What is the special enrollment period?
Special Enrollment Periods are times when you can sign up for Medicare even outside of the Medicare Open Enrollment Period. The open enrollment period, also called the annual enrollment period (AEP), runs from October 15 to December 7 of each year.
However, there are certain circumstances that allow you to enroll in Medicare Part A, B, or both at a different time. For example:
- If you currently have coverage through an employer group health plan (except a COBRA or retiree plan), the special enrollment period is as long as you or your spouse continues to work. (Or if you are disabled, when a family member continues to work.)
- An eight-month special enrollment period begins if either of these two events occurs: your employment ends or your employer-provided group health coverage ends. Coverage will begin the following month.
- If you’re eligible for Medicare or Medicaid (in Oregon, the Oregon Health Plan is Medicaid), you can sign up for Medicare at any time. Your enrollment period is always open.
Can I change my mind after I join a Medicare Advantage plan?
Yes, Medicare rules allow Medicare Advantage plan members a limited amount of time to override their election. This three-month period is called the Medicare Advantage Open Enrollment Period. From January 1 to March 31, you can leave the Medicare Advantage plan or cancel your enrollment and switch to Parts A and B of Original Medicare. If you disenroll, the change will take effect on the first day of the month following the date your plan receives notice of disenrollment.
To switch to Original Medicare, contact your current plan or call 800-MEDICARE
If you disenroll from Medicare Advantage, you will be able to join a Part D prescription drug plan. This is important because Original Medicare does not provide prescription drug coverage. Your new Part D drug benefits will begin the first day of the month after the plan receives your enrollment form.
The actions permitted during the disenrollment period are very limited. You can’t switch from one Medicare Advantage plan to another Medicare Advantage plan, or from a Part D plan to another plan, or from Original Medicare to a Medicare Advantage plan.
What is “Extra Help” from Medicare?
Extra Help is a government program for Medicare beneficiaries who have limited income and resources. If you qualify, Extra Help covers part of your Part D prescription drug copays. Depending on your situation, you may also be able to get help with your monthly Part D premiums and yearly deductible.
For 2021, the income limits are $19,320 a year for an individual and $26,130 for a married couple. The program also limits certain resources, such as savings, bonds, and stocks. The program does not consider other resources, such as a house, a car, and a burial plot, when analyzing eligibility. Income and resource limits usually change each year.
If you think you or a loved one might be eligible for Extra Help, it’s worth looking into. Generally, people who receive full Medicaid benefits are automatically eligible. For more information, call Social Security at 800-772-1213, TTY 711, or visit Medicare’s “Save on Drug Costs” page .
What if I don’t have creditable drug coverage?
You decide whether you want to pay out-of-pocket for all your prescription drugs or join a drug plan that Medicare doesn’t consider creditable coverage. Be careful, though, as this choice could become an expensive problem if you later (after about two months without Medicare-backed drug coverage) decide to switch to a Part D drug plan.
That’s because most people have to pay a penalty if they sign up for Part D late; this is not a one-time charge. The late enrollment penalty is added to her Part D premium for the months that she has Medicare drug coverage. (This could be a premium you pay for a stand-alone Part D plan, or a Medicare Advantage plan that includes drug coverage, or another Medicare plan that includes prescription drug coverage.)
Medicare uses a formula to calculate the Part D late enrollment penalty. The later you sign up, the more expensive the penalty will be. This topic is explained here .
Here’s the technical rule for late enrollment: After the initial enrollment period is over, Medicare considers you to be late if you enroll in Part D after 63 continuous days or more without creditable or Medicare prescription drug coverage. part d
However, there are exceptions to the Part D late enrollment penalty. For example, if you are in Extra Help with Medicare Prescription Drug Costs, you will not be charged the penalty. Generally, anyone covered by both Medicaid and Medicare automatically qualifies for Extra Help.
The bottom line is that you should think carefully before deciding whether to drop Part D or creditable drug coverage. You may not need expensive prescription drugs today, but no one can predict what will happen in the future.
What is “creditable coverage”?
This term relates to prescription drug coverage. Some Medicare beneficiaries have access to a prescription drug plan other than Medicare Part D drugs. For example, they may have drug coverage through a current or former employer or union, a spouse’s employer, the Armed Forces, Indian Health Services, or an alternative drug plan.
“Creditable coverage” means that Medicare has determined that this non-Part D prescription drug plan is expected to cover, on average, as much coverage as a standard Medicare Part D plan. Your drug plan or the Department of Human Resources will be able to tell you if Medicare considers your coverage creditable. It is an important question.
Is there a premium for Original Medicare Part A (Hospital) coverage?
Most people do not have to pay a premium for Medicare Part A. It is related to employment history. If you, your current spouse, or a former spouse paid Medicare taxes while working, you’ll probably have a $0 monthly Part A premium. Medicare calls it Premium-Free Part A. As with most Medicare benefits, there are many rules. When you enroll, you’ll know where you stand.
When should you apply for Medicare coverage?
It is best to apply three months before your 65th birthday. Are you enrolled in Social Security? If you are, you will automatically be enrolled in Medicare. The red, white and blue card will arrive three months before his birthday. If your card doesn’t arrive or you’re not yet receiving Social Security benefits, you’ll need to contact Social Security to sign up for Medicare. Do it during your Initial Enrollment Period (a seven-month period that starts three months before your 65th birthday).
What is Medicare open enrollment?
It is the period in which anyone with a red, white and blue Medicare card can buy Medicare coverage. Open enrollment always covers the same period: from October 15 to December 7. Coverage begins January 1.
Open enrollment gives you the chance to take a hard look at the premium, copay, provider network, and benefits your plan will have and decide if you want to switch. During the open enrollment period, you can join a Part D drug plan, a Part C Medicare Advantage plan, a Medigap plan, or return to Original Medicare.
You may have also heard of open enrollment as Annual Enrollment Period, Annual Election Period, AEP, or Fall Open Enrollment Season. It’s all the same.
What is an Annual Notice of Changes?
Your Medicare plan’s premium, copays, provider network, and benefits may change every January 1. That’s why each September your health plan mails you a document called the Annual Notice of Changes. It compares your current plan benefits to the next year’s benefits.
Please read the Annual Notice carefully and see if the new coverage fits your health needs and your budget. It will help you decide whether to keep your plan or explore other options.
If you have questions about the Annual Notice of Change, please call your health plan or the agent who helped you enroll.
Does Medicare cover prescription drugs?
Yes, prescription drugs are covered through a Part D plan or a Medicare prescription drug plan. To enroll in Part D, you must also be enrolled in Part A (hospital coverage) and/or Part B (medical coverage).
Beneficiaries generally obtain Part D coverage in one of two ways. They can purchase a separate Part D plan. These plans charge a monthly fee, or premium; cost varies by plan. The other way is by joining a Medicare Advantage plan that includes Parts A, B, and D. Not all Medicare Advantage plans include Part D, so be sure to ask.
What do Medicare Parts A and B cover?
Part A is hospital insurance. Covers if you are admitted to a hospital or if you are discharged from a hospital and sent to a skilled nursing facility. It also covers hospice and home health care in certain cases.
Part B is health insurance. Covers outpatient care, such as doctor visits, checkups and tests, immunizations, physical therapy, some psychotherapy, and some durable medical equipment.
What is the red, white and blue Medicare card?
It’s the ID card the federal government sends you when you sign up for Medicare. It shows the effective date of coverage and whether you are covered by Medicare Part A (Hospital), Part B (Medical), or both. Whether you call Social Security to apply or the government signs you up as you approach age 65, this card shows you have Medicare.
