Medicare 101: An Overview

ORIGINAL ENROLLMENT

You can join, switch, or drop Medicare Advantage or a Medicare drug plan:

• If you can get Medicare because of your age, the original period for enrollment is a seven month period which starts 3 months before the month you turn 65. It continues for 3 months after the month in which you were born. For example, if your birthday is July 6, you can start applying April 1. The open enrollment continues until October 31. 
• If you get Medicare due to a disability, the original enrollment period relates to your 25th months after the onset of your disability. Eligibility starts during the 3 months before your 25th month of disability and continues until your 25th month after. You will have another chance to join 3 months before the month you turn 65 to 3 months after the month you turn 65.

SPECIAL ENROLLMENT

• You can enroll in a Medicare Advantage or Part D Plan in your area with an overall 5 star rating any time during the year. This special enrollment period can only be used once a year. The special enrollment period begins December 8 of the year before the plan is considered to be a 5 star plan and ends November 30 of the year the plan is considered to be a 5 star plan. Enrollments are effective the first of the following month. You must live in the service area covered by the plan.
• If you didn't sign up for Medicare Part B when you were first eligible because you or your spouse was working and had group health plan coverage through an employer or union based on this current employment, you may be eligible for a Special Enrollment Period. If this applies to you, you can sign up for Medicare Part B any time you are still covered by the employer or union group health plan through your (or your spouse's) current or active employment, or during the eight months following the month the group health plan coverage or the employment ends (whichever is first). Your Medicare Part B coverage will begin:
  • The month you enroll in Medicare Part B if you enroll while you are covered under the group health plan based on current or active employment, or during the first full month after the coverage or employment ends (whichever comes first). You can also delay the start date for Medicare Part B coverage until the first day of any of the following three months; or
  • The month after the month you enroll if you enroll during the remaining 7 months of the Special Enrollment Period.

HOW TO ENROLL

You can enroll in Medicare by  either:

• Calling Medicare at 800 Medicare or you can enroll online at www.Medicare.gov . Look in the "Getting Started" section, or
• By calling a Medicare Advantage plan directly.

Medicare Rights Center recommends that people enroll by calling Medicare to reduce chances of administrative error.

If you are already in a Medicare Advantage plan,:

• If you want to move to another Medicare Advantage plan: You do not have to disenroll from the old plan when choosing a new one. In fact, it is preferred that you just enroll in the new plan. The old plan will automatically be advised of your change. This system avoids the potential for any gaps in coverage because the old coverage will not stop before the new one starts. 
• If you want to move to Original Medicare: enroll in a prescription drug plan.

CHANGES

During October each year, information is published about the coming year for Original Medicare and Medicare Advantage plans.

Original Medicare

You have from October 15 to December 07 to change plans for the coming year.

New coverage begins January 1 of next year. 

Medicare Advantage

You can change plans between October 15 and December 07. Your coverage will begin on the first of next year.

If you are in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare during the period between January 1–February 14. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

During this period, you cannot do any of the following:

• Switch from Original Medicare to a Medicare Advantage Plan. 
• Switch from one Medicare Advantage Plan to another. 
• Switch from one Medicare Prescription Drug Plan to another. 
• Join, switch, or drop a Medicare Medical Savings Account Plan. 

In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan at other times. Some of these situations include the following: If you move out of your plan’s service area. If you qualify for Extra Help. Or if you live in an institution (such as a nursing home).

Part D Drug Coverage

You can sign up between October 15 and December 7. Your coverage will begin on January 1, as long as the plan gets your enrollment request by December 7. 

You can sign up anytime, if you qualify for  Extra Help.

In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans at other times. Some of these situations include the following:

• If you move out of your plan’s service area; 
• if you lose other creditable prescription drug coverage  
• If you live in an institution (such as a nursing home).  
• If you want to move to a Medicare Advantage plan with a  5 star rating.

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