If you’re looking to secure a Medicare-approved healthcare plan in New Mexico, do you know when you are eligible to enroll? Take a few minutes to understand your Medicare enrollment period, and avoid missing your deadline, or having to pay a penalty.
When You First Join Medicare – Initial Enrollment Period
At the age of 65, most individuals are automatically enrolled in Medicare Part A and Part B. As long as you are eligible to receive Social Security or Railroad Retirement Board benefits, you qualify for Medicare coverage. Everyone who has worked for at least 10 years will receive Part A benefits premium-free. You do not need to do anything at all and you will automatically be enrolled in Medicare Part A coverage.
However, Part B is not premium free and you will need to pay monthly. Like Part A, enrollment is automatic – if you choose not to accept Part B coverage, you can “opt out”. If you are still working at age 65 and receive employer-sponsored health care, you may still enroll in Part B coverage and would need to sign up during your Initial Enrollment Period. If you choose to continue receiving coverage through work, it is acceptable to delay enrollment in Part B benefits. In this case, there is a Special Enrollment Period that typically begins when employer-based coverage ends.
Medicare Enrollment Periods
Initial Enrollment Period:
Medicare offers those who are turning 65 a 7-month period of time to enroll called the Initial Enrollment Period. Initial Enrollment begins three months prior to your 65th birthday and ends three months after you turn 65.
General Enrollment Period:
For those who miss the Initial Enrollment Period, there is a General Enrollment Period, which extends from January 1st through March 31st each year. Keep in mind, enrollment begins on January 1st for coverage that begins on July 1st.
Open Enrollment Period:
Changes can be made during this period to switch from a Medicare Advantage Plan to Original Medicare plus a Part D Plan or to switch from one Medicare Advantage Plan to another. This period is from January 1st to March 31st. Plan changes take effect the month after it is submitted.
Special Enrollment Periods:
Special Enrollment Periods are available for people to join who are undergoing special life events or circumstances that make it difficult to enroll during designated enrollment periods.
Making Changes to Your Medicare Coverage
Medicare realizes that sometimes people want to change their Medicare plan. An Annual Election Period is available from October 15th through December 7th. During this time, anyone is entitled to do the following:
If you receive Original Medicare:
Leave Original Medicare for a Medicare Advantage plan (with or without prescription drug coverage)
Join or drop Medicare Prescription Drug coverage
Switch between Medicare Prescription Drug plans
If you are enrolled in Medicare Advantage:
Switch to Original Medicare
Switch between Medicare Advantage plans with prescription drug coverage
Switch between Medicare Advantage plans without prescription drug coverage
With all changes to your Medicare plan, as long as your enrollment request is made by December 7th, new coverage begins January 1st of the following year.
Like most seniors, there’s a good chance you’ve heard of Medicare – you may even know that it’s a federally funded health insurance program. But if you’re not enrolled, you may not understand in detail the different parts of the program and how they work together to provide health insurance coverage. If you’re approaching the age of 65 and interested in learning more about Medicare Part A and Part B, here’s some information to get you started.
What Is Medicare Part A – Hospital Insurance
Medicare coverage is divided into several parts, which are differentiated by letters of the alphabet. Medicare Part A is one of the basics, providing hospitalization coverage, including hospital stay, skilled nursing facility care, home health care (skilled nursing, physical therapy), and hospice care. For most people, Medicare Part A is premium-free, meaning there is no charge for coverage as long as you meet a few basic eligibility requirements.
Generally, as long as you are a permanent resident of the United States and you or a spouse paid Social Security taxes while employed, enrollment is automatic. While Medicare Part A is free, there are deductibles and co-insurance that you are responsible for paying.
What Is Medicare Part B – Medical Expenses
Medicare Part B covers expenses that are medically necessary to treat or prevent a disease or condition. Basically, other fees that occur outside of room and board while in the hospital- those related to diagnostic testing, preventative care, and the supplies needed to diagnose or treat medical conditions. Fees for visiting the doctor are also included in Medicare Part B. Medicare Part B pays 80 percent of approved charges. Part B is not premium-free.
The standard Part B premium amount in 2023 is $164.90 (or higher depending on your income). However, most people who get Social Security benefits pay less than this amount. This is because the Part B premium increased more than the cost-of-living increase for Social Security benefits.
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Now that you’ve decided to join Medicare Advantage (Part C) as a way to receive your Medicare benefits, you may be wondering when you can enroll. Medicare only allows you to join, switch, or make changes to Part C at very specific times—when you first get Medicare and during yearly enrollment periods. It’s important to know when these specific deadlines occur to avoid missing them and delaying your health care coverage.
Initial Enrollment Period
When you first become eligible to receive Medicare, you enter your Initial Enrollment Period. This is a 7-month period of time that begins 3 months before your 65th birthday, includes your birthday month, and ends 3 months after. For 7 full months, you are in your unique initial enrollment period and can sign up for Medicare Part C. In most cases, this is the best time to join. However, if you didn’t join and you already have Original Medicare, you can still join a Medicare Advantage plan during other enrollment periods.
Other Enrollment Periods
Annual Enrollment extends between October 15 and December 7. During this time, anyone can join, switch or drop a Medicare Advantage plan. As long as the plan you are requesting receives your information by December 7, your new coverage will begin on January 1. During Annual Enrollment, you can:
Change from Original Medicare to a Medicare Advantage plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage plan to another Medicare Advantage plan.
Medicare Open Enrollment Period (January 1 – March 31) If you’re interested in dropping your current Medicare Advantage Plan to return to Original Medicare, a specific period has been created for you to do so. The Open Enrollment Period extends from January 1 through March 31.
This is the time for you to drop Medicare Advantage and return to Original Medicare plus a Part D Plan or change from one Medicare Advantage Plan to another Medicare Advantage Plan.
All changes made during this period will be effective on the first day of the following month. For example, if you drop your Part C plan on January 22, your new coverage will begin on February 1.
Special Enrollment periods were created for people to join and make changes to Medicare Part C when circumstances make it difficult for them to meet regular enrollment periods. For instance, if you move, lose your current coverage, have the opportunity to get other coverage, or meet one of several other special situations, you can usually join, switch or drop a Medicare Advantage plan.
For example, if you are enrolled in Medicare Part C, but move to a new address with better coverage available, you have 2 months to switch plans. If you were living abroad, but are now back in the United States, you have 2 months to join a Medicare Advantage plan. Or, if you lose coverage through an employer (COBRA included) you typically have 2 months to join a Medicare Advantage plan. While there are many special circumstances that may qualify for Special Enrollment, here is a quick summary of the main conditions that meet Special Enrollment criteria:
Move to a new address, move back into the country, or move into or out of a nursing home or assisted living facility.
No longer being eligible for Medicaid or extra help, or losing employer coverage.
Has your current Part C plan been terminated by Medicare or not renewed?
Reviewing Coverage and Switching Medicare Advantage Plans
When the goal is to spend the least amount of money for the most amount of coverage, you owe it to yourself to get the best deal you can with Medicare Part C. Initial Enrollment is usually the best time to sign up, but once you have coverage, Annual Enrollment (Oct 15 – Dec 7) is a great time to make changes to an existing plan or switch between plans.
Even if you think your current Medicare Advantage plan meets your needs, it makes sense to look over new coverage options. Shopping around for better rates and benefits for the upcoming year is a smart way to make sure you’re getting a plan that fits your healthcare needs and your budget.
With Annual Enrollment just around the corner, seniors everywhere are reviewing their Medicare plans to see if they need to make changes to their healthcare coverage. If you’re new to Medicare, you may be wondering where to start, and how to make sure you are enrolled in the right plan to fit your needs and your budget.
While there are many things to learn as a new Medicare recipient, here’s some help reviewing your coverage before Annual Enrollment.
With Original Medicare, Review Costs and Benefits for Next Year
As a recipient of Original Medicare (Part A and Part B), you should take the time to look over next year’s costs and benefits to see if Original Medicare will still work for you. Review your Annual Notice of Change, which should arrive by mail in October.
If you are not happy with what you see, Annual Enrollment (October 15-December 7) is the time to make changes. Remember, any changes you make during Annual Enrollment will take effect on January 1 of next year.
Remember to Check You Prescription Drug Formulary
If prescription medication is a significant part of your medical care, be sure to check the formulary for next year to make sure your needs will still be met. Many times, the formulary (list of covered drugs) changes from year to year.
You need to know if your drug is no longer available or will change tiers and become more expensive. This applies to Medicare Part D, as well as prescription drug coverage you may have with a Medicare Advantage plan.
With a Medicare Advantage Plan, Don’t Forget to Review Changes in Networks
Many times, benefits and costs stay the same with Medicare Advantage, but networks change from year to year. Be sure to confirm that your doctor is still part of your plan’s care network and that any hospitals you use are still available under the plan.
Of course, it’s smart to review a few new plans in your area to see if the same coverage is available at a lower cost to you. If your Medicare Advantage plan includes prescription drug coverage, don’t forget to look over next year’s formulary for changes to drugs, dosage amounts, and pharmacy availability.
Annual Enrollment Does Not Apply to Medicare Supplement Insurance
If you have Medicare Supplement insurance (a Medigap policy), Annual Enrollment does not apply. Any changes you wish to make to your Medicare Supplement insurance plan are best made during your unique Medicare Supplement Open Enrollment period.
Medicare Supplement Open Enrollment is not Annual Enrollment.
Medicare Supplement insurance Open Enrollment begins the first month you turn 65 and enroll in Part B. During this six-month period of time, you have a guaranteed issue right, meaning no insurance company can turn you down or charge you more for a Medicare Supplement Insurance Plan.
After your Medicare Supplement insurance Open Enrollment period ends, insurance companies may refuse to sell you a policy and can charge you more for the same policy. If you have a pre-existing health condition, make changes to your policy during your Medicare Supplement Open Enrollment, as you may not be able to get a plan after it ends.
Luckily, if you miss your enrollment period for Medicare Supplement insurance, there are a few exceptions and you may have a guaranteed issue right in some situations. If, for instance, you move out of your plan’s service area or you have Original Medicare and your employer coverage is ending, you will likely have a guaranteed issue right to buy a new policy.
The good news is, if you are happy with your current Medicare coverage, whether it’s a Part D plan, Original Medicare, or Medicare Advantage plan, you usually are not required to do anything at all. But, it’s always a good idea to take a look, and avoid being surprised on January 1.