The Medicare Open Enrollment Period (OEP) begins on October 15 and runs through December 7 to allow people who are eligible for Medicare to enroll in new programs or change their existing programs. Many people are confused about what they can do to enroll in Medicare and if they are eligible to apply during the OEP. To help clear up some confusion, we wanted to go over who is eligible for Medicare and other common Medicare questions we hear from our clients.
Who is Eligible for Medicare?
Generally speaking, anyone who is 65 is eligible for Medicare although you have a window around your 65th birthday when you can initially enroll in the program. When you turn 65, you must hit some additional requirements to be eligible. The first is being a US citizen or legal resident that has resided in the US for a minimum of five years. The second is working for at least 10 years in Medicare-covered employment, meaning you had to have Social Security deductions taking from your payroll. Meeting these eligibility requirements means you will be automatically enrolled in Medicare Part A and Part B, also known as original Medicare.
People who are 65 but have not worked long enough with Social Security deductions from payroll can still be eligible for Medicare, but it is known as voluntary enrollment. With voluntary enrollment, you have to pay monthly premiums for original Medicare. You may have to manually enroll in Medicare if you have never applied for Social Security or Railroad Retirement benefits. Some government employees must also manually apply for Medicare. Also depending on your medical history, like people with kidney diseases, you may have to manually apply.
Some people under 65 are eligible for Medicare as well. If you have received Social Security Disability Income (SSDI) payments for 24 months, have received SSDI in the first month for ALS, or if you have End Stage Renal Disease (ESRD), then you are eligible for Medicare.
Original vs Supplemental Medicare
Original Medicare is what you are automatically enrolled in during your Initial Enrollment Period (IEP) which we will cover in more detail later. However, Medicare Parts A and B will not cover all of your healthcare costs. Prescription drug costs, premiums, copay, routine eye care, homeopathic care, and more are considered out-of-pocket costs.
During the Medicare Open Enrollment Period, you have the ability to purchase additional Medicare plans that will help cover these costs from original Medicare. You have three supplemental Medicare plan options during the OEP to help cover costs.
- Medicare Supplement/Medigap Insurance. Medicare Supplement helps cover some of the costs that original Medicare does not cover. There are ten different Medicare Supplement plans available that provide different coverages for you insurance costs.
- Medicare Part D. Medicare Part D goes hand-in-hand with Medigap insurance and are often purchased together. This plan covers prescription drug costs that are not included in original Medicare.
- Medicare Advantage/Part C. Medicare Advantage combines the coverage offered by original Medicare and adds prescription drug coverage and additional benefits. Part C is a well-rounded coverage solution that is a perfect alternative to original Medicare.
Timeline for Medicare Enrollment
From the initial enrollment in original Medicare to choosing and changing your supplement plans, it is important to know the Medicare timeline. Enrolling past the due dates for any of these services has the potential to cause a penalty you have to pay or denial of certain coverage.
- Initial Enrollment Period (IEP) is the first time you get to enroll in Medicare. It spans the three months before your 65th birthday, the month of, and three months afterward. Coverage starts on the first day of the month following your enrollment. Enrolling after the IEP can cause increased plan costs or reduced coverage.
- Open Enrollment Period (OEP) is the period we are about to enter where you can choose to enroll in new Medicare supplement plans or change your current coverage by switching to a different private company provider. Always take a look at your supplemental Medicare coverage during the OEP with a professional to see if there are ways to save money or get more coverage at the same price.
- Special Election Period (SEP) is a period of time you can make changes to your Medicare coverage due to special circumstances. This included retirement where you leave your employer-provided coverage or if you move out of your current health plan’s coverage area.
To learn more about the OEP, check out our blog on everything you need to know about Medicare Open Enrollment.