Medicare Enrollment Periods and their Overlapping

According to Medicare rules, you are not allowed to enroll or disenroll in different parts of Medicare (Part A, Part B, Part C, and Part D) whenever you want. Rather, there are 6 different enrollment periods in relation to the different parts of Medicare. Below we describe Medicare enrollment periods, and rules of applying them when they are overlapping each other.

Medicare Enrollment Periods

Initial Enrollment Period

7-month period that begins 3 months before you turn age 65, or, in the case of disability, 3 months before your 25th month of disability. You can sign up anytime during the Initial Enrollment Period. If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, your coverage will start in most cases the first day of your birthday month. However, by waiting until you are 65 or older, your Medicare coverage will be delayed. As long as you’ve signed up for Part A and Part B, you also may use this period to sign for Part C and Part D.

General Enrollment Period

People who did not enroll in Part A or B during their Initial Enrollment Period may enroll in either one or both parts during the General Enrollment Period (GEP), which is January 1 to March 31 of each year. Your benefits will begin the following July 1.

Annual  Election  Period

The Annual Election Period (AEP) is running from October 15 to December 7 of every year. During this time, people can join, change or drop a Part C (Medicare Advantage) or Part D (Prescription Drug) plan. Coverage begins January 1.

Special Enrollment Period (SEP)

A Special Enrollment Period (SEP) exists for Part B. It is defined as a set time when you can sign up for Medicare Part B if you didn’t take Medicare Part B during the Initial Enrollment Period, because you or your spouse were working and had group health plan coverage through the employer or union. You can sign up at any time you are covered under the group plan based on current employment status. Alternatively, you may sign up during eight months starting the month after the employment ends or the group health coverage ends, whichever comes first.

Special Election Period (SEP)

Special Election Periods (also referred to as SEPs) exist for Part C (Medicare Advantage) and Part D plans in certain circumstances. They are defined as the time that a beneficiary can change health plans or return to Original Medicare, such as: you move outside the service area, your Medicare Advantage plan violates its contract with you, the organization does not renew its contract with CMS, or other exceptional conditions determined by CMS. The Special Election Period is different from the Special Enrollment Period.

Medicare Advantage Disenrollment Period (MADP)

Held January 1 through February 14. During this time Medicare Advantage members can disenroll from their current plan, but only return to Original Medicare. They can also select a PDP for Part D coverage.

Open Enrollment Period for Institutionalized Individuals (OEPI)

The OEPI is continuous enrollment period for eligible individuals to enroll in or disenroll from a Part C (Medicare Advantage – Special Needs Plan). For purposes of enrollment under the OEPI election period, an institutionalized individual is defined as an individual who moves into, resides in, or moves out of an institution. The OEPI ends two months after the month the individual moves out of the institution.

 

Order for overlapping Medicare Enrollment Periods – Part A and Part B

In the case where an individual qualifies for more than one enrollment period, the order for Medicare enrollment periods is:

  1. Initial Enrollment Period (IEP)
  2. Special Enrollment Period (SEP)
  3. General Enrollment Period (GEP)

Both the Special Enrollment Period and the General Enrollment Period are only available following the end of an individual’s IEP.  This means that the individual must be out of their IEP before they can use the SEP to enroll. If an individual tries to use the SEP and enroll during the last 3 months of his/her IEP, the enrollment will be processed as an IEP enrollment and the individual will have a delay in the start of the Part B coverage.

Order for overlapping Medicare Enrollment Periods – Part C and Part D

In the case where an individual qualifies for more than one enrollment period, use the following hierarchy to determine which enrollment period to use

  • 1: Initial Enrollment Period (ICEP/IEP)
  • 2: Special Election Period (SEP)
  • 3-4: Annual Election Period (AEP) and Medicare Advantage Disenrollment  Period (MAPD)
  • 5: Open Enrollment Period Institutional (OEPI)

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