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Updated onJun. 10, 2022

How Do Medicare Special Enrollment Periods Affect You?

If you are thinking about your Medicare coverage and wondering when you can participate in one of the Medicare Special Enrollment Periods, here are some of the things you should know.

Medicare Enrollment Period

How Do You Know If You are Eligible for Medicare?

There are two categories in which you can determine if you are eligible for Medicare:

If you are 65 years old or older, you automatically qualify for Medicare, simply based on your age.

If you are under 65 years old, then one of the following have to apply to you in order for you to qualify:

  • You suffer from end-stage renal disease (ESRD)
  • You suffer from a serious qualifying disability, such as Amyotrophic Lateral Sclerosis (or ALS)

Once you qualify for Medicare, there is a seven-month Initial Enrollment Period in which you are able to enroll in Medicare Part A and Part B. 

If you have received Social Security disability or Railroad Retirement Board benefits for at least 24 months, you will also qualify for Medicare coverage.

Now, one question still remains: once you are eligible for Medicare: What are the Special Enrollment Periods for Medicare?

The Medicare Special Enrollment Period — Explained

Once you qualify for Medicare, there is a seven-month Initial Enrollment Period in which you are able to enroll in Medicare Part A and Medicare Part B, also know as Original Medicare.

If you are eligible to enroll in the Medicare program when you turn 65 years old, you have three opportunities to sign up for Medicare during the Initial Enrollment Period (IEP).

  1. Three months before you turn 65 years old
  2. The exact month you turn 65 years old (your birthday month)
  3. Three months after you turn 65 years old

If you do not take advantage of the Initial Enrollment Period for Medicare, there is still a chance to sign up for the Medicare program via a Medicare Special Enrollment Period.

There are many circumstances in which it would be appropriate for you to enroll in Medicare during a Special Enrollment Period. Some of these circumstances include the following:

  • If you have moved to a new location
  • If you have lost other insurance coverage
  • If you are eligible for both Medicare and Medicaid

Additionally, there is an eight-month Special Enrollment Period in which you can enroll in Medicare Part A and Part B. This period will begin at one of these instances:

  • A month after your employment ends
  • A month after your group health insurance plan, which was based on the time that your employment ends.
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Medicare Part B Special Enrollment Period

Once you are eligible for Medicare and it is time to enroll, it is best to sign up for your Medicare Part B plan as soon as possible. 

If you wait too long — until the exact month that you turn 65 years old and beyond — there could be a serious gap in your healthcare coverage. You do not want to put yourself in a position where you need medical assistance, yet cannot receive the help that you need because your Medicare coverage has not kicked in yet.

There are many circumstances in which it would be appropriate for you to enroll in Medicare during a Special Enrollment Period.

It is also important to note that if you don’t enroll in Medicare Part B during the time window that you first become eligible for it, a late enrollment penalty will be applied.

When To Enroll In A Special Enrollment Period If You Have Disability Benefits

If you already have disability benefits, you do not have to worry about enrolling in Medicare Part A and Part B. This is because you will be automatically enrolled to receive Medicare Parts A and B coverage due to your disability benefits.

Late Enrollment Penalty

This is a penalty in which your monthly premium can increase up to 10% for each 12-month period that you could have been enrolled in Medicare Part B, yet did not sign up at the appropriate time.

Every time you pay your premiums, as long as you have Medicare Part B coverage, you will have to pay for this penalty. Plus, this penalty will increase over the amount of time you delay in enrolling in Medicare Part B.

Sometimes you will not have to pay a late enrollment penalty, but this is only if you meet the requirements of enrolling in Medicare Part B during a Special Enrollment Period.

Medicare General Enrollment Period

The Medicare General Enrollment Period takes place every year between January 1 and March 31. If the following applies to you, this is the time that you should enroll in Medicare:

  1. When you originally became eligible, you did not enroll in Medicare Part A and/or Part B.
  2. The option for enrolling during a Special Enrollment Period is not applicable to you.

Special Enrollment Period for Medicare Advantage and Prescription Drug Plans

There are two separate enrollment periods that occur each year for Medicare Advantage and prescription drug plans.

  • Open Enrollment Periods for Medicare Advantage and prescription drug plans are from October 15 through December 7.
  • During this time, you are able to:
  • Enroll in a prescription drug plan
  • Switch Medicare prescription drug plans
  • Disenroll from a prescription drug plan
  • Open Enrollment Period for Medicare Advantage Plans occur from January 1 through March 31. During this time, you are able to switch Medicare Advantage plans.

Making sure that you take advantage of the right enrollment period at the right time is essential for ensuring that you are maintaining continuity in your medical coverage.

Making sure that you take advantage of the right enrollment period at the right time is essential for ensuring that you are maintaining continuity in your medical coverage.

It is simple to see which enrollment period applies to you. All you need to do is review your circumstances, find the timeframes for the different enrollment periods, and determine your Medicare eligibility.