Medicare Eligibility and Enrollment Periods

Nothing about Medicare is crystal clear, particularly eligibility and enrollment periods. But that’s why we’re here.

At Florida Medicare Specialists, we work for you and make sure you understand all the ins and outs of Medicare—from the different Parts to various enrollment periods, penalties, and more.

When it comes to Medicare, you shouldn’t wait until your 65th birthday is right around the corner to understand what you’re getting and what your options are. It’s important to do your research early, starting with understanding Medicare eligibility and enrollment periods.

Many seniors confuse the eligibility rules for Medicare and Social Security. Although initial enrollment in Medicare is processed by the Social Security Administration, it’s important to remember that these two federal programs are distinctly separate.

Who Is Eligible for Medicare?

For the overwhelming majority of people, to be eligible to enroll in Medicare you must meet the following requirements:

• You must be 65 or older
• You must be a US citizen
• You must be a Legal Resident in the US for at least 5 years

However, you will also qualify for enrollment in Medicare at any age if:

• You are diagnosed with End Stage Renewal Disease (ESRD), which is kidney disease that requires dialysis
• You are diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
• You are awarded Social Security disability. You will be automatically enrolled in Medicare on the 24th month of Social Security disability

What Are the Medicare Enrollment Periods?

Medicare establishes various Enrollment Periods during which you may enroll in Parts A, B, C, or D, or you may change your enrollment in each of these Parts of Medicare.

If you qualify for enrollment in Medicare by reaching age 65 and you are receiving Social Security retirement benefits, you will be automatically enrolled by the Social Security Administration. Very easy.

If you have not elected Social Security retirement benefits prior to reaching age 65, you will need to take action to enroll in Medicare, and you will need to pay close attention to Medicare rules for the Initial Election Period.

Failure to act within set time limits or failure to follow rules may result in delays in coverage and lifelong penalties.

Initial Election Period (IEP)

The IEP is the seven-month period that begins three months prior to the month you reach age 65 and extends until the end of three months after you reach 65.

During IEP you should enroll in Parts A, B and D, to avoid paying penalties. But, as always with Medicare there is an exception. In addition, you may enroll in Part C (Medicare Advantage) or Medicare Supplement Plans during IEP.

But, as always with Medicare, there is an exception.

Is enrollment in Parts A, B, and D mandatory during IEP? The answer is YES, UNLESS you work for an employer that employs more than 20 employees AND you are enrolled in the employer’s group health insurance plan.

It’s crucial that you understand the IEP requirements. The penalties you incur for late enrollment are charged each year, not one time only.

Annual Enrollment Period (AEP)

AEP, commonly referred to as the Open Enrollment Period, takes place every year between October 15th and December 7th. During this time, you are permitted to add, delete, or change Parts C and/or D.

Any changes you make will be effective on January 1st. You are permitted an unlimited number of changes during AEP.

Medicare Advantage Open Enrollment Period (MAOEP)

The MAOEP is only for those who are enrolled in a Medicare Advantage Plan and decide to switch to a different plan. MAOEP begins January 1st of each year and ends March 31st.

During this enrollment period you are permitted to make one change. The change can be from one Medicare Advantage Plan to another one, or you may disenroll from your plan and return to Medicare Part A and B and add a stand-alone Part D Plan (prescription plan).

The primary reason this enrollment period exists is for those who discover, after the AEP has ended, that their MA Plan is not the best plan for their needs. MAOEP now allows that problem to be corrected.

Special Enrollment Periods (SEP)

SEP’s were created to allow those enrolled in Medicare Advantage Plans and stand-alone Part D plans, to change, or enroll in a new plan, in situations where they lose enrollment in a current plan for reasons out of their control, such as the plan withdrawing from the market, Medicare failing to renew a plan, or a variety of additional reasons.

When an SEP is triggered, the enrollee will have up to 60 days to enroll in a new plan.

If you believe you’re eligible for an SEP, please contact Florida Medicare Specialists so we can address your questions directly.

General Election Period (GEP)

The GEP is the “catch all” enrollment period. for anyone who has failed to enroll in Part B in a timely manner. The GEP begins on January 1st of each year and ends on March 31st.

If you enroll in Part B during the GEP your coverage will be delayed until July 1st following your enrollment.

This is the enrollment period you never want to find yourself in because late enrollment penalties are likely to apply.

Contact Florida Medicare Specialists With All Your Medicare Eligibility and Enrollment Questions

Eligibility requirements and enrollment periods are not always as straightforward as they seem. That’s why we’re here.
At Florida Medicare Specialists, we’ll guide you through your options and explain the different enrollment periods to help you avoid penalties.

We’re available by phone, email or contact form, and we’ll be in touch right away to get your questions answered!