Medicare Enrollment Periods
Understanding Medicare enrollment periods can be confusing. It’s important to distinguish between enrollment for Original Medicare Part A and Part B, Medicare Supplement (Medigap) plans, Prescription Drug Plans (PDP), and Medicare Advantage Plans (MAPD).
Original Medicare (Part A & Part B)
- If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits, you’ll generally be automatically enrolled in Medicare Part A (Hospital) and Part B (Medical). Coverage typically begins the first day of the month you turn 65. If your birthday falls on the 1st of the month, coverage begins the month prior.
- If you’re under 65 and receiving Social Security disability benefits, Medicare coverage generally begins on the 25th month of disability benefits.
- If you are not receiving Social Security or RRB benefits, you’ll need to enroll yourself. You can contact Social Security directly or, to save time, we can help you create your Social Security portal and assist with your online Medicare application.
- We recommend applying approximately three months before turning 65 to allow enough time for processing or additional documentation requests.
- If you’re actively working for an employer with more than 20 employees, you may only want to enroll in premium-free Part A since your employer coverage is usually primary.
Leaving employer coverage after age 65 is one of the most common reasons people qualify for a Medicare Special Enrollment Period. We recommend contacting us before leaving your employer plan to ensure a smooth transition.
You generally have an 8-month Special Enrollment Period beginning the month after your employment or employer coverage ends, whichever occurs first. Please note that COBRA coverage does not count as active employer coverage for Medicare enrollment purposes.
We’ll help you complete the proper paperwork to avoid late enrollment penalties and delays in coverage.
If you missed your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you may enroll in Medicare Part B during the General Enrollment Period from January 1 through March 31 each year.
You may also enroll in Part A during this period if you are not eligible for premium-free Part A.
Please note: your Part B premium may increase by 10% for each full 12-month period you were eligible for Part B but did not enroll.
Medicare Advantage (MAPD) & Prescription Drug Plan (PDP) Enrollment Periods
You may join, switch, or drop a Medicare Prescription Drug Plan (PDP) or Medicare Advantage Plan (MAPD) during the following enrollment periods:
When you first become eligible for Medicare, you generally have a 7-month Initial Enrollment Period:
- 3 months before the month you turn 65
- The month you turn 65
- 3 months after the month you turn 65
If you enroll in Medicare Part B for the first time during the General Enrollment Period, you generally have 2 months to join a Medicare Advantage or Prescription Drug Plan.
From October 15 through December 7 each year, you may join, switch, or drop a Medicare Advantage or Prescription Drug Plan. Coverage becomes effective January 1.
If you are already enrolled in a Medicare Advantage Plan, you may make a one-time change from January 1 through March 31 each year. During this period, you can:
- Switch to another Medicare Advantage Plan, or
- Return to Original Medicare and enroll in a standalone Prescription Drug Plan
Coverage generally begins the first day of the month following your enrollment request.
Certain life events may qualify you for a Special Enrollment Period, including:
- Losing employer coverage
- Moving outside your plan’s service area
- Gaining or losing Medi-Cal eligibility
- Qualifying for “Extra Help”/Low Income Subsidy (LIS)
- Qualification for a Chronic Special Needs Plan (C-SNP) due to eligible health conditions
- Natural disasters or other exceptional circumstances
If you enroll in Medicare Part A or Part B during a Special Enrollment Period related to exceptional circumstances, you generally have 2 months to enroll in a Medicare Advantage or Prescription Drug Plan.
Medicare Supplement (Medigap) Enrollment Periods
Your Medicare Supplement (Medigap) Open Enrollment Period begins the first month you are both:
- Age 65 or older, and
- Enrolled in Medicare Part B
This enrollment period lasts for 6 months. During this time, you may enroll in a Medicare Supplement plan without answering medical questions.
Know Your Rights
Medicare Supplement Trial Rights
Federal Medicare rules provide trial rights in certain situations:
- If you joined a Medicare Advantage Plan when first eligible for Medicare at age 65 and leave the plan within 12 months, you may have guaranteed issue rights to purchase a Medicare Supplement plan.
- If you dropped a Medicare Supplement plan to try a Medicare Advantage Plan for the first time, you generally have a 12-month trial period to return to your Medicare Supplement coverage.
Additional California Guaranteed Issue Rights
California provides additional guaranteed issue protections for Medicare Supplement enrollment, including:
- Loss of employer group coverage while enrolled in Original Medicare
- Medicare Advantage plan termination in your service area
- California Birthday Rule (beginning 30 days before your birthday and ending 60 days after)
- Medicare Advantage plan increases in copayments and/or premiums of 15% or more
- Loss of Medi-Cal eligibility
Unlike Medicare Advantage and Prescription Drug Plans, Medicare Supplements do not have an annual open enrollment period. If you apply outside your Open Enrollment Period or a qualifying Special Enrollment Period, medical underwriting and health questions will apply.
Carriers We Represent
-
Anthem Blue Cross (Elevance)
-
Aetna
-
Alignment Health Plan
-
Beam
-
Blue Shield of CA
-
Cigna
-
Delta Dental
-
Health Net
-
HealthSpring
-
Humana
-
Kaiser
-
Imperial Health Plan of California
-
LA Care
-
Medico/Wellabe
-
Molina
-
SCAN
-
Sutter Health
-
UCLA Health Medicare Advantage
-
United Concordia
-
UnitedHealthcare / AARP
-
VSP
-
WellCare / Centene
Questions About Medicare Enrollment?
Call us for assistance with Medicare eligibility, enrollment periods, plan benefits, Medicare Supplements, Medicare Advantage Plans, and Prescription Drug Plans.