Senior Services’ Sept. 9 webinar comes just weeks before Medicare’s annual Open Enrollment period. But turning 65, changing a Medicare plan and buying Medigap all run on different clocks.
WS Chronicle | Staff Report
For a caregiver helping a parent navigate Medicare, the phrase “open enrollment” can sound like one deadline everyone needs to remember.
It is not.
Medicare has several enrollment periods, and each serves a different purpose. Confusing them can mean delayed coverage, fewer insurance choices or late-enrollment penalties.
Senior Services of Winston-Salem is offering a caregiver webinar, “Simplifying the Medicare Enrollment Process,” from noon to 1 p.m. Wednesday, Sept. 9. The timing is especially useful because Medicare’s annual Open Enrollment period begins Oct. 15.
But Oct. 15 through Dec. 7 is not the sign-up window for everyone entering Medicare for the first time.
The first question is simpler: Which Medicare clock applies to you?
Turning 65: the seven-month clock
For most people becoming eligible for Medicare because of age, the Initial Enrollment Period lasts seven months.
It begins three months before the month a person turns 65, includes the birthday month and ends three months afterward.
That is the period most people approaching Medicare for the first time should watch.
Some people are enrolled automatically, depending in part on whether they are already receiving Social Security benefits. Others need to sign up themselves.
Missing the Initial Enrollment Period without other qualifying coverage can lead to a gap in coverage and, in some cases, late-enrollment penalties.
Already on Medicare: Oct. 15-Dec. 7
The annual Medicare Open Enrollment period runs from Oct. 15 through Dec. 7.
That period is primarily for people who already have Medicare and want to change their coverage for the following year.
During Open Enrollment, beneficiaries can switch Medicare Advantage plans, join or change a Medicare prescription drug plan, move from Original Medicare to Medicare Advantage or move from Medicare Advantage back to Original Medicare. Changes generally take effect Jan. 1.
That means someone turning 65 in September should not wait for Oct. 15 simply because television advertisements call that period “open enrollment.”
That person has an Initial Enrollment Period.
The two deadlines serve different purposes.
Medigap has its own one-time window
Medicare Supplement Insurance, commonly called Medigap, follows another clock.
Medicare says a person age 65 or older generally has a one-time, six-month Medigap Open Enrollment period that begins the first month the person has Medicare Part B.
During that window, a person generally can buy any Medigap policy sold in the state without being denied because of pre-existing health problems.
After the six-month period ends, options may become more limited and a policy may cost more, depending on the person’s circumstances and protections available under law.
The key point for caregivers is that this Medigap enrollment period does not return every October.
It is separate from Medicare’s annual Open Enrollment season.
Working after 65 requires another calculation
People who continue working after 65 may face a different set of rules.
If a person or spouse is still working and has qualifying employer-sponsored group health coverage, that person may be able to delay Medicare Part B without a late-enrollment penalty. But the answer depends on the type of coverage and individual circumstances.
When employment or active group health coverage ends, Medicare may provide a Special Enrollment Period of up to eight months to sign up for Part B without a penalty.
COBRA deserves particular attention.
Medicare says choosing COBRA does not extend the Part B Special Enrollment Period tied to active employment. The eight-month clock can begin when employment or qualifying employer coverage ends, even if the person elects COBRA afterward.
That is the kind of situation in which individualized counseling is more useful than a general article.
Employer size, retiree coverage, disability-based Medicare, VA benefits, TRICARE and other insurance arrangements can affect what a beneficiary should do.
Caregivers can organize without taking over
Caregivers often become the person who gathers insurance mail, medication lists and questions.
That can be useful without making decisions for an older adult.
A practical preparation folder can include the beneficiary’s current insurance information, medication list, doctors, preferred pharmacies, employer or retiree coverage and Medicare notices.
With those materials in hand, the beneficiary and caregiver can compare options with a trained counselor or other trusted adviser.
Senior Services says its Aging Resources team provides caregiver information and referral services free of charge. Its Help Line is 336-724-2040.
For Medicare-specific counseling, North Carolina’s Seniors’ Health Insurance Information Program, known as SHIIP, can be reached at 1-855-408-1212 from 8 a.m. to 5 p.m. weekdays.
SHIIP says trained counselors are available in every North Carolina county and provide free, unbiased information about Medicare, Medicare Advantage, Part D, Medigap and long-term-care insurance. The program does not sell or endorse insurance products.
For caregivers, that distinction matters because the most important Medicare deadline may not be the one advertised most heavily in the fall.
For someone already enrolled and reviewing next year’s coverage, Oct. 15 matters.
For someone turning 65, the clock may have started months earlier.
For someone leaving a job, another clock may already be running.
And for someone considering Medigap, a valuable enrollment protection may come only once.
The safest first question is not, “When is Open Enrollment?”
It is: “Which enrollment period applies to me?”