Enrolling in Medicare? Here’s What You Need to Know

When it comes to Medicare, knowing when and how to enroll isn’t always straightforward. Medicare has different parts and enrollment periods, each with its own dates and sign-up rules. The enrollment period that applies to you depends on your situation.

Here’s some information to help you understand your options, enroll on time, and choose Medicare coverage that meets your needs.

What is Medicare?

Medicare is a federal health insurance program available for people age 65 and older (or people younger than 65 with certain medical disabilities).

Medicare is divided into four parts:

1. Part A (Hospital Insurance): Helps cover hospital stays, skilled nursing facility care, hospice care, and some home health care.

2. Part B (Medical Insurance): Helps cover doctor visits, many preventive services (screenings, vaccinations, annual wellness visits), and durable medical equipment (walkers, wheelchairs, crutches).

3. Part C (also called Medicare Advantage): An alternative to Original Medicare offered by a private insurance plan approved by Medicare. It includes Part A and Part B, and most plans also include prescription drug coverage and extra benefits (vision, hearing, dental).

4. Part D (Drug coverage): Helps cover prescription medications.

When can I enroll in Medicare?

There are several enrollment periods for joining Medicare or making changes to your coverage. The enrollment period that applies to you depends on your situation.

The main enrollment periods are:

Initial enrollment period

When it happens: Begins three months before the month you turn 65, includes your birthday month, and ends three months after you turn 65.

Who it’s for: People turning 65 or those younger than 65 with certain medical disabilities or conditions.

What you can do: This is the first opportunity to enroll in both Medicare Part A and Part B (Original Medicare) if you’re not enrolled automatically.

General enrollment period

When it happens: January 1 through March 31 each year.

Who it’s for: People who did not sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) during the initial enrollment period and do not qualify for the special enrollment period.

What you can do: Enroll in Part A and/or Part B. Late penalties may apply.

Annual enrollment period

When it happens: October 15 through December 7 each year.

Who it’s for: All Medicare beneficiaries.

What you can do: This is a good time to look at your current coverage and consider whether it will continue to support your needs in the coming year.

During the annual enrollment period, you may be able to:

• Switch from Original Medicare to a Medicare Advantage plan
• Switch from Medicare Advantage to Original Medicare
• Change Medicare Advantage plans
• Switch, drop, or join Medicare Part D (prescription drug coverage)

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

Special enrollment period

When it happens: Timing depends on various qualifying life events.

Who it’s for: People who experience qualifying life events.

A qualifying life event may include:

• Moving to a new address outside your health plan’s service area
• Losing employer or union health coverage
• Gaining or losing Medicaid or Extra Help
• Entering or leaving a nursing facility or long-term care hospital

What you can do: You may be able to enroll in or make changes to your Medicare plan outside of the usual initial enrollment period or annual enrollment period.

Medicare Advantage open enrollment period

When it happens: January 1 through March 31 each year.

Who it’s for: People who are already enrolled in a Medicare Advantage (Part C) plan.

What you can do: Eligible members may be able to make changes to their current plan.

During this period, you may:

• Switch to a different Medicare Advantage plan, with or without prescription drug coverage
• Drop Medicare Advantage and return to Original Medicare
• Join a separate prescription drug plan if you return to Original Medicare

Before you enroll

Medicare plans can change each year, and so can your healthcare needs and priorities.

Even if you are satisfied with your current coverage, take a few moments to review your plan’s most current information, including costs such as deductibles and copays, covered medications, participating providers, and benefits.

It can be helpful to first start by making a list of your:

• Providers (doctors, specialists, preferred hospitals)
• Prescription medications
• Current and expected healthcare needs
• Preferred benefits (dental, vision, hearing, wellness and fitness programs)

Then compare your list with the most current details for each plan you are considering.

Take the next step

If you would like help reviewing your options, support is available.

Contact Medicare at 1-800-MEDICARE (1-800-633-4227), connect with your local State Health Insurance Assistance Program, speak with a licensed insurance agent, or call your current health plan’s Member Services team.

If you live in Fresno, Kern, Kings, Tulare, Los Angeles, or Ventura County in California, and are interested in receiving care from Adventist Health, visit AdventistHealth.org/CareNetwork to learn more about participating Medicare plans and available care network options in your area.