least 40 quarters (10 years) in jobs where either they or their spouses paid Medicare through their payroll taxes and are at least 65 years old. Documented immigrants who are 65 or older who do not have this work history can buy Medicare Part A after legally residing in the country for five continuous years.
Documented immigrants (residents, not permanent citizens) with disabilities who are under 65 can also qualify for Medicare, but in general, they first must meet the eligibility requirements for disability insurance (SSDI) that apply to citizens, which are based on work history and contribution to Social Security through income taxes; they must also have accumulated between 20 and 40 work credits (5-10 years) worth of earnings taxed by Social Security.
New immigrants are not eligible for Medicare, no matter their age. Once immigrants meet residency requirements, eligibility and enrollment function the same way as for anyone else.
What is a Medicare Advantage plan? How is it different from traditional Medicare?
Medicare Advantage is made up of private healthcare plans, such as HMOs or PPOs, that are offered by insurers who have contracts with the Medicare program to offer benefits to insured parties. Plans offer all of the benefits covered by Medicare in Parts A and B, and also generally offer prescription medication benefits from Part D.
Some Medicare Advantage plans can also provide benefits that are not covered by traditional Medicare, such as glasses, some dental care, or gym memberships. Plans also have out-of-pocket spending limits for the services covered in Parts A and B, and may have lower cost-sharing than traditional Medicare for the services covered by Medicare.
However, Medicare Advantage plans restrict the medical care providers that participants may visit (provider networks), while traditional Medicare beneficiaries can see any doctor who accepts Medicare without the need for prior authorization or order from their primary care physician.
Sources: Kaiser Family Foundation, Medicare and Medicaid Service Centers