What is a special enrollment period?

Special enrollment periods are times when you may be eligible to enroll in Medicare even though it’s outside of Medicare open enrollment. Open enrollment, also called the annual enrollment period (AEP), runs from October 15 to December 7 every year.

Certain circumstances, though, make you eligible to enroll in Medicare Part A, B or both at other times. For example:

• If you’re covered by a current employer’s group health plan (not as a retiree plan or COBRA), your special enrollment period covers the entire time you’re working or your spouse is working. (Or, if you’re disabled, when a family member is working.)
• An eight-month special enrollment period is triggered by whichever of these two events happens first: your employment ends or your employer-provided group health coverage ends. Coverage will begin the following month.
• If you are eligible for both Medicare and Medicaid (in Oregon, the Oregon Health Plan is Medicaid), you may enroll in Medicare at any time. Your enrollment period never closes. 

May I change my mind after enrolling in a Medicare Advantage plan?

Yes, the Medicare rules offer Medicare Advantage plan enrollees a limited chance to back out of their choice. This three month opportunity is called the Medicare Advantage Open Enrollment Period. From January 1 to March 31, you may drop or disenroll from your Medicare Advantage plan and switch to Original Medicare Parts A and B. If you disenroll, the change takes effect the first day of the month after your plan gets your disenrollment notice.

To switch to Original Medicare, contact your current plan, or call 800-MEDICARE (800-633-4227).

If you disenroll from Medicare Advantage, you’re allowed to enroll in a Part D prescription drug plan. This is important because Original Medicare doesn’t include prescription drug coverage. Your new Part D drug benefits will start on the first day of the month after the plan gets your enrollment form.

The allowed actions during the disenrollment period are very narrow. You may not switch from one Medicare Advantage plan to another Medicare Advantage plan, you may not switch from one Part D plan to another and you may not switch from Original Medicare to a Medicare Advantage plan.

What’s Medicare “Extra Help?”

Extra Help is a government program for Medicare beneficiaries who have limited income and resources. If you qualify, Extra Help pays part of your Part D prescription drug copays. Depending on your situation, you may also get help with monthly Part D premiums and the annual deductible.

For 2023, the resource limits are $9,030 a year for individuals, and $13,630 for married couples.

The program also limits certain resources, such as savings, bonds and stocks. The program doesn’t count other resources — such as a house, one car and a burial plot — against your eligibility. Income and resource limits typically change each year.

Extra Help is worth looking into if you think you or a loved one may qualify. People with full Medicaid benefits generally qualify automatically. To find out more, call Social Security at 800-772-1213, TTY 711 or visit Medicare's "Save on drug costs" page.

What happens if I don’t have creditable drug coverage?

It’s up to you if you want to pay out of pocket for all your prescriptions, or enroll in a drug plan that Medicare does not consider to be creditable coverage. Be careful, though. That choice may become a pricey problem if you decide later (after about two months without Medicare-endorsed drug coverage) to switch to a Part D drug plan.

That’s because most people must pay a penalty if they enroll late in Part D. This is not a one-time fee. The late enrollment penalty is added to your Part D premium every month you have Medicare drug coverage. (This could be a premium you’re paying for a standalone Part D plan, or a Medicare Advantage plan that includes drug coverage, or another Medicare plan that includes prescription drug coverage.)

Medicare uses a formula to calculate the Part D late enrollment penalty. The later you enroll, the stiffer the penalty. It's explained here. 

Here's the technical rule for late enrollment: After your initial enrollment period ends, Medicare considers you to be late if you enroll in Part D after 63 or more continuous days without Part D or creditable prescription drug coverage.

There are exceptions to the Part D late penalty. For example, if you're part of the Extra Help program for Medicare prescription drug costs, you won't be charged the penalty. Usually, anyone covered by both Medicaid and Medicare automatically qualifies for Extra Help.

The bottom line is you need to think carefully before you decide to go without Part D or without creditable drug coverage. You may not need expensive prescriptions today, but none of us can predict the future.

What’s "creditable coverage?"

This term has to do with prescription drug coverage. Some Medicare beneficiaries have access to a prescription plan that is not a Medicare Part D drug plan. For example, they may have pharmaceutical coverage from a current or former employer or union, a spouse's employer, the military, Indian Health Services or an alternative drug plan.

"Creditable coverage" means that Medicare has determined that this non-Part D prescription drug plan is expected to pay, on average, as much as a standard Medicare Part D. Your drug plan or HR department can tell you whether Medicare considers your coverage to be creditable. It's an important question.

Is there a premium for Original Medicare Part A (hospital) coverage?

Most people do not need to pay a premium for Medicare Part A. It has to do with work history. If you, your current spouse or a former spouse paid Medicare taxes while working, you’ll probably have a $0 monthly premium for Part A. Medicare calls this premium-free Part A. Like much with Medicare, there are many rules. When you enroll, you’ll find out your situation.

When should I apply for Medicare?

It’s best to apply three months before you turn 65. Are you on Social Security? If you are, you’ll automatically be enrolled in Medicare. Expect your red, white and blue card to arrive three months before your birthday. If your card doesn’t come then, or you’re not yet taking Social Security benefits, you must contact Social Security yourself to enroll in Medicare. Do this during your initial enrollment period — a seven-month window that opens three months before your 65th birthday.

What is Medicare open enrollment?

This is the time when anyone with a red, white and blue Medicare card can shop around for Medicare coverage. Open enrollment always spans the same period: October 15 through December 7. Coverage starts the following January 1.

Open enrollment is your chance to look carefully at your plan's upcoming premium, copay, provider network and benefits and decide if you want to make a change. During open enrollment, you can enroll in a Part D drug plan, Part C Medicare Advantage plan or a Medigap plan, or go back to Original Medicare.

You may also hear open enrollment called the annual enrollment period, annual election period, AEP or fall open enrollment season. They're all the same.

What’s an Annual Notice of Changes?

Your Medicare plan's premium, copays, provider network and benefits can change every January 1. So each September your health plan mails you a document called an Annual Notice of Changes. It compares, side-by-side, your plan's current benefits and the following year's benefits.

Read the annual notice carefully, asking yourself if the upcoming coverage meets your health needs and budget. It can help you decide whether to keep your plan or to explore options.

If you have questions about the Annual Notice of Change, call your health plan or the agent who helped you enroll.

Does Medicare cover prescription drugs?

Yes, prescription drugs are covered through a Medicare Prescription Drug Plan, or Part D plan. To enroll in Part D, you must also be enrolled in Part A (hospital) and/or Part B (medical).

Typically, beneficiaries get Part D coverage in one of two ways. They can buy a separate Part D plan. These charge a monthly fee, or premium; the cost varies by plan. The other way is by joining a Medicare Advantage plan that bundles Parts A, B and D. Not all Medicare Advantage plans include Part D, so be sure to ask.

What’s covered by Medicare Parts A and B?

Part A is hospital insurance. It covers you if you're a hospital inpatient or you're discharged from the hospital to a skilled nursing facility. It also covers hospice and some home health care.

Part B is medical insurance. It covers outpatient care like doctor visits, screenings and tests, shots, physical therapy, some counseling and some durable medical equipment.

What’s a Medicare red, white and blue card?

It's the ID card the federal government sends when you're enrolled in Medicare. It shows the date coverage takes effect, and if you have Medicare Part A (hospital), Part B (medical) or both. Whether you call Social Security to apply or the government enrolls you as you approach age 65, this card proves you have Medicare.

How do I enroll in Medicare?

You may be enrolled automatically. If that happens you’ll know, because the government will mail you a red, white and blue Medicare ID card a few months before you turn 65. Mark your calendar for three months before your 65th birthday. If you don't receive your Medicare ID card at that time, you’ll need to apply through Social Security. Call 800-772-1213 or go to ssa.gov.