Knowing Medicare’s key dates and deadlines can save you from potential penalties and ensure you get the coverage you need. In this article, we’ll break down the important details in simple terms so you can confidently manage your Medicare choices.

Understanding Eligibility for Medicare

Before exploring the enrollment periods, it's crucial to understand the eligibility criteria for Medicare. Here’s a breakdown of who qualifies:

  • U.S. Citizenship or Permanent Resident: You must be a U.S. citizen or a permanent resident who has lived in the U.S. for at least five consecutive years.
  • Age 65 or Older: Most individuals become eligible for Medicare when they turn 65. If you or your spouse have paid Medicare taxes for a sufficient period, you may qualify for premium-free Part A. Part B, however, usually requires a monthly premium.
  • Under 65 with Disabilities: You may qualify for Medicare if you have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or if you have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD).
  • Specific Medical Conditions: Individuals with ESRD or ALS qualify for Medicare regardless of age, provided they meet certain criteria related to work history or family connections.

Additionally, if you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Parts A and B upon turning 65. If you are not receiving these benefits, you will need to enroll yourself. Learn more about eligibility. 

Key Enrollment Periods to Remember

There are several enrollment periods in Medicare, each serving a specific purpose. Missing these can lead to delayed coverage or penalties, so it’s crucial to mark your calendar.

1. Initial Enrollment Period (IEP)

  • When: A seven-month window surrounding your 65th birthday, beginning three months before, including your birthday month, and ending three months after.
  • What You Can Do: Enroll in Medicare Parts A and B. After enrolling in Parts A and B, you can choose to enroll in Part C (Medicare Advantage) or Part D (prescription drug coverage).

2. General Enrollment Period (GEP)

  • When: January 1 to March 31 each year.
  • What You Can Do: If you missed your IEP, you can enroll in Medicare Parts A and B during this period. Coverage begins on July 1 of the same year.

3. Special Enrollment Period (SEP)

  • When: Varies based on qualifying events, such as losing employer coverage or moving out of your plan’s service area.
  • What You Can Do: Enroll in Medicare Parts A and B without penalty if you have qualifying circumstances, such as being covered under an employer’s plan when you turn 65.

4. Medicare Advantage Open Enrollment Period

  • When: January 1 to March 31 each year.
  • What You Can Do: Switch from one Medicare Advantage plan to another or switch from a Medicare Advantage plan to Original Medicare.

5. Annual Open Enrollment Period (AEP)

  • When: October 15 to December 7 each year.
  • What You Can Do: Make changes to your Medicare Advantage or Part D plans. This is the time to switch plans, join a new plan, or drop coverage

6. 5-Star Special Enrollment Period

  • When: December 8 to November 30 each year.
  • What You Can Do: Switch to a 5-star rated Medicare Advantage or Part D plan once per year.

Learn more about enrollment periods.

Avoiding Late Enrollment Penalties

One of the biggest concerns with missing enrollment deadlines is the potential for late enrollment penalties, which can significantly increase your costs. For example:

  • Part B: If you delay enrolling in Part B and don’t qualify for a Special Enrollment Period, you could face a penalty of 10% for each full 12-month period that you could have had Part B but didn’t sign up. This penalty is added to your monthly premium and lasts as long as you have Part B.
  • Part D: The penalty for Part D is 1% of the national base beneficiary premium for each month you delay enrollment. This penalty is permanent and added to your monthly premium.

Stay Ahead of the Deadlines

Understanding these key dates and deadlines is essential to managing your Medicare coverage effectively. By knowing when and how to enroll, you can avoid unnecessary penalties and ensure you have the coverage you need when you need it. Remember, Medicare isn’t a “set it and forget it” kind of program—it requires your attention at these critical times of the year.

If you’re feeling unsure about when or how to enroll, consider consulting with a Medicare advisor for personalized guidance and support or taking a Medicare class on GetSetUp. Staying informed is the best way to ensure your health coverage is in place when you need it.

Reviewed By: Keith Gilbert