By Tyler Haskell, CFP®

Medicare has several different enrollment periods, and each one serves a different purpose. If you’re new to Medicare or already enrolled in a Medicare Advantage or Part D plan, knowing when you can enroll or make changes can help you avoid missed deadlines and unnecessary penalties.

The good news is that the Medicare enrollment periods used in Utah are the same federal enrollment periods used throughout the country. The key is understanding which one applies to your situation.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period, or “IEP”, is usually the first opportunity you have to enroll in Medicare.

For most people turning 65, the IEP lasts 7 months:

• 3 months before the month you turn 65
• The month you turn 65
• 3 months after the month you turn 65

For example, if your birthday is in July, your Initial Enrollment Period generally runs from April through October.

During your IEP, you may be able to enroll in:

• Medicare Part A
• Medicare Part B
• A Medicare Advantage plan
• A Medicare Part D prescription drug plan
• A Medicare Supplement plan (You actually have a 6 month window from when your Medicare part B goes into effect to sign up for any Medicare Supplement Plan available in Utah)

For many people in Utah, this is the most important Medicare enrollment period because it is when they make their first major Medicare coverage decisions.

Annual Enrollment Period (AEP)

The Annual Enrollment Period, often called AEP or Medicare Open Enrollment, runs every year from:

October 15 through December 7

Changes made during this period generally take effect January 1 of the following year.

During AEP, Medicare beneficiaries can generally:

• Change from one Medicare Advantage plan to another
• Move from Original Medicare to Medicare Advantage
• Leave Medicare Advantage and return to Original Medicare
• Change Medicare Part D prescription drug plans
• Enroll in or drop Part D coverage

This is a good time for Utah Medicare beneficiaries to review their coverage because Medicare Advantage and Part D plans can change from year to year.

Premiums, copays, prescription drug formularies, provider networks and pharmacy networks can all change.

Even if you are happy with your current plan, it is a good idea to review your coverage each fall.

Medicare Advantage Open Enrollment Period (OEP)

The Medicare Advantage Open Enrollment Period runs from:

January 1 through March 31

This period is only available to people who are already enrolled in a Medicare Advantage plan.

During this period, you can generally:

• Change from one Medicare Advantage plan to another Medicare Advantage plan
• Leave Medicare Advantage and return to Original Medicare
• Enroll in a standalone Part D plan if you want to return to Original Medicare

You generally cannot use this period to move from Original Medicare into Medicare Advantage if you were not already enrolled in Medicare Advantage.

This can be especially useful if you enrolled in a Medicare Advantage plan during AEP and then realize early in the year that the plan isn’t a good fit.

Special Enrollment Periods (SEP)

A Special Enrollment Period, or SEP, allows you to make certain Medicare changes outside the normal enrollment periods when you experience a qualifying event.

There are many different Special Enrollment Periods. Here are some of the most common ones Utah residents encounter.

You Move

Moving can create a Special Enrollment Period.

For example, if you move outside your Medicare Advantage or Part D plan’s service area, you may be able to:

• Join a new Medicare Advantage plan
• Join a new Part D plan
• Change plans
• Return to Original Medicare

Medicare provides specific enrollment opportunities when your permanent residence changes and your current plan is no longer available where you live.

This comes up frequently for Utah residents who move from another state, relocate to another part of Utah, or move closer to family during retirement.

You Lose Employer Coverage

Some people continue working after age 65 and remain covered by an employer health plan.

When that employment or coverage ends, they may qualify for a Special Enrollment Period to enroll in Medicare Part B.

In many cases, the Part B Special Enrollment Period lasts 8 months after employment or qualifying employer coverage ends, although Part D and Medicare Advantage enrollment rules have their own timelines.

This is one reason it is important to talk with someone before retiring or leaving employer coverage.

You Lose Creditable Prescription Drug Coverage

If you lose prescription drug coverage that Medicare considers creditable, you may receive a Special Enrollment Period to enroll in Medicare Part D or a Medicare Advantage plan that includes drug coverage.

Medicare generally gives you 2 full months after the month you lose creditable drug coverage to enroll.

Waiting too long could potentially result in a Part D late enrollment penalty.

You Qualify for Medicaid or Extra Help

People who qualify for Medicaid or Medicare’s Extra Help program may have additional opportunities to change their Medicare drug coverage.

Current Medicare rules allow many people with Medicaid or Extra Help to make certain coverage changes once per calendar month, depending on the type of coverage and their eligibility.

These rules can be more complicated than the standard Medicare enrollment periods, so it is important to review the person’s exact situation.

Your Medicare Plan Leaves Your Area or Terminates

If a Medicare Advantage or Part D plan stops serving your area, terminates its Medicare contract, or otherwise becomes unavailable, you may qualify for a Special Enrollment Period.

This allows you to choose new coverage without waiting until the next Annual Enrollment Period.

General Enrollment Period (GEP)

There is one other enrollment period worth knowing about.

The General Enrollment Period runs from:

January 1 through March 31

It is primarily for people who did not enroll in Medicare Part A or Part B when they were first eligible and do not qualify for a Special Enrollment Period.

Coverage generally begins the month after enrollment.

Depending on the circumstances, someone who delayed Medicare without qualifying employer coverage may also face a late enrollment penalty.

Medicare Enrollment Periods at a Glance

Which Enrollment Period Applies to Me?

That depends on your individual circumstances.

Someone turning 65 may be using their Initial Enrollment Period, while someone retiring at age 68 may be using a Special Enrollment Period after leaving employer coverage. Another person may be changing Medicare Advantage plans during AEP.

The important thing is not to assume that you have to wait until October to make a Medicare change.

Depending on your circumstances, you may qualify for a Special Enrollment Period during another part of the year.

Get Help With Medicare Enrollment in Utah

At Professional Insurance Solutions, we help Utah residents understand when they can enroll in Medicare and when they can make changes to their existing coverage.

We can help you review:

• Medicare Advantage plans
• Medicare Supplement plans
• Medicare Part D prescription drug plans
• Employer coverage and Medicare
• Medicare enrollment deadlines
• Special Enrollment Period eligibility

If you’re turning 65, retiring, moving, losing employer coverage or simply wondering whether you can change your Medicare plan, we can help you understand your options.

Contact Professional Insurance Solutions for a free Medicare review.