Medicare Advantage Open Enrollment Period
Jan 1 – Mar 31
Introduction to Medicare
Introduction to Medicare
Medicare is a federal health insurance program in the United States that primarily serves individuals aged 65 and older and certain younger individuals with specific disabilities or medical conditions. The program was established in 1965 under the Social Security Administration and is designed to provide a safety net for healthcare coverage.
Eligibility and Enrollment
Medicare eligibility is primarily based on age, disability status, or specific medical conditions. Here are the main categories of individuals who are eligible for Medicare:
- Individuals Aged 65 and Older: Most individuals become eligible for Medicare when they turn 65. This includes U.S. citizens and permanent residents who have lived in the country for at least five continuous years.
- Individuals Under 65 with Disabilities: Individuals under the age of 65 may be eligible for Medicare if they have received Social Security Disability Insurance (SSDI) benefits or certain Railroad Retirement Board disability benefits for at least 24 months.
- Individuals with End-Stage Renal Disease (ESRD): Individuals of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) are eligible for Medicare.
- Individuals with Amyotrophic Lateral Sclerosis (ALS): Individuals of any age diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, are eligible for Medicare immediately upon receiving Social Security Disability benefits.
It’s important to note that eligibility for Medicare is not automatic for everyone. Some individuals are automatically enrolled, while others may need to take specific steps to enroll in Medicare. Automatic enrollment typically occurs for individuals receiving Social Security benefits or Railroad Retirement benefits when they turn 65.
For those not automatically enrolled, there are specific enrollment periods, and individuals may need to sign up for Medicare during these periods to avoid potential late enrollment penalties. The Initial Enrollment Period (IEP) begins three months before the individual turns 65 and extends for seven months (three months before, the month of, and three months after the 65th birthday).
Understanding the eligibility criteria and enrollment process is crucial to ensure timely access to Medicare coverage. Individuals can contact the Social Security Administration or visit the official Medicare website for personalized information regarding their eligibility and enrollment options.
Important Dates
Initial Enrollment Period (IEP)
Your IEP includes your 65th birthday month, the 3 months before and the 3 months after.
- Example: You turn 65 on June 7. Your IEP is March 1 – September 30. If, however, your birthday is on the 1st of the month, then your IEP is determined as though you were born the month before.
- Example: You turn 65 on June 1. Your IEP is February 1 – August 31.
Special Enrollment Period (SEP)
Timing depends on the reason for SEP
- Example: moving, low income, qualify for a Special Needs Plan (SNP)
Consult with a Licensed Insurance Agent for all available options
Annual Election Period (AEP)
Oct 15 thru Dec 7
Enroll in a Medicare Advantage plan for the next calendar year
Enroll in a standalone Part D drug plan for the next calendar year
Open Enrollment Period (OEP)
Jan 1 thru March 31
Choose a different Medicare Advantage plan
Disenroll from their Medicare Advantage Plan