What to Do If You Missed the Medicare Enrollment Period

Uh Oh. Missed the Enrollment Period?

Maybe you were busy, or it just slipped your mind, but now that the enrollment periods are over, when can you sign up for Medicare? Medicare enrollment periods can be overwhelming at first, but depending on your circumstances, you might still be eligible to enroll in Medicare without realizing it!

The Enrollment Seasons of Medicare

There are two major Medicare enrollment periods that take place each year: Annual Enrollment, from October 15 – December 7, and Open/General Enrollment from January 1 – March 31. However, for most people, these enrollment periods are primarily for making modifications to coverage.

Generally speaking, there are four reasons why you’d need to enroll in Medicare outside of the typical enrollment periods.

• You’ve just turned 65, or have otherwise become eligible for Medicare.
• You’ve experienced a life-changing circumstance, like retirement or moving, that has left you without your existing coverage.
• You’re only enrolled in one part of Original Medicare (Part A or Part B) and want to expand your coverage.
• You’ve put off enrollment for some reason, and now are looking to enroll.

There are ways to address these circumstances that, in most cases, will allow you to get coverage as soon as the month after you enroll. However, the way of getting coverage will vary depending on your circumstances.

Medicare for the Newly Eligible

Medicare for the Newly Eligible

The majority of people become eligible for Medicare upon turning 65, though people with certain conditions are eligible at any age. However, this doesn’t mean that you need to wait until the day you turn 65 to enroll. You don’t even need to wait until the month you turn 65. 

Everyone eligible for Medicare is entitled to an Initial Enrollment Period (IEP). If you’ve aged into Medicare, this period begins three months before the month you turn 65, and ends three months afterward, for a total of seven months. So, if you were born August 27th, your IEP would begin May 1 and end November 30. 

It’s likely your IEP will overlap with one of the yearly enrollment periods, but this doesn’t mean you should put things off. Failing to apply for Medicare when you’re first eligible can lead to financial penalties, such as increased premiums. 

Exceptional Circumstances

Life happens. Maybe you were getting coverage through your employer but retired this year. Maybe you moved to a new location, and your former Medicare Advantage plan couldn’t follow you. You might even be newly eligible for Medicare thanks to a recent marriage, depending on your work history. However, it’s nowhere near an enrollment period, and you aren’t in your initial enrollment, so what do you do? That’s where the Medicare Special Enrollment Period (SEP) comes in.

There’s no single SEP, nor is there a standard duration for said period. Instead, your eligibility and the length of the enrollment period vary depending on the qualifying circumstance. 

Examples of qualifying circumstances include:

• Losing Medicaid coverage.
• Missing your IEP due to a natural disaster or emergency.
• Missed your IEP because you got inaccurate or misleading information from your health plan provider or employer.
• Missed your IEP due to incarceration..
• Losing group health coverage offered by either your own or your spouse’s employer.
• Returning to the US after volunteering for a nonprofit organization overseas.
• Other exceptional circumstances.

You do NOT qualify for a SEP if you’ve lost your COBRA or Marketplace coverage. 

If you qualify for a SEP, you can freely submit a Medicare application at any point during the appointed period. However, exceptional circumstances aren’t the only reason one might qualify for a SEP.

Be Aware: If you’re already enrolled in a Medicare Advantage plan and lose that coverage due to a special circumstance, you’ll simply be switched back to Original Medicare. You’ll lose any additional benefits offered by your Part C plan, but will still have the standard Medicare benefits.

The 5-Star SEP

Medicare Advantage plans have official star ratings, which are a general indicator of the plan’s overall quality of care. 5-Star plans are among the best, and there are a lot of incentives to enroll. The most notable, however, is the 5-Star Special Enrollment Period.

The 5-Star SEP  is an enrollment period you can use at any time between December 8 and November 30 of the following year, which allows you to sign up for a 5-Star Medicare Advantage, Part D, or Cost Plan. That is, only a 5-Star Plan. This, unfortunately, does not include Original Medicare: if you’re not already enrolled in Original Medicare, you can’t use the 5-Star SEP to enroll at any time. Also, if a 5-Star plan isn’t available in your area, you can’t use this benefit either. The 5-Star SEP is a useful tool, but it’s no free pass.

None of these apply to me! What should I do?!

First, don’t panic. This isn’t an all-inclusive list of qualifying factors. If you want to find specific information about your specific circumstances, you can call one of our licensed agents at (800) 950-0608. We’ll confirm your eligibility (or lack thereof) and give you options on how to proceed. There might be an edge case we forgot to cover in this article.

In the event you really don’t qualify, you simply can’t enroll in Medicare until an enrollment period. If someone attempts to sell you Medicare coverage without first confirming your eligibility for an enrollment period, they’re violating the law and likely trying to scam you. Don’t fall for it. 

If you have yet to enroll in Medicare, you can still enroll in a private insurance plan. However, as the enrollment periods for the Healthcare.gov marketplace roughly line up with those for Medicare, this isn’t much of a help. What you can do, however, is seek out short-term health insurance. These are offered through private insurance companies and are designed to provide insurance coverage for people caught without coverage between enrollment periods. However, they come with some pretty big catches.

These plans aren’t subject to Affordable Care Act (ACA) regulations. This means that they may not meet the minimum level of coverage established by the ACA, and may deny coverage to people with pre-existing conditions. As such, they’re only recommended for use by reasonably healthy individuals in emergencies. These plans also won’t protect you from the financial penalties for late enrollment. Each year you fail to sign up for Part B coverage is a 10% penalty to your monthly premium, which can add up very quickly.

It’s best to enroll in Medicare as soon as you are able. If you’re unsure about your eligibility, we can help. Our licensed insurance agents are waiting to take your call at (800) 950-0608, and our free comparison tool is available 24/7. No matter where you are in the Medicare enrollment process, we’re ready to help.