Medicare Insurance Plan Enrollment Periods
Medicare Supplement Plan, Medicare Advantage Plan, & Part D Enrollment Timelines.
Applying for Medicare insurance plans.
Are you getting close to your 65th birthday month? You may already have your Medicare card, waiting for it in the mail, or you’re planning your Medicare insurance enrollment ahead of time. At this point, you’ve likely figured out the coordination of starting Medicare with Social Security. Now it’s time to view the Medicare insurance enrollment periods as you explore which Medicare plan path you’d like to choose to “supplement” or “exchange” for your Medicare coverage.
When it comes to Medicare insurance enrollment, there are different windows depending on the product you’re looking to enroll in as well as whether it surrounds your 65th birthday or another enrollment period. Of course, having varying timelines doesn’t make much sense, just as most of Medicare does not make sense. However, I’ll clearly define each enrollment period for each Medicare product, so there is less confusion with timing your Medicare insurance plan coverage.
Remember, this is the “second enrollment” when it comes to completing your Medicare Planning. If you want to review or conceptualize this “second enrollment”, please go to Step 2 of my 5 Step Medicare Enrollment Guide. This will clearly define the two different enrollments– visualize each separately. The first enrollment is starting Medicare itself, the second being your enrollment into Medicare insurance products.
Medicare Supplement Plans (Medigap)
Medicare Insurance Enrollment - Medicare Supplement Plan
If you enrolled in Medicare surrounding your 65th birthday using the Initial Enrollment Period (IEP).
Your Medicare Supplement Plan is guaranteed-issue if you are within 6 months of your 65th birthday or Part B effective date. If you used your IEP and enrolled in Medicare 3 month before your 65th birthday, you not only turn 65 the month that your Medicare becomes active, but your Part B is also active the 1st of your 65th birthday month. Therefore on an application for Medicare Supplement Plans, you are able to select the appropriate options indicating you are guaranteed-issue and skip the health questions (medical underwriting). I recommend applying 1-3 months before this 6 month window so coverage “supplements” your Medicare on day 1. The additional 6 month window is open, but 99% of my clients enroll in their insurance plan(s) prior to their Medicare start date.
If you enrolled in Medicare Part B with 40B/L564 using a Special Election Period (SEP) for Part B after leaving an employer group health plan.
In this scenario, you’ve likely worked past your 65th birthday and/or are covered through a spouse’s employer group health plan and now making the transition to Medicare. For these reasons, your Part B has been delayed because you had what’s called, creditable coverage. Using this SEP to start Part B with creditable coverage, you are now guaranteed-issue into a Medicare Supplement Plan just as you were eligible at 65. Since your effective Medicare Supplement Plan start date would now be within 6 months of your Part B effective date (likely the same day you start), you are guaranteed-issue and can skip the health questions (medical underwriting). I recommend applying for the Medicare Supplement Plan 1-3 months before the 6 month window so coverage “supplement” your Medicare on day 1.
Medicare Insurance - Medicare Supplement Plan start date:
Turning 65 or Part B Effective Date
Guaranteed-Issue Period
No medical underwriting
The next 6 months
Enrolling 1-3 months before your Medicare start date (1st of the month your Medicare starts/Part B), your Medicare Supplement Plan will be effective (guaranteed-issue) along with your Medicare on the 1st of your 65th birthday month/Part B effective date.
If you apply the month of your 65th birthday, or anytime within the next 6 months (guaranteed-issue), your Medicare Supplement Plan will start the 1st of the following month that you applied for your Med. Supp. Plan.
I recommend applying for your Medicare Supplement Plan 1-3 months before your intended start date. Although the guaranteed-issue window is the “future 6 months” after turning 65 or the start of Part B, 99% of clients want the Medicare Supplement Plan start date to coincide with the start of their Medicare effective dates on the 1st of the month. If this is you, apply with us at MedicareSupplementMentor.com prior to your effective dates so we can get you covered on day 1. I will personally work with you one-on-one to get you covered!
There are other guaranteed-issue scenarios that apply to Medicare Supplement Plans. If you have recently lost employer coverage, lost Medi-Cal in the last 6 months, or recently lost/cancelled coverage coverage due to changing residences, please contact my office to see if you qualify for guaranteed-issue for a Medicare Supplement Plan.
Medicare Prescription Drug Plans (Part D)
Medicare Insurance Enrollment - Part D Prescription Drug Plan
If you enrolled in Medicare surrounding your 65th birthday using the Initial Enrollment Period (IEP).
In the 7 month period surrounding your 65th birthday when enrolling to start your Medicare using the IEP, the Medicare Prescription Drug Plan window is open to apply. This Part D enrollment period mimics the same Medicare IEP enrollment period. Three months before your 65th birthday month, the month of, and three months after. Part D plan applications do not ask health questions, so you do not need to worry about being accepted. It is more or less a “signing up” within the window.
If you apply 1-3 months before your 65th birthday month with the intent of Medicare starting on the 1st of the month, the Medicare Prescription Drug Plan or Part D plan will also begin on the 1st of the month that your Medicare begins. If you apply in the month of, or the next three months after your 65th birthday month, your Medicare Prescription Drug Plan will begin on the 1st of the following month that you applied. It’s ideal to have your Medicare Prescription Drug Plan and Medicare Supplement Plan begin on the first date Medicare starts. I recommend applying for the insurance plan 1-3 before the start date, so you are covered as of the first of the month on your 65th birthday.
Medicare Insurance - Prescription Drug Plan start date for IEP:
3 months before 65th birthday month
Applying 1-3 months before, Part D Plan starts 1st of birthday month.
Month of 65th Birthday
Applying the month of your birthday, Part D Plan starts the 1st of the next month.
3 months after 65th birthday month
Plan starts the 1st of the month after you applied for the Part D Plan.
If you enrolled in Medicare Part B with 40B/L564 using a Special Election Period (SEP) for Part B after leaving an employer group health plan.
The rules for enrolling in a Medicare Prescription Drug Plan (Part D) are different when applying with the SEP – starting Part B when leaving an employer plan versus the 65th birthday IEP enrollment window. When you elect to start Part B at a later age (over 65 and outside IEP), you’ll have the month you’re losing coverage and the next 63 days from the last day of creditable coverage in your employer plan to elect to start Part D. Of course, you can apply before the Medicare SEP effective dates. Do this so your Part D drug plan can start along with Medicare and your Medicare Supplement Plan all on day 1 (no lapse in coverage).
Medicare Insurance - Prescription Drug Plan start date for SEP:
Before SEP Part B effective date
Apply before SEP Medicare start date, Part D (Rx) starts the1st of month Part B is effective.
Month of SEP Part B effective date
Applying the month SEP Part B is effective, Part D (Rx) Plan starts the 1st of the next month.
63 days after SEP Part B effective date
Coverage starts the 1st of the month after you have applied for the Part D (Rx) Plan.
In either scenario, applying for a Medicare Prescription Drug Plan or Part D Plan in IEP or SEP, I recommend applying a month or two before your intended start date. This insures that the Part D Drug Plan begins on the 1st of the month you need the plan’s coverage to begin without having a lapse in prescription drug coverage. Again, 99% of clients choose to enroll in a plan the month prior to the start date. Contact us to get the process planned out. If you happen to pass the 1st of the month your Medicare began, contact us so we can quickly review your options and get an application in before the end of the month. This will allow us make sure coverage begins the 1st of the following month. Applying early not only provides you with coverage, but also ensures you are not subject to the Part D late enrollment penalty!
There are some additional SEP scenarios that provide you windows to enroll and/or change your Part D plan. Contact us directly to review your specific situation. We can then present you with Medicare Prescription Drug Plan enrollment options in California and get you enrolled in the plan of your choice. To illustrate, in California, there are 22 different Part D plans you can choose from in 2024 to add or complement your Medicare Supplement Plan coverage.
Medicare Advantage Plans (Part C)
Medicare Insurance Enrollment - Medicare Advantage Plan
If you enrolled in Medicare surrounding your 65th birthday using the Initial Enrollment Period (IEP).
This one is easy to remember since it mimics the IEP window of starting Medicare. The Medicare Advantage Plan enrolled period is exactly the same as the IEP when turning 65. So, three months before your 65th birthday month, the month of, and three months after is your window to apply. These plans do not have health questions like Medicare Supplement Plan applications. Therefore, it’s more about timing the right window and “signing up” for the plan of your choice. If you apply before your 65th birthday month with the intent of Medicare starting on the 1st of the month, the Medicare Advantage Plan or Part C plan will also begin on the 1st of that month. If you apply in the month of, or the next three months after your 65th birthday month, your Medicare Advantage Plan will begin on the 1st of the month after that you applied. The health portion and prescription portion of your Medicare Advantage/Part C plan will begin on the same day. Again, as this is a “bundled” plan.
Medicare Insurance - Medicare Advantage Plan start date for IEP:
3 months before 65th birthday month
Applying 1-3 months before, Part C Plan starts 1st of birthday month.
Month of 65th Birthday
Applying the month of your birthday, Part C Plan starts the 1st of the next month.
3 months after 65th birthday month
Plan starts the 1st of the month after you applied for the Part C Plan.
If you enrolled in Medicare Part B with 40B/L564 using a Special Election Period (SEP) for Part B after leaving an employer group health plan.
The rules that apply to Part C plan enrollment are slightly different because they most often include a Medicare Prescription Drug Plan (Part D). Since a Part D plan is typically included in your Medicare Advantage Plan, the window of time is shorter to enroll in a Medicare Advantage Plan than it is for a Medicare Supplement Plan- guaranteed-issue. Again, you will not have to answer health questions. Therefore, this is more or less about “just signing up” in the proper window of time after you’ve activated the SEP with form 40B and L564 to activate your Part B of Medicare when older than 65 and leaving an employer group health plan with creditable coverage.
When you activate your Part B (Medicare) using this SEP, you will be able to apply for a Medicare Advantage Plan prior to your Medicare effective dates for the Medicare Advantage Plan to begin on the 1st of the month you specified. You will also have up to 63 days to make an election into a Part C/Medicare Advantage Plan if you did not before your Medicare is active. If you apply within the 63 days, the Medicare Advantage Plan will become effective the 1st of the month after you applied.
Medicare Insurance - Medicare Advantage Plan start date for SEP:
Before SEP Part B effective date
Applying before SEP Medicare start date, Part C starts 1st of month the Part B is effective
Month of SEP Part B effective date
Applying the month SEP Part B is effective, Part C Plan starts the 1st of the next month.
63 days after SEP Part B effective date
Coverage starts the 1st of the month after you applied for the Part C Plan.
In either scenario, applying for a Medicare Advantage/Part C Plan in IEP or SEP, I recommend applying a month or two before your intended start date. This insures that the Part C plan begins on the 1st of the month you need the plan’s coverage to begin without having a lapse in health coverage or prescription drug coverage. Again, 99% of clients choose to enroll in a plan prior to the start date, so contact my office to get started planning. If you happen to be past the 1st of the month your Medicare began, contact us so we can quickly review your options and get an application in before the end of the month so you have coverage beginning the 1st of the following month. Applying early, not only provides you with coverage, but also ensures that you are not subject to the Part D late enrollment penalty!
There are some additional SEP scenarios that provide you windows to enroll and/or change your Medicare Advantage/Part C plan. Contact us directly to review your specific situation. We can then present you with Medicare Advantage Plan/Part C enrollment options in your county and get you enrolled in the plan of your choice.
